Using videoconsultations to deliver dietary advice to children with chronic kidney disease: a qualitative study of parent and child perspectives.

BACKGROUND: Children with chronic kidney disease require specialist renal paediatric dietetic care, regardless of disease severity or geographical location; however, under-resourcing makes this challenging. Videoconsultation may offer a solution but research exploring its acceptability is limited. The present study explored parent/carer and child perspectives of videoconsultation as an alternative or supplement to existing regional dietetic care. METHODS: Children and families using a regional paediatric nephrology service were recruited through purposeful sampling techniques. Renal paediatric dietitians used existing hospital software to host videoconsultations with families. Perspectives were subsequently explored in telephone interviews with the children, their parents and separately with the renal dietitians. Data were transcribed verbatim and an inductive framework analysis conducted. RESULTS: Twelve families took part in the study, comprising 13 parents and five children (aged 9 months to 14 years). Two renal dietitians were also interviewed. Six themes emerged which were 'Logistics', 'Understanding Information', 'Family Engagement', 'Establishing Trust', 'Willingness to Change' and 'Preferences'. Satisfaction with the videoconsultations was high, with no data security fears and only minor privacy concerns. Parents reported that screen-sharing software enhanced their understanding, generating greater discussion and engagement compared to clinic and telephone contacts. Parents praised efficiencies and  improved access to specialist advice, requesting that videoconsultations supplement care. Children preferred videoconsultations outright. CONCLUSIONS: Dietetic videoconsultations were acceptable to families and perceived to be a feasible, high-quality complement to regional specialist dietetic care. Enhanced understanding and engagement might improve self-care in adolescents. The acceptability and feasibility of videoconsultations could address inequitable regional service provision.

Glycated hemoglobin is not an accurate indicator of glycemia in rainbow trout.

Glycation occurs when glucose reacts non-enzymatically with proteins. This reaction depends upon time, ambient glucose concentration, and the molecular conformation of reactive amino acids. Little is known about protein glycation in fishes and the main objective of this study was to measure glycated hemoglobin (GHb) in rainbow trout, a glucose-intolerant species, under normoglycemic and hyperglycemic conditions. We also identified GHb isoforms in vivo and analyzed the structural environment surrounding potential glycation sites. Despite similar glycemia to healthy humans, GHb was an order of magnitude lower in rainbow trout (0.6%) compared with humans (6%) and was not affected by long-term hyperglycemia. Species differences in GHb appear to be related to differences in erythrocyte glucose, and differential expression and glycation of hemoglobin (Hb) isoforms may explain intraspecific differences in rainbow trout GHb. Computer analysis of glucose isomers (ringed-open and α- and ß-pyranoses) interacting with the ß-chain of rainbow trout HbI and HbIV, and human HbA did not reveal structural or energetic constraints for glucose binding (the initial step of glycation) for rainbow trout Hbs. Overall, there are significant differences between Hb glycation in humans and rainbow trout, and GHb does not appear to be an accurate indicator of glycemia over time in rainbow trout.

Polyamine-sensitive binding of [125I]ifenprodil in washed, frozen-thawed synaptic membranes: evidence for high affinity binding requiring an open NMDA channel.

Binding of [125I]-labelled ifenprodil, a non-competitive N-methyl-D-aspartate (NMDA) antagonist acting at the polyamine domain, was studied in washed, frozen-thawed synaptic membranes. Under these conditions where the NMDA channel is essentially in a closed channel state and in the presence of GBR 12909, [125I]ifenprodil binding was rapid, reversible, stereospecific, saturable and to a single population of sites (Kd 76 microM, Bmax 140 nmol/mg protein). Binding was inhibited by spermine, spermidine and ifenprodil congeners. These characteristics differed from those found in fresh membranes (open channel state), with ifenprodil congeners being less potent and potencies of polyamines being unchanged. These data suggest independent, but interacting sites for polyamines and ifenprodil congeners, the latter sensitive to endogenous modulators, labelled by [125I]ifenprodil and probably not NMDA-linked. High affinity binding of ifenprodil congeners seems likely to require an open ('activated') NMDA channel.

The measurement of ethylenethiourea and ethyleneurea in the rat and common marmoset Callithrix jacchus after zineb (zinc ethylenebisdithiocarbamate) dosing.

