Posters (in alphabetical order by author)


183 Applying Genetics to Daily Dietetic Practice: Practical Case Studies from the Field

MELISSA ADAMSKI, GEORGIE RIST

MyGene Pty Ltd, South Yarra, VIC 3181, Australia

Nutritional genomics and genetic testing in dietetics has been a hot topic of late, but how do dietitians apply genetics to their day-to-day practice? Dietitians using genetic tests as part of their practice were interviewed to investigate the practicalities of using genetic testing with their patients. Interview questions were designed in order to highlight the benefits, challenges and knowledge gaps around genetic testing, and to gather general feedback on the use of genetic testing in the field. The responses have been pooled and sorted into different categories, to create a basic framework for dietitians to refer to when using this technology in daily practice. The different categories include:

  • General principles
  • When to use genetic tests?
  • How do patients respond to genetic testing? (What they do differently)
  • How has genetic testing changed your dietetic practices?
  • How to talk about genetic testing with your patient

From those interviewed, the results of using genetic testing in dietetic practice were positive. However, the interviews highlighted the need for clinical guidelines and standards to be developed for dietitians. The resulting needs/questions uncovered as part of this study could be used as a starting point to inform the development of guidelines, standards and education in the future. It is proposed that this data could be presented by way of discussion accompanied by a series of live case studies in order for delegates observing the presentation to have greater confidence in using this technology with their patients after viewing this presentation.

Funding source: Research funding from MyGene Pty Ltd

Contact author: Melissa Adamski – melissa.adamski@mygene.com.au

174 Dietetic Practice by Australian and Canadian Dietitians with People with Parkinson's Disease

JAMIE SHEARD, SUSAN ASH

Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

Although Parkinson's disease (PD) is a complex disease for which appropriate nutrition management is important, limited evidence is currently available to support dietetic practice. Existing PD-specific guidelines do not span all phases of the Nutrition Care Process (NCP). This study aimed to document PD-specific nutrition management practice by Australian and Canadian dietitians. DAA members and PEN subscribers were invited to participate in an online survey (late 2011). Eighty-four dietitians responded (79.8% Australian). The majority (70.2%) worked in the clinical setting. Existing non-PD guidelines were used by 52.4% while 53.6% relied on self-initiated literature reviews. Weight loss/malnutrition, protein intake, dysphagia and constipation were common issues in all NCP phases. Respondents also requested more information/evidence for these topics. Malnutrition screening (82.1%) and assessment (85.7%) were routinely performed. One-third did not receive referrals for weight loss for overweight/obesity. Protein intake meeting gender/age recommendations (69.0%), and high energy/high protein diets to manage malnutrition (82.1%) were most commonly used. Constipation management was through high fibre diets (86.9%). Recommendations for spacing of meals and PD medications varied with 34.5% not making recommendations. Nutritional diagnosis (70.2%) and stage of disease (61.9%) guided monitoring frequency. Common outcome measures included appropriate weight change (97.6%) and regular bowel movements (88.1%). With limited PD-specific guidance, dietitians applied best available evidence for other groups with similar issues. Dietitians requested evidence-based guidelines specifically for the nutritional management of PD. Guideline development should focus on those areas reported as commonly encountered. This process can identify the gaps in evidence to guide future research.

Contact author: Jamie Sheard – jamiesheard@gmail.com

21 Dietary Patterns of Australian Children Aged 14 and 24 Months and Associations with Socio-Demographic Factors and Adiposity

LUCINDA K BELL1, REBECCA K GOLLEY2, LYNNE DANIELS3, ANTHEA M MAGAREY1

1Nutrition and Dietetics, Flinders University, Adelaide, SA 5042, Australia

2Sansom Institute of Health Research, University of South Australia, Adelaide, SA 5000, Australia

3School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD 4000, Australia

Previous research has shown, in predominantly European populations, that dietary patterns are evident early in life. However, little is known about early-life dietary patterns in Australian children. We aimed to describe dietary patterns of Australian toddlers and their associations with socio-demographic characteristics and adiposity. Principal component analysis was applied to three days (1 × 24-hour recall and 2 × 24-hour record) data of 14 (n = 552) and 24 (n = 493) month old children from two Australian studies, NOURISH and SAIDI. Associations with dietary patterns were investigated using regression analyses. Two distinct patterns were identified at both ages. At 14 months, the first pattern was characterised by fruit, bread, vegetables, cheese and eggs and not commercial baby foods (‘core non-baby foods’) and the second by bread, milk, spreads, juice and ice-cream (‘basic combination’). Similarly, at 24 months the ‘core foods’ pattern included several core foods such as vegetables, fruit, low-fat potatoes, meat, dairy and water, whilst the ‘non-core foods’ pattern included sweetened beverages, snack products, chocolate and processed meat. Lower maternal age and earlier breastfeeding cessation were associated with higher ‘basic combination’ and ‘non-core foods’ pattern scores whereas higher ‘basic combination’ and ‘core foods’ pattern scores were associated with earlier and later solid introduction, respectively. Patterns were not associated with BMI z-score. In conclusion, dietary patterns in Australian children are identifiable in the second year of life. These findings support the need to intervene early with parents to promote healthy eating in children and can inform future investigations on the effects of early diet on long-term health.

Funding source: National Health and Medical Research Council of Australia (426704, NOURISH) and SA Health (SAIDI). RKG is supported by a National Heart Foundation Fellowship.

