Antonella Ghezzi, Digestive Diseases Nurse Lead at Nottingham University Hospitals Queens Medical Centre, has been awarded a Florence Nightingale Foundation research scholarship to undertake her second year Doctor of Health and Social Care Practice degree. Her study is titled ‘Can dietary and lifestyle interventions modify disease progression in early cirrhosis of the liver?’ We spoke to Antonella to find out a bit more about her project.
How did you find out about the Florence Nightingale Foundation research scholarships?
I am currently enrolled in the Doctor of Health and Social Care Practice Degree at the University of Derby and thanks to the Florence Nightingale Foundation research scholarships I am able to start the second year of this exciting course. I was encouraged to apply for this award by Joanne Cooper, Head of Research at Nottingham University Hospitals NHS Trust and even though the process is highly competitive, the application was both straight forward and is extremely rewarding when you are successful.
Why did you choose to conduct your research on this topic?
Currently, the vast majority of research studies have attempted to assess and quantify malnutrition at the end of stages of liver disease, and although current literature confirms that liver patients are at risk of malnutrition from the very early stage of the disease, there are currently no implemented interventions.
Why is there a need for this study?
Most patients are not aware of the correlation between dietary intake and liver disease progression. This nurse-led study will hopefully lead the way towards better care and improved practice. If successful, services will be shifted from secondary to primary care, relieving outpatient clinic overload and giving patients the choice to be seen in a community setting. The development of extensive nurse practitioner skills will save time and costs in the long-term and most importantly, achieve a better quality of life for people suffering with liver disease.
What are the aims of your research?
The aim of this study is to show that a very simple nutritional assessment and care plan including dietary/health promotion advice delivered during outpatient clinics, can improve the quality of life. It is my intention to involve and engage patients/users in research. Findings from this initial study will feed into an extensive project where patients will be involved in the designing and writing of the research protocol.
What do you hope to achieve?
I hope to demonstrate the feasibility and cost effectiveness of this study with the aim to apply the same principles to a randomised controlled trial – a type of scientific experiment, where the people being studied are randomly allocated one of the different treatments under study. The final aim of this project is the successful implementation of a new care plan for early nutritional interventions in this country.
What research methods will you use to achieve your objectives?
I plan to follow 20 malnourished patients for six months using very simple and economic screening tools such as anthropometry (the study of the measurements and proportions of the human body), simple blood tests, subjective global assessment and dual-energy X-ray absorptiometry (DEXA) scanning. Quantitative research methods will also be applied in this small feasibility study.
We will also be able to highlight bone density defects due to impaired liver functions. This test is reasonably economic but at the moment it is not routinely prescribed to assess malnutrition. The second objective is to assess dietary compliance. A targeted dietary plan will be formulated by a specialist gastroenterology dietician and a 30 minute consultation will be delivered by the dietician to the volunteer on a one-to-one basis.
Volunteers will be followed up at baseline (the starting point of the project), in the second month via telephone consultation, the third month via clinical assessment and the fourth month also via telephone consultation. A final DEXA scan, biomarkers and anthropometry assessment will be undertaken in the sixth month, which will mark the end of the study. A quality of life questionnaire or interview will also be completed at baseline, the third month and sixth month.
How have patients reacted to your proposed research subject?
This nurse-led project was discussed with members of our patient advisory group (PAG) during a focus meeting. Patients suffering with liver cirrhosis showed a remarkable interest in the subject and are looking forward to be included in a small feasibility study.
We will be following Antonella’s research progress over the next year and look forward to seeing the results.