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...

al.
World Journal of Gastro enterology

2008

Multicenter and cross- sectional with questionnaire

340 adults

GIQLI scores and analysis of cross tabulation

Preference scales based on quantitative measures

In untreated celiac, diet is most important variable on patient health.

Gluten free diet control improves quality of life

Ciacci, et.al.

Digestive Diseases and Sciences

2002

Self-administered Questionnaire

114 celiac patients

Cross tabulation with demographic issues

Psych. Measures quantified

Importance of psychological effects on celiac patients

Mixed study, qualitative and quantitative

Gainer, C.

The Nurse Practitioner

2011

Review of literature

Previous research

Diagnostics from previous studies

Data Analysis

It is critical for the modern nurse to take a leadership role in helping patients live a gluten-free life.

Needs expansion into specific ideas on how to be gluten free.

Leffler, et. al.

Digestive Diseases and Sciences

2008

Original research, questionnaire

154 adults

Multivariate analysis based on cross tabulation

Questionnaire data analyzed

There are specific factors related to gluten free dietary adherence

Education is primary tool that focuses on proper dietary issues surrounding celiac

Marnett, et.al.

Annual Review of Pharmacological Toxicology

2002

Research Review

Case Studies

Literature Review

Previous Data reviewed and Analyzed

Use of COX-2 inhibitors to aid patients in preventing colon cancer

Dietary issues with GF diet may not allow the use of NASIDs as much as a regular diet.

Mazzone, et.al.

BMC Pediatrics

2011

MASC score and self-reporting questionnaires

200 children; 100 with celiac, 100 without

Scales and Child Behavior Checklist completed by parents

Several psychological scales measured and cross tabulated

There are increased rates of emotional and behavioral problems in children and adolescents with celiac disease

Self- reported questionnaires should be validated with other, empirical research.

Mustalahti, et.al.

Effective Clinical Practice

2002

Prospective study, medical biopsy and special questionnaire

40 patients

GSRS scale and PGWB psychological scales

Biopsy and questionnaire scales analyzed and compared

Gluten free diets improve quality of life index

What are implications of GFD in the long-run?

Roma, et. al.

Journal of Human Nutrition and Dietetics

2010

Primary compliance with special questionnaire

73 children

Cross tabulation of questionnaire

Special questionnaire

Children have low dietary compliance

Some of the data is based on what parents think children are eating

B3.1

Bebb, J., et.al. (2006). Long-term follow-up of coeliac disease -- what do coeliac patient's want? Alimentary Pharmacology and Therapeutics. 23 (1): 827-31.

This article used a questionnaire sent to 183 patients who had a duodenal biopsy between 1994 and 2004 that was consistent with coeliac disease. A total of 126 patients responded with 88% trying to follow a strict gluten free diet. The results of the research showed that most patients (92%) found outpatient services very helpful, and needed the support and advice of a professional to help with their compliance to a specific diet. The research suggests a more robust non-clinical care protocol would be helpful, although the data set is rather limited and likely needs more longitudinal responses.

Bongiovanni, T., et.al. (2010). Pediatrics. 125 (3): e524-e529.

Children between the ages of 7 and 17, all with celiac disease, were sent to a gluten-free camp for a week. Of the 104 campers, 77 completed a survey dealing with physical and emotional symptoms at the beginning and end of the week. Most found that there were positive effects from a strict gluten free diet, not only on physical symptoms but particularly in the reduction of stress and anxiety surrounding food occasions. The researchers used statistical tools to validate the diet, and the findings that those who had been on a GF diet for less than 4 years would benefit more from the camp seem logical.

Casellas, F., et.al. (2008). Factors that impact health-related quality of life in adults with celiac disease. World Journal of Gastroenterology. 14 (1): 46-52.

In this very robust study, 343 patients, 163 with a GF diet and 177 newly diagnosed with celiac and a normal diet, were surveyed using standard quality of life questionnaires. In untreated CD, the most important factors that influence individual perception of health are the lessening of symptoms and being able to eat a normal diet. For all patients with physical or psychological symptoms, there were vast improvements using a GF diet. This research focused more on quality of life issues that were standardized based on a Health-Related Quality of Life and GIQLI (Gastrointestinal Quality of Life) index system. Because of these standardized scales and the number of responses, the data is more appropriately extrapolated.

Ciacci, C., et.al. (2002). Psychological Dimensions of Celiac Disease. Digestive Diseases and Science. 47 (9): 2082-87.

Many diagnosed with celiac disease also report critical emotional issues the longer they live with the disorder.…