Contact author: Ms Lucinda Bell – lucy.bell@flinders.edu.au

113 Scales Tip towards Weighed Food Intake Methods to Calculate Energy and Protein Intake in Hip Fracture Patients

JACK BELL1,2, JUDITH BAUER1, SANDRA CAPRA1

1Centre for Dietetics Research, University of Queensland, St Lucia, QLD 4067, Australia

2The Prince Charles Hospital, Chermside, QLD 4032, Australia

Dietary intake assessment methods vary significantly and the best method of estimating energy and protein intake in acute care remains unclear. This study aimed to identify a pragmatic method of estimating energy and protein intake in patients with acute hip fracture. Retrospective methods including food frequency questionnaire or diet history were considered inappropriate for evaluating short term intake. Twenty-four hour recall methods were excluded with data demonstrating poor participant or surrogate memory of intake, recall bias, and substantial misreporting in this patient group. An adjusted weighed food record method was developed utilising duplicate (reference) trays matching individual patient (test) trays; component intake in grams was calculated by subtracting test-tray component waste from reference components. Adjusted weighed, direct visual estimate and quartile methods were then compared to weighed standard meals across a variety of textures and consumption patterns for 40 trays. Data were collected and evaluated by a single senior dietitian and energy and protein intakes were analysed using AUSNUT (99) data. The adjusted weighed method was more strongly correlated with true energy and protein intakes (Pearsons r = 0.98, 0.96) than the quartile (0.93, 0.91) and direct visual estimate (0.92, 0.90) methods. Agreement between the adjusted weighed method and true energy and protein intakes were confirmed using Bland-Altman plots (21 ± 202 kJ; 0.25 ± 3.4 g respectively). The adjusted weighed method is practical, efficient and easy to apply and should be considered a useful method of determining energy and protein intake in routine clinical practice.

Funding source: The Prince Charles Hospital Foundation Novice Researcher Grant

Contact author: Jack Bell – Jack_Bell@health.qld.gov.au

62 Diabetes Care Project (DCP) – a Three-Year Pilot to Test New Ways of Providing More Flexible, Better Coordinated Care, to Improve the Management of Care for People with Diabetes

NEHA BHATIA

Darling Downs South West Queensland Medicare Local (DDSWQ Medicare Local), Toowoomba, QLD 4350, Australia

The DCP is a 3-year pilot (delivered in 3 phases; 6 month design, 2-year implementation and 6 month evaluation) of a new model of healthcare delivery designed to improve care for people with diabetes. The DDSWQ Medicare Local is working closely with the team across areas where the pilot will be trialled. In its entirety, the pilot will involve up to 150 practices in 3 states, and will compare results between two intervention groups of general practices and a control group, to enable a rigorous evaluation of the outcomes. The DCP will evaluate the impact of four changes: an integrated information and technology system, a new model of funding, the inclusion of a Care Facilitator in the care team, and an education and training program that builds capabilities related to the project and overall care management. For patients, clinical measures, appointment dates, referrals, and other beneficial information will be available online or in hard copy. At the end of the pilot implementation phase, the groups will be compared to evaluate whether these new models of care can deliver better quality healthcare outcomes, enable care to be provided in more flexible ways, improve patient and practitioner experiences, and prove economically sustainable and scalable nationally.

Contact author: Neha Bhatia – nbhatia@ddswqmedicarelocal.com.au

131 Mom's the Word … Maternal Obesity Management

NICOLE BOYER

West Gippsland Healthcare Group, Warragul, VIC 3820, Australia

Maternal obesity and excessive gestational weight gain (GWG) is a growing concern in Australia and is associated with increased risk of birth complications such as gestational diabetes and caesarean delivery. The Positive Pregnancy Program (PPP) conducted at West Gippsland Healthcare Group aims to reduce birth complications for obese pregnant women by optimising GWG through individual nutrition counselling and health coaching. Pregnant women with BMI ≥35 kg/m2 (n = 91, mean BMI 39.7 ± 5.8) were referred for individual assessment and dietary counselling, and those with complete data over two years (n = 70) were included in data analysis. A dietitian conducted an initial one hour assessment and education with monthly reviews delivering tailored advice around nutrition education and lifestyle behaviours to achieve appropriate weight gain during pregnancy. The intervention was associated with a significant reduction (p = 0.009) in gestational weight gain (8.0 ± 7.6 kg) when compared to any previous pregnancy (15.7 ± 14.9 kg) and a significant reduction in birth complications when GWG <5 kg (p = 0.006). Rates of caesarean delivery and gestational diabetes were reduced amongst PPP participants when compared with obese control groups in comparable studies. Individual dietetic counselling (PPP) is a cost-effective approach to reducing GWG and birth complications while also promoting healthy eating and lifestyle changes for obese mothers and future generations. These findings support continuation of the PPP in the current setting, and suggest potential for improved maternal outcomes when adopting this program in similar healthcare settings.

Contact author: Nicole Boyer – nicole.boyer@wghg.com.au

70 The New Whole Grain Ingredient Content Claim: How will it Help People Make Better Food Choices?

MICHELLE BROOM

Grains and Legumes Nutrition Council, North Ryde, NSW 2113, Australia

The new Australian Dietary Guidelines recommend people eat a wide variety of grain foods, mostly whole grain and/or high cereal fibre varieties. However, choosing whole grain foods can be confusing. Foods currently on shelf vary considerably in whole grain content from 1.4 g whole grain to 75 g whole grain per serve. In addition, manufacturers currently communicate the whole grain content a variety of different ways. To help support the Dietary Guidelines the Grains and Legumes Nutrition Council (GLNC) sought to develop a whole grain ingredient content claim to allow clear, consistent communication of the whole grain content of foods. The development of the three levels of whole grain content claim included an assessment of marketplace data, benchmarking against nutrition content claims and international whole grain claims, qualitative and quantitative consumer research and review by an expert panel. GLNC has launched the industry standard set of claims and is actively encouraging food manufacturers to adopt the standard. It is the intention of GLNC that the industry standard will be used across a broad range of food categories to assist consumers recognize, choose and eat foods that will contribute to their Daily Target Intake of whole grain (48 g/day). Dietitians play a key role as consumer research indicates the public health benefit can only be fully realized if people understand how the claim relates to the recommendations for whole grain intake.