The metabolism of the fungicide zineb, (zinc ethylenebisdithiocarbamate), has been studied in the rat and the marmoset. 2. It was found in both species that a relatively large proportion (21-22%) of the original zineb administered was detectable in the excreta as ethylenethiourea (ETU) a known mutagen, teratogen and carcinogen. 3. A further proportion (2-5%) was determined to be ethyleneurea which is a metabolite of ETU. 4. Results of comparative experiments in marmosets revealed that ETU was photolabile in the presence of excreta, thus showing the importance of conducting the studies in the dark.

Stimulation of microsomal lipid peroxidation by iron and cysteine. Characterization and the role of free radicals.

The stimulation of microsomal lipid peroxidation by FeSO4 and cysteine has been investigated. Although both FeSO4 and cysteine alone promoted an increase in malonaldehyde production, when these agents were added together to microsomes the resultant level of malonaldehyde was greater than the sum of the amounts formed by these pro-oxidants when acting individually. A further indication of an interaction between FeSO4 and cysteine was shown by the inhibitory action of chelating agents. Stimulation of peroxidation was shown to be independent of microsomal protein, including cytochrome P-450. The system has been characterized for the effects of cysteine, Fe2+ and O2 concentrations, pH, temperature and antioxidants. The results indicate that the high level of peroxidation attained with this system, its non-enzymic character and the involvement of hydroxyl radicals make it particularly useful for the investigation of the action of antioxidants. Furthermore it may also be a model of way in which decompartmentalized, delocalized or 'free' iron initiates peroxidation in vivo.

Metronidazole (flagyl) and misonidazole (Ro-07-0582): reduction by facultative anaerobes and cytotoxic action on hypoxic bacteria and mammalian cells in vivo.

The toxic actions of the "nitro" radiosensitizers, metronidazole and misonidazole on the bacteria E. coli B/r and Serratia marcescens have been investigated under anareobic and aerobic conditions. The rates of reduction of the drugs by suspensions of these bacteria as well as by suspensions microorganisms from the rat caecum have been measured. Both drugs were reduced or were toxic only under anaerobic conditions. In all instances misonidazole was reduced more rapidly than metronidazole but metronidazole was more toxic. It is suggested that these phenomena may model those occurring with hypoxic mammalian cells in vivo and that care should be taken before automatically extrapolating in vitro data to the in vivo situation.

Metronidazole (Flagyl), misonidazole (Ro 07-0582), iron, zinc and sulphur compounds in cancer therapy.

The nitro radiosensitizers, metronidazole and misonidazole, have been shown to react rapidly with the sulphydryl compounds cysteine and cysteamine in the presence of ferrous ions. Similar reactions occur in the presence of copper ions but these are much slower. The initial interactions of the drugs and of oxygen with an iron-cysteine complex are extremely rapid: in the case of oxygen reaction half-lives of 27 ms have been measured. Misonidazole also reacts rapidly with glutathione in the presence of ferrous ions and is subsequently reduced: metronidazole is reduced only slowly if at all. These reactions, which have been found to be inhibited by high concentrations of zince ions, are discussed in the light of the known radiosensitizing and chemotherapeutic efficiencies of the nitro drugs and the side effect of peripheral neuropathy sometimes observed during their clinical use.

Metronidazole (Flagyl): degradation by the intestinal flora.

1. Metronidazole (Flagyl) is reduced exponentially by the contents of the rat caecum in the absence of oxygen. The rate of removal is highest at pH 7 and 37 degrees. 2. Reduction of the drug is inhibited by boiling of the caecal contents, CHCl3, Cu2+, Ag+, azodicarboxylic acid bis-dimethylamide, p-chloromercuric benzoate, N-ethylmaleimide and 4,4,4-trifluoro-1,2-thienyl-1,3-butanedione. Nitrate, ethanol (3%), CO, phenol and amytal did not affect the rate of reduction. 3. It is concluded that iron-sulphur systems are involved in degradation of the drug.

Metronidazole (Flagyl): characterization as a cytotoxic drug specific for hypoxic tumour cells.

The cytocidal properties of metronidazole against hypoxic mammalian cells are described. This chemotherapeutic action has been shown to be dependent on drug concentration and duration of exposure. The x-ray TCD50 for a murine anaplastic carcinoma was reduced from 6081 rad to 4643 rad when animals were given metronidazole orally for 36 h before radiation treatment. The effect is attributed to the direct killing of hypoxic tumour cells by a mechanism analogous to that proposed for the action of the drug on anaerobic micro-organisms. It is concluded that further work with metronidazole as a cytotoxin specific for hypoxic cells is warranted, particularly in view of the reported lack of toxicity associated with the preliminary clinical use of the drug as a radiosensitizer in man.