Mustalahti, K., et.al. (2002). Gluten-Free Diet and Quality of Life in Patients
With Screen-Detected Celiac Disease. Effective Clinical Practice. 5 (3):
Key areas of research
SPECIFIC DATA ANALYSIS
Overview of celiac disease with a focus on patient consequences and lack of treatment options.
Limited, in this case. Brief overview, but no substantial literature review presented.
Used Gastrointestinal Symptoms Rating Scale (GSRS) and Psychological General Well-Being Questionnaire (PGWB) to establish quality of life index.
Analysis of data based on scores from methodological studies. Gluten free diets were associated with improved quality of life.
Over the short-term, a modern gluten free diet with more acceptable offerings and choices will provide an adequate quality of life for most patients.
The authors examined the effects of a gluten-free diet on patients that had "clinically silent -- that is, among people who ingest gluten and feel healthy (or have only minor, nonspecific symptoms) despite having typical gluten-triggered lesions of the small-bowel mucosa" (p. 109). The specific focus of the study was how a gluten free diet would influence the quality of life of patients with silent celiac. Because "psychological general well-being and abdominal discomfort are highly subjective and personal matters that depend, at least in part, on personality and environment" a set of standardized questionnaires were used to compare the subjects. Analysis of the questionnaires showed that "most patients… reported improved psychological well-being and gastrointestinal symptoms…. Implying that asymptomatic patients…. Will benefit from a gluten free diet" (p. 111).
A.4 -- Since there was no actual control group, no individuals who could have been helped with a gluten free diet were denied. Instead, "although the quality of life of patients with screen or symptom-detected celiac disease improved during the first year of a gluten-free diet" the authors are unable to gage long-term effects (p. 112). The authors do acknowledge that their findings may not necessarily be applicable to all countries and all cultures, and therefore ethically need to broaden the scope of their study geographically in order to make their assumptions valid for a larger population. Additionally, it was unclear as to the robustness of the type of gluten free diet included in the study, and likely was based on the individual's preferences and demographics.
A-5 -- Forty patients with screen-detected celiac disease and 21 consecutive patients with symptom detected celiac disease were given two sets of standardized questionnaires that would focus on their quality of psychological life and their quality of gastrointestinal symptoms. Both questionnaires were self-administered due to reasons of privacy and the fact that both issues are extremely personal. The authors "performed repeated measures analysis of covariance to study the significance of possible confounding factors (i.e. age, sex, economic situation and BMI)" to validate responses (p.108). For the purposes of this type of study, with the limitations in time, funding and staff, the standardized questionnaires were valid. Each participant was an adult; each assured of their privacy, and, in this case, it is likely the data is as valid as possible for the age groups and celiac situation.
Part B
B.1 -- The modern nurse's role has expanded enough to be one of the predominant figures in the way individuals manage their prevention of disease risk and their control of issues once disease has occurred. In the case of the gastrointestinal system, studies have shown that when a nurse advises a patient and family on proper diet for a specific condition, that advice is typically taken more seriously. In the case of risk for colon cancer or other gastrointestinal issues, for instance, the use of a low-gluten diet, use of probiotics and prebiotics, as well as fructoligosaccarides in the patient's diet has both symbiotic and therapeutic qualities and can prevent colon issues. In addition, adding pro and pre-biotics to the diet often increases the absorption of more nutrients from food, allowing the individual to feel less hungry, to digest better, and to have less potential gastric upsets (heart-burn, belching, etc.). Prebiotics are non-digestible carbohydrates that act as food for probiotics. Probiotics are found in such foods as yogurt, while prebiotics are found in bananas, onions, garlic, honey, and whole grains. It is relatively easy to add both to the diet, and the positive and proactive effects are well worth the nursing efforts involved (Zeratsky, 2010; Losada, 2001).
Sources:
Losada, M. (2001). Towards a healthier diet for the colon: The influence of fructo-oligosaccharides and lactobacilli on intestinal health. Nutrition Research. 22 (1): 71-84, Retrieved from: http://www.nrjournal.com/article/S0271-5317(01)00395-5/abstract
Zeratsky, K. (2010). Is it important to include probiotics and prebiotics in a healthy diet? Mayo Clinic. Retrieved from: http://www.mayoclinic.com/health / probiotics/AN00389
B.2. Matrix
Author
Source
Research Type
Population Sample
Outcome Measure
Data
Conclusions
Comments
Bebb, et. al.
Alimentary Pharmacology
2005
Primary Questionnaire
126 diagnosed with coeliac disease
Primary patient opinions and data
Patient oriented opinions
Respondents show distinct variation
Dietician probably necessary to maximize efficacy of therapy
Bongiovan-ni, et.al.
Pediatrics
2010
Primary questionnaire
77 children
Survey and Linkert scale on emotional outlook
Patient oriented opinions
Children with celiac disease who attended a week-long gluten free camp showed improvement in numerous psychological...
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