Contact author: Michelle Broom – m.broom@glnc.org.au

71 A Cross Sectional Study Investigating the Effects of Post-Operative Feeding Practices of Patients Undergoing Bowel Resection Surgery

MEGAN CAMERON-LEE1, NAOMI CROCKETT2

1University of Wollongong, Wollongong, NSW 2522, Australia

2St George Hospital, Kogarah, NSW 2217, Australia

Recent literature has demonstrated that there are numerous benefits to initiating early oral feeding (on post-operative day (POD) 0 or 1) in bowel resection patients. This study aimed to describe current post-operative feeding practices and dietitian involvement in these patients in an Australian context, and to determine if there were any associations with length of stay (LOS) or post-operative complications. A retrospective medical records audit of 39 adult patients who underwent bowel resection surgery at St George Hospital (SGH) between March and May 2012 was undertaken. In this cohort, the initial post-operative diet of nil by mouth was usually followed by clear fluids on a median (IQR) of POD 1 (1.00–1.25), full fluids on POD 2 (2.00–3.00) and a regular oral diet on POD 4 (3.00–6.00). Only 36% of patients were referred to a dietitian, including just 50% of those with ileostomies, despite SGH protocol dictating automatic referrals in this case. A moderate, positive correlation was found between LOS and the POD a regular oral diet began (r = 0.361) and slower progression to a regular oral diet was associated with a statistically significant increase in post-operative complications (P = 0.004). Hence LOS and the incidence of post-operative complications were seen to increase when there was slower progression to a regular oral diet, which indicates that implementation of an early oral feeding guideline, as well as greater adherence to dietitian referral protocol at SGH, could benefit these patients. However a more comprehensive study, to examine other influential factors to diet progression, is necessary.

Contact author: Megan Cameron-Lee – mscl999@uowmail.edu.au

201 Kiama Meals on Wheels Service: Who is Referring and What is on the Menu?

MELISSA TJONG, KAREN CHARLTON, KAREN WALTON

University of Wollongong, Wollongong, NSW 2522, Australia

Meals on Wheels (MOW) is a community service which aims to support the nutritional needs of the frail aged, disabled and their carers, and is particularly useful for those recovering from illness, or after hospitalisation. This study described the referral patterns, client meal ordering and the nutrient composition of meals from Kiama MOW, New South Wales. A retrospective chart audit was undertaken with de-identified client information obtained regarding referral sources between 2008 and 2012. Menu order forms were collated for a two-week period in September 2012 to determine the five most commonly ordered meal components and meal combinations (MC) thereof. Energy and protein content of these MCs were expressed as a percentage of daily estimated energy requirements (%E) and recommended dietary intakes for protein (>70 years). A decline in referrals from hospitals was observed between 2008 (22%), as compared to 2012 (10%), with accompanying increases in self/family referrals (55% to 71%). The main meal alone was the most popular component ordered by 53% of clients, providing 20 and 24%E, and 31% and 44% of RDI for protein, in men and women, respectively. If all three components (soup, main, dessert) were ordered this would provide 39 and 45%E, and 40% and 58% RDI protein, however only 9% of clients ordered three items. Further advocacy and marketing of MOW services to medical staff in hospitals appears indicated to meet the needs of community based older people. Strategies to increase protein and energy content of main MOW meals are warranted.

Funding source: The University of Wollongong and Kiama Meals on Wheels

Contact author: Karen Charlton – karenc@uow.edu.au

168 Validated Nutrient Profiling Systems: A Systematic Review

SHERI COOPER, FIONA PELLY, JOHN LOWE

University of Sunshine Coast, Sippy Downs, QLD 4556, Australia

Nutrient profiling systems categorise foods based on their nutritional composition and form the basis for the scientific algorithm behind many front-of-pack nutrition labels. These labels can guide consumers to make healthy food choices, so it is imperative that profiling systems provide an accurate representation of the ‘healthiness’ of food. A significant number of nutrient profiling systems have been developed and implemented internationally. However the reliability and validity of many of these systems has not been established, thus impacting on their ability to categorise food accurately. Therefore, the aim of this study was to review the reliability and validity of existing nutrient profiling systems. A systematic review guided by the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was conducted using the electronic databases Medline, Scopus and Global Health Database. The search terms food label*, nutrient profil*, point-of-purchase, front-of-pack label*, nutrition label, food scoring system and nutrient scoring system were utilised. Additional studies were identified by searching bibliographies and web based grey literature. Eligibility assessment was performed using a predetermined exclusion and inclusion criteria. To date, a total of 39 nutrient profiling systems have been sourced in the literature, however there is currently little published evidence of comprehensive validation for the majority of these systems. The results of this study suggest that there is a strong and urgent need for more reliability and validity testing to be carried out on nutrient profiling systems to confirm the accuracy of front-of-pack nutrition labels.

Funding source: Partly funded by The Wiggles

Contact author: Sheri Cooper – scooper2@usc.edu.au

186 Our Idnt Implementation Experience: Local Champions Take Up the Challenge

ELESA CROWLEY1, DEANNE HARRIS1, CHASSAGNE MILLER2, HELEN JACKSON3

1Tamworth Rural Referral Hospital, Tamworth, NSW 2348, Australia

2Campbelltown Hospital, Campbelltown, NSW 2560, Australia

3Cessnock Hospital Cessnock, NSW 2325, Australia

Communication with all health professionals involved in patient care is of paramount importance to Dietitians. Enthusiasm to implement the IDNT standardized language has evolved at Tamworth Rural Referral Hospital. The aim of this quality project is to: (1) Describe the implementation process of IDNT across HNE Local Health District and (2) Evaluate the experiences of champions implementing IDNT at local facilities. A workshop of nine interested District dietitians was held in March 2012. The Hunter New England Local Health District IDNT working group was then established to support IDNT implementation and practice. Group members meet monthly via phone and computer link. Over 50 dietitians attended workshops held at the HNE Dietitians Professional Development Day in July 2012, to further develop skills in IDNT using more complex case studies. A follow up survey of the local champions across HNE was conducted at the end of 2012 with six out of the nine dietitians completing the survey. Initially, 2 out of 9 felt confident, 6 out 6 now felt confident or very confident in implementing IDNT at their facility. Confidence in identifying nutrition diagnosis and writing PES statements increased from 5 out of 9 initially to 6 out of 6 at the end of 2012. Barriers to implementing the IDNT at the end of 2012 included staff lack of knowledge, time, organisational constraints and the need for training and support. With further training and support for dietitians within the HNE Local Health District the continued rollout of IDNT will enhance medical record communication.

Contact author: Elesa Crowley – elesa.crowley@hnehealth.nsw.gov.au

199 Statewide Nutrition Training for Foodservices Staff: Reflections on the Queensland Experience

DENISE CRUICKSHANK1, TROY LITZOW1, JACQUELINE HARLE2

1Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

2SunshineCoast Technical and Further Education College, Maroochydore, QLD 4558, Australia

Nutrition training for Foodservices staff was identified as a high priority in the initial 2007 Queensland survey of foodservices managers and dietitians. This was supported in the 2008 Statewide foodservice training needs survey, where over 80% of foodservice staff at all levels identified the need for training in general nutrition and patient diets. In 2010 Statewide Foodservices developed the content for 3 nutrition units in the national training package HLTNA 302, HLTNA 303, HLTNA 304 in a power point format. In partnership with Sunshine Coast Technical and Further Education College, the units were converted to an online format and made available to Queensland Health foodservices staff for a corporate price. Two cohorts totaling 88 staff from 11 of 17 Health Districts enrolled for the training commencing in 2011 and 2012 with 77 completing the 3 units. Sixty percent of staff enrolled were cooks with 80% coming from small rural facilities. Sixteen percent of staff identified as indigenous. Support for training and assessment was provided by Dietitians at the site or by the Statewide Foodservice dietitian if no dietitian was available. Outcomes included improved understanding and awareness of nutrition and diet in patient treatment, improved knowledge of common therapeutic diets and increased confidence in cooking and managing diets. Suggested improvements included providing a workbook format for those with limited computer access or poor computer skills and improved communication with supervising dietitians. A third round of training is being run in 2013.

Contact author: Denise Cruickshank – Denise_Cruickshank@health.qld.gov.au

66 A Novices Guide to Working with Cald Groups: Interpreting the Australian Dietary Guidelines for Muslims

LYNN FIELD, LOUISA MATWIEJCZYK, ELIZABETH HOUSE, JANE SCOTT

Flinders University, Adelaide, SA 5000, Australia

Since 2001 the number of new arrivals from non-English-speaking countries has increased substantially. Allied health workers and others are finding their capacity to develop and deliver nutrition programs that meet the specific needs of culturally and linguistically diverse (CALD) groups a challenging task. The development of resources requires more than merely translating current resources into different languages. Nutrition education programs also need to take into consideration cultural eating practices when delivering the healthy eating messages contained in the Australian Dietary Guidelines. A picture based nutrition education resource has been developed in collaboration with the Muslim Women's Association in South Australia covering six topics. The topic modules cover the basic nutrition needs of CALD groups and are designed to be delivered by people without dietetic or nutrition training with the aim of freeing up dietitians/nutritionists for vital service delivery instead of program development. Sessions are delivered via a flip chart with an accompanying script and handbook, which are free to download. This model has been found to work well in other fields with workers delivering information to CALD groups on sexual health and financial literacy. The initial pilot at three community centres found new arrivals adopted healthier eating behaviours as a result of participating in the program. This presentation will provide results from the pilot program and share the reflections of the developers about the challenges of developing resources for CALD groups.

Contact author: Lynn Field – lynnette.field@flinders.edu.au

216 Using a Digital Photo Resource to Enhance the Understanding of Food Products and Their Composition in a University and Clinical Setting

MEGHANN FITZPATRICK, KAREN WALTON, ANNE MCMAHON, CHRIS BREWER, CAITLIN LAWSON, MEREDITH KENNEDY

University of Wollongong, Wollongong, NSW 2522, Australia

The aim was to determine the views of dietetic students, dietitians and clients of a Diabetes Service, regarding the usefulness of a Digital Photo Resource for instructing food composition. Students (n = 48) dietitians (n = 5) and clients (n = 5) were introduced to a Digital Photo Resource (160 photos with nutrient profile information). It was incorporated into lectures and uploaded to UOW eLearning sites. Most responding students (95.2%) agreed that the resource enhanced their understanding of food composition. 80% of the dietitians agreed the resource would be useful in a clinical practice for client education while 60% of the clients found it assisted their understanding of food composition.

Funding source: A faculty grant from the university of Wollongong

Contact author: Meghann Fitzpatrick – mef252@uowmail.edu.au

169 Incidence of Malnutrition and Associated Issues in Community-Living Older Adults Accessing Community Nursing Services in a Rural Area

CATHERINE FORBES1, ELIZABETH JEFFRIES1, JANICE KWOK2, SABRINA MOK2

1St Vincent's Health & Community Services, Bathurst, NSW 2795, Australia

2University of Sydney, Sydney, NSW 2006, Australia

Issues associated with ageing such as living alone, nutritional frailty, chronic and acute diseases, decrease in appetite and food intake and polypharmacy put community living older adults at higher risk of malnutrition (Skates & Anthony, 2012). It is widely accepted by health professionals that malnutrition has significant health, social and economic implications yet malnutrition often goes unrecognised and untreated in the community (Visvanathan, 2003).

This study aimed to determine the incidence of malnutrition and malnutrition risk among older adults accessing community nursing services. Over a 1-month period (July 2012) 72 community nursing clients aged 65 years and over were assessed for malnutrition using the Mini Nutritional Assessment (MNA®, Nestle). Of the 72 clients assessed twenty nine percent (29.2%) were identified as at risk of malnutrition and fifteen percent (15.3%) as malnourished. These findings indicate that malnutrition and risk of malnutrition are significant issues facing community living older adults accessing community nursing services and highlights the need for routine nutrition screening in this client group. Discussions between dietetic and community nursing staff which have occurred as a result of these findings have resulted in the following strategies being implemented: routine nutrition screening and weighing of community nursing clients and monthly meetings and formalised referral pathways between dietitians and community nurses.

Contact author: Catherine Forbes – cforbes@chcs.com.au

124 Does a Higher Ketotic State Improve Weight Loss?

ALICE GIBSON1, RADHIKA SEIMON1, LAUREN TOUYZ1, NUALA BYRNE2, IAN CATERSON1,3, TANIA MARKOVIC1,3, AMANDA SAINSBURY1

1University of Sydney, Sydney, NSW 2006, Australia

2QueenslandUniversity of Technology, Brisbane, QLD 4000, Australia

3Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia

The worldwide prevalence of obesity is increasing at an alarming rate and is a major risk factor for type 2 diabetes and other diseases. The physiological adaptation that occurs in response to weight loss via energy restriction is multifaceted. Key features of this response include an increase in appetite, reductions in physical activity and metabolic rate, as well as changes in neuroendocrine status and circulating gut hormone concentrations. These adaptive responses work together to hinder weight loss maintenance and thereby promote weight regain. The intensity of the adaptive response to energy restriction may be ameliorated by ketone bodies, circulating concentrations of which are characteristically increased during very low energy diet (VLEDs). This paper will present the protocol of a trial investigating whether the concentration of circulating ketone bodies observed during a VLED is associated with a reduced adaptive response to energy restriction. Volunteers will be participating in a weight loss intervention consisting of 12 weeks on a VLED. Circulating ketones and the adaptive response to weight loss (appetite, resting metabolic rate, physical activity and neuroendocrine status) will be measured at 0 and 12 weeks. If a less intense adaptive response to weight loss is associated with higher ketotic states then strategies to ensure that people using VLEDs maximise levels of ketosis could have important benefits for attaining and maintaining optimal body composition; and thereby contribute to effective weight loss strategies to combat the obesity epidemic.

Funding source: National Health and Medical Research Council Project Grant APP1026005

Contact author: Alice Gibson – alice.gibson@sydney.edu.au

156 Nutrition Risk Screening (NRS): Implementation in a Large Metropolitan Health Service

JANET GOLDER, RAISA SHAIKH, MARYANNE SILVERS, ALISON STEWART, PAULINE COOPER, RUBINA RAJA, MARIA APOSTOLIDES, JENNIFER SEQUEIRA, JUNE SAAVA

Southern Health (SH), Melbourne, VIC, Australia

A gap analysis against the Draft Victorian Nutrition Standard by the Nutrition Risk Committee (NRC) indicated that NRS was the highest priority for SH. An adhoc approach had previously been adopted with poor uptake. The project's aim was to roll out a validated NRS tool across adult bed-based services with an active implementation strategy. A Dietetics working party was established to finalise a NRS tool, and develop an education and implementation plan. The Malnutrition Universal Screening Tool was adopted as the NRS tool and training commenced for nurses across 35 wards with NRS now implemented on 40% of wards. This project had a strong governance process with direct reporting to the CEO led SH National Standards Committee (NSC). Malnutrition was integrated as a high risk into SH clinical and allied health risk registers. The NRC (with executive sponsorship) now reports directly to the SH NSC on NRS, providing NRS data and promoting the significance of nutrition risk throughout SH. A cycle of process evaluation and feedback to address barriers and maintain sustainability has been incorporated by establishment of quarterly reporting of NRS compliance via DASH board, reporting at site based Clinical Risk meetings, ward based screening audits, and provision of ongoing training. NRS requires commitment from the entire organisation and a clear accountability pathway to ensure a change in clinical practice is sustained. A structured implementation process, supported by organisational policy and active collaboration by dietitians and nurses will indicate an improvement in nutrition risk screening rates. Screening results are pending.

Contact author: Janet Golder – janet.golder@southernhealth.org.au

26 Nutrition-Related Hospital Admissions of Head and Neck Cancer Patients with Prophylactic Percutaneous Endoscopic Gastrostomy Tube Placed during Chemoradiation

VIVIENNE GUAN1, NINA BONNER2

1School of Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

2St George Hospital, Kogarah, NSW 2217, Australia

Head and neck cancer (HNC) patients undergoing chemoradiation typically receive prophylactic percutaneous endoscopic gastrostomy (PEG) feeding to prevent weight loss and use bolus feeding due to costs associated with equipment for continuous-feeding. There is little evidence on the association between bolus feeding and nutrition-related hospital admissions. This study aimed to determine the effect of bolus feeding on admissions for HNC patients during chemoradiation. Medical records of HNC patients who received chemoradiation with PEG bolus feeding between April 2011 and March 2012 at St George Hospital were reviewed retrospectively. Thirteen records were reviewed. Patients who had nutrition-related admission were compared with those without admission, in terms of demographics, BMI in Week 1 chemoradiation, percentage weight loss and average percentage intake of Estimated Energy Requirement (EER) before admission. Four out of 13 (31%) patients were admitted to hospital for malnutrition in Week 5 chemoradiation due to refusal (n = 2) and intolerance (n = 2) to the prescribed feeding. Patients who had admission tended to be male, 3 out of 4 patients were unpartnered and had a BMI<22.5 in Week 1 chemoradiation. These patients lost 5.24% (p = 0.016) more weight, and consumed 29% less energy (64% of EER only) (p = 0.000) prior to admission than those without admission. Establishment of bolus feeding did not avoid nutrition-related complications (weight loss) and admissions in high-risk patients and these patients could be identified by sex, living arrangements and relatively low weight at commencement of treatment. Consideration of alternative nutritional treatments (continuous feeding) and social support is required in high-risk groups.

Contact author: Vivienne Guan – xg885@uowmail.edu.au

149 Has Sugar Consumption in Australia Really Changed Over Time? An Update of the Data 1999–2011

MARY HARRINGTON1, TOM MCNEILL2

1Sugar Australia Pty Limited, Australia

2Green Pool Commodity Specialists, Brisbane, QLD, Australia

The media and others perceive that sugar intake has increased significantly in Australia and parallels the rise in obesity. Current intake levels are unknown and dietary intake data has not been updated since 1995. In the meantime, per capita consumption data can be used to indicate population trends. The Australian Bureau of Statistics (ABS) collected per capita consumption data for a range of commodities from 1939, but ceased in 1999. The aim of this study was to update this data for sugar (sucrose), from 1999 to 2011. Liaising with ABS and using their methodology, an independent commodity specialist (Green Pool) sourced data from refiners, mills supplying processors and end users, ABS, Australian Customs imports and exports declarations, and census data. Domestic sugar consumption was calculated using [opening stock + production + imports] – [consumption – exports] = end stock. Adjustments were made for imports and exports of sugar containing foods, and population growth, resulting in apparent per capita consumption. Data was merged with ABS reports and linear regression carried out to examine the trend. A downward trend in per capita sugar consumption was observed over time (R2 = 0.5266).1 ABS reported 48.3 kg/capita in 1938 and in 2011 this was estimated to be 42 kg/capita. This analysis provides an important update from where the ABS left off. The downward trend in sugar consumption raises queries about the relationship with increasing obesity rates, and suggests focussing on sugar alone may not be the correct approach. It helps target investigations for the forthcoming dietary survey update.

Reference

https://greenpoolcommodities.com/files/8113/4932/3223/121004_Sugar_Consumption_in_Australia_-_A_Statistical_Update_-_Public_Release_Document.pdf

Funding source: Sugar Australia Pty Limited, Bundaberg Sugar, Manildra Harwood Sugars, CANEGROWERS.

Contact author: Mary Harrington – mharrington@sugaraustralia.com.au

227 Clinicians and Consumers Working Together to Improve Patient Care – the Parenteral Nutrition Pamphlet Project

TANYA HAZLEWOOD1, KAREN WINTERBOURN2, KATHY STEWART3, SUZIE DANIELLS4, MARK SUTHERLAND4, KAREN RANKIN5, KATIE MARKS5, SUBHACHA GANYAMAS6, KIRSTINE METCALFE7, KATHERINA ANGSTMANN8, LYNN HYDE-JONES9

1Agency for Clinical Innovation, Chatswood, NSW 2067, Australia

2Parenteral Nutrition Down-Under, Hornsby, NSW 2077, Australia

3IBD Support Australia, South Penrith, NSW 2750, Australia

4Prince of Wales Hospital, Randwick, NSW 2031, Australia

5Sydney Children's Hospital Network – Westmead Campus, Westmead, NSW 2045, Australia

6Bankstown Hospital, Bankstown, NSW 2200, Australia

7Dubbo Base Hospital, Dubbo, NSW 2830, Australia

8Royal North Shore Hospital, St Leonards, NSW 2065, Australia

9Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia

Parenteral nutrition (PN) is a life sustaining therapy that can be confronting for patients and their carers. In 2008, the NSW Agency for Clinical Innovation (ACI) Nutrition and Gastroenterology Networks began developing best practice guidelines for the use of PN in hospitals. Throughout the project, consumer working group members identified the need for a resource specifically for consumers and their carers. Following the launch of the ACI PN Pocketbook the Networks approached relevant consumer groups to develop a patient and carer resource. With their endorsement, a working group consisting of consumer group representatives and clinical experts was formed. Chaired by a consumer, the group created a pamphlet that provides introductory information for patients who are about to commence PN and their carers. The pamphlet was piloted in 4 NSW hospitals and patients who were about to commence PN or their carers were invited to participate. Patients or their carers received standard care (no pamphlet during education on PN) or education using the PN pamphlet. They then completed a multiple choice questionnaire relating to the education and information they received. Results of the pilot were used to revise the pamphlet before making it available to clinicians and consumers across NSW. Consumer working group members were involved at all stages and ensured that the clinical content of the PN pamphlet reflected consumer needs. The consumer involvement has evolved the Networks' approach to similar projects by ensuring there is balance between clinical content and consumer comprehension for resources to have the maximum effect.

Contact author: Tanya Hazlewood – Tanya.hazlewood@aci.health.nsw.gov.au

107 Twitter Time! The Use of Social Media During a Professional Education Event in Dietetics

CLANCY HENDERSON, YASMINE PROBST

University of Wollongong, Wollongong, NSW 2522, Australia

Social media platforms such as; Twitter, Facebook, MySpace, Wikis, and Blogs, continue to grow rapidly, with social networking now accounting for 11% of all time spent on the Internet. Twitter, a micro-blogging tool, has become valuable in both professional and academic settings. The aim of this study is to investigate the use of social media during a professional dietetic education event. The primary objective was to identify patterns or themes in Twitter postings. Data was captured using Ncapture for Internet Explorer (2012 QSR International) web browser extension and examined in Dedoose analysis application (2011 SocioCultural Research Consultants). Following a grounded theory approach, the data was coded into 14 categories and three tones of communication; positive, neutral, and negative. Categories were then analysed in Microsoft Excel 2010 to ascertain category and tone distributions and variation over time. The categories, informative (20%) and opinion (17%) were the most prevalent form of tweet, and the majority (81%) of tweets had a neutral tone. Tweeting was most popular on the second day of the conference and was most likely influenced by the events occurring at the conference. Micro-blogging at conferences continues to grow as new users embrace the social media phenomenon. The main forms of communication at a dietetic conference were the sharing of facts and opinions with other users. It is apparent that encouragement of the use of social media during in a conference has an impact on the number of tweets, often through online networking.

Contact author: Clancy Henderson – ceh535@uowmail.edu.au

110 Implementation and Evaluation of a Framework for Clinical Dietetic Workforce Development and Support

JAN HILL, MERRILYN BANKS

Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia

Research on clinical dietetic workforces has found that team collegiality and opportunities for professional development assist with job satisfaction and retention. The multi-strategy workforce development and support program at Royal Brisbane and Women's Hospital was evaluated in 2012. The program utilises a combination of bottom-up and top-down approaches to enable team membership and participation, thereby providing a range of opportunities for staff to contribute to the development and implementation of clinical initiatives, and to the overall strategic direction of the Department. Each dietitian is a member of a clinical team (medicine, surgery, oncology), and one or more functional team/s (research, education, food service, nutrition support). Functional teams are lead by senior clinicians and supported by team leaders. Each dietitian is expected to maintain APD status and to attend professional development regularly (two one hour sessions/week). Coaching with Team Leaders is scheduled monthly. In addition, a structured supervision program with a senior clinician is provided to all new staff. Evaluation of the framework was undertaken in November 2012. Respondents felt that membership of both clinical and functional teams allows them to influence decisions about service delivery (overall rating 3.9 and 4.0 respectively out of 5), and provides a supportive environment to learn from others (4.3 and 4.2 respectively). Staff agreed that the weekly department PD session meets their needs and that they have access to research training and opportunities. Furthermore, staff felt that both team leaders and their clinical supervisors provide support to improve skills and performance (4.0 and 4.1 respectively).

Contact author: Jan Hill – Jan_hill@health.qld.gov.au

116 Implementation and Evaluation of Hospital Enteral Nutrition Policy and Procedures

TERESA BROWN, JAN HILL, SARAH ANDERSEN, MERRILYN BANKS

Royal Brisbane & Women's Hospital, Brisbane, QLD 4029, Australia

Policies and procedures to standardise and ensure evidence-based practice with respect to nutrition support for patients were developed in 2008 at the Royal Brisbane & Women's Hospital. Multidisciplinary working groups, including medical, nursing, pharmacy, speech pathology, dietetics, nurse education, safety and quality representatives, were established to review the evidence in the following areas: nutrition risk screening, assessment and support, medication administration, nasoenteral tube insertion and management, gastrostomy (PEG) and jejunostomy tube management, home enteral nutrition and re-feeding syndrome. A dedicated Nurse Educator project officer supported implementation of the policies and procedures to the clinical areas focusing on enteral nutrition. An audit in 2009 to review adherence to the new procedures identified clinical areas requiring further education. A second audit was undertaken in 2010. Dietitians audited all patients receiving enteral nutrition in a given week (n = 26). Patient characteristics were: 65% nasogastric, 19% gastrostomy, 8% nasojejunal and 8% other, with 54% continuous feeds and 46% bolus feeds. The majority of patients were from stroke, ICU and burns units. Several areas had >75% adherence, including timely commencement of nutrition support. Overall the introduction of the policies and procedures has resulted in improvement in processes related to nutrition support. Identified areas for improvement (<60% adherence) include: monitoring of weight and blood glucose levels, use of pH indicator paper to confirm nasogastric tube placement, labelling feeds with time commenced and the use of stickers to document tube re/insertion. This informed targeted education for the wards. Results from a further audit in 2012 are now due.

Contact author: Teresa Brown – Teresa_Brown@health.qld.gov.au

81 Moving Healthy Eating Policy in Local Government Beyond Rhetoric Into Practice

ELIZABETH HOUSE, SOPHIE PALYGA, LOUISA MATWIEJCZYK, LYNN FIELD, JANE SCOTT

Flinders University, Adelaide, SA 5000, Australia

The development of healthy eating policy (HEP) is gathering momentum in local government. One of the key challenges identified is how to translate policy into practice, specifically in relation to providing healthy catering. To align organisational expectations of healthy catering with what caterers can realistically provide, a six-step collaborative process involving caterers and local government was developed. The result of this process is a list of healthy food items that is specific to each local government and their preferred caterers.

The educative process aimed to establish a common understanding of the types of food and drinks that meet policy guidelines. The involvement of caterers in this process is pivotal as those ordering catering may have unrealistic expectations of what caterers can provide. The resulting list addresses some of the barriers organisations experience when implementing HEP such as alleviating the stress staff feel when ordering catering. This process was piloted with two local councils in South Australia and their preferred caterers, along with staff responsible for ordering catering. Feedback from councils demonstrated differences in council practices and attitudes as a result of the list. Caterers appreciated the opportunity to have input in the process as they are now receiving more requests to provide healthy catering and are keen to establish themselves in this growing market. Once policy is established, the challenge is to ‘walk the talk’. This presentation details the process used in the pilot and showcases the resources developed to assist councils to move their HEP beyond rhetoric into practice.

Contact author: Elizabeth House – liz.house@flinders.edu.au

211 Access and Accuracy: The Eternal Challenge of Weighing Patients

RACHEL JAMIESON, ANITA WILTON, JUDI PORTER

Eastern Health, Box Hill, VIC 3128, Australia

Obtaining an accurate weight measurement is essential for medication prescription, manual handling and identifying malnutrition risk. Whilst literature supports the recording of weight during the admission process, little was known of the accessibility and accuracy of weighing scales within our complex multi-site health network. This quality project aimed to identify the weighing equipment available across the continuum of care, their calibration history, and to plan for the purchase of new scales. An audit tool was developed for completion by dietitians and nurse managers across 90 acute, sub-acute, residential facilities and outpatient services in mid-2012. In total, 199 adult and paediatric scales were identified. Thirty-five percent were bathroom scales that were unable to be calibrated. Another 21% were stand-on scales, 16% were seated scales and nine percent were baby scales. The remainders were bed weighing scales, wheelchair scales and hoist scales. Access for bariatric patients was limited with only eight percent of scales weighing to 300 kg. Excluding bathroom scales, six percent of scales had not been serviced within the last 12 months and 24% of wards indicated no formal cleaning procedures. All facilities had the capability of weighing patients, although some scales may not be appropriate for the area of service. Network guidelines are presently being developed for weighing scale procurement and use that consider the need of bariatric patients, methods of weighing and record keeping.

Contact author: Rachel Jamieson – rachel.jamieson@easternhealth.org.au

87 Reflecting on the Year Past – Using Workforce Surveys of Dietetic Staff to Provide Feedback and to Plan for the Future

ANITA WILTON, TERRIE JEFFS

Eastern Health, Box Hill, VIC 3128, Australia

Public hospital dietitians have been reported to be accepting of their work environment and have an underlying optimism that they make a difference despite obstacles.1 A workforce survey designed to elicit the opinion and reflections of dietitians working across inpatient, outpatient and ambulatory clinical settings within a large metropolitan multicampus health service has been developed and administered annually. Survey questions focus on achievements by the Dietetic service; effectiveness of staff meetings; and feedback about quality improvement activities. Specific questions have been developed for response by staff at different career stages. An opportunity to nominate high achieving staff for reward and recognition has been included resulting in the naming of a service “Dietitian of the Year”.

Analysis of the responses indicated staff were satisfied with their work and felt appreciated; valued working in teams to complete tasks, enjoyed the stimulation and networking of meetings with their colleagues, valued professional development and opportunities to participate in research and quality improvement; and were becoming more confident with IDNT. Ineffective and inefficient processes were identified with different issues identified by staff at different career stages. Staff were provided with the collated responses and action plans were formed to address identified issues at an annual staff planning meeting.

Contact author: Anita Wilton – anita.wilton@easternhealth.org.au

Reference

Marianna Milosavljevic, “NSW Public-Hospital Dietitians and Their Workplace: True Love or a Marriage of Convenience?” (August 8, 2012). SBS HDR Student Conference. Paper 7. http://ro.uow.edu.au/sbshdr/2012/papers/7

143 Reflections on Tomorrow's Menu: Evidence for Inpatient Meal Preferences at a Large Tertiary Public Hospital

PHILIP JUFFS1, JENNIFER ELLICK1, MERRILYN BANKS1, MARY HANNAN-JONES2, ANGELA NEIL2, REBECCA EVANS2, SANDRA CAPRA3

1Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

2QueenslandUniversity of Technology, Kelvin Grove, QLD 4059, Australia

3TheUniversity of Queensland, St Lucia, QLD 4072, Australia

There are limited studies that describe patient meal preferences in hospital; however this data is critical to develop menus that address satisfaction and nutrition whilst balancing resources. This quality study aimed to determine preferences for meals and snacks to inform a comprehensive menu revision in a large (929 bed) tertiary public hospital. The method was based on Vivanti et al. (2008) with data collected by two final year dietetic students. The first survey comprised 72 questions, achieved a response rate of 68% (n = 192), with the second more focused at 47 questions achieving a higher response rate of 93% (n = 212). Findings showed over half the patients reporting poor or less than normal appetite, 20% describing taste issues, over a third with a LOS > 7 days, a third with a MST ≥ 2 and less than half eating only from the general menu. Soup then toast was most frequently reported as eaten at home when unwell, and whilst most reported not missing any foods when in hospital (25%), steak was most commonly missed. Hot breakfasts were desired by the majority (63%), with over half preferring toast (even if cold). In relation to snacks, nearly half (48%) wanted something more substantial than tea/coffee/biscuits, with sandwiches (54%) and soup (33%) being suggested. Sandwiches at the evening meal were not popular (6%). Difficulties with using cutlery and meal size selection were identified as issues. Findings from this study had high utility and supported a collaborative and evidenced based approach to a successful major menu change for the hospital.

Contact author: Philip Juffs – philip_juffs@health.qld.gov.au

24 Outpatient Compliance with Scripted Oral Nutritional Supplements (ONS)

AMANDA KEATING1, BROOKE STARKEY-LUKE2, MICHELLE SUTER3

1School of Public Health QUT, Kelvin Grove, QLD 4059, Australia

2Department of Nutrition and Foodservices Redcliffe Hospital, Redcliffe, QLD, Australia

3Department of Nutrition and Foodservices Caboolture Hospital, Caboolture, QLD, Australia

Adherence with oral nutritional supplement (ONS) regimes is notoriously poor, significantly limiting their effectiveness. No previous literature has investigated compliance in the context of patient access to supplements. The aim of this study is to be the first to determine the level of outpatient compliance with scripted ONS in the context of both patient access and patient intake; and to determine factors associated with compliance levels. Outpatients who had been prescribed ONS between the 1st July 2010 and 1st July 2011 were recruited from Redcliffe Community Health, Redcliffe hospital and Caboolture Community Health. Medical charts and HENS (Home Enteral Nutrition) records were used to identify patients' current prescription details and medical history. A patient questionnaire investigating factors affecting compliance was completed with patients and carers who were referred by prescribing dietitians. Compliance was defined into three variables (adequate access, pickup compliance and adequate intake) and calculated by comparing current prescriptions with pharmacy and questionnaire data. These were than tested against potential factors affecting compliance. 175 patients were included in the study with 43 patients and carers completing the patient questionnaire. 23.4% (n = 175) of patients were found to have adequate access; 48.8% (n = 43) were found to have adequate intake; and pickup compliance was 78.9% (n = 175). Results from this study support the generally poor levels of compliance found in previous literature. Patients at risk of experiencing access issues need to be identified prior to prescription so that strategies can be devised to increase compliance rates and in turn the effectiveness of ONS prescription.

Contact author: Amanda Keating – amanda_keating@health.qld.gov.au

188 Prevalence of Malnutrition Amongst Adult Inpatients at a Tertiary Teaching Hospital in the Act Region

JANE KELLETT1, CATHERINE ITSIOPOULOS2, GREG KYLE1, NARELLE LUFF3

1University of Canberra, ACT, Australia

2LaTrobe University, VIC, Australia

3The Canberra Hospital, ACT, Australia

Malnutrition has been identified as a significant clinical problem in hospital settings both nationally and internationally. Malnutrition adversely affects physical well-being, interferes with health treatments, and increases healthcare costs. However, there is no current data on malnutrition in adults residing in the Australian Capital Territory. To determine the prevalence of malnutrition amongst adult inpatients admitted to a tertiary teaching hospital in the ACT region, a point-prevalence study was conducted over two consecutive days in June 2012. The Patient-Generated Subjective Global Assessment tool was used to determine the prevalence of malnutrition in 189 adult inpatients in the aged care, rehabilitation, surgical, medical, critical care, acute care and oncology wards. 47% were classified as well-nourished, 47% as moderately or suspected of being malnourished, and 6% as severely malnourished. The prevalence of malnutrition found in this study is similar to other studies conducted in Australian hospitals. Of those patients classified as moderately or suspected of being malnourished or severely malnourished, 59.4% had not been referred to see a dietitian. This study provided a “snapshot“ of the prevalence of malnutrition in this population and will help to inform decisions regarding the appropriate provision of nutrition services to this population.

Contact author: Jane Kellett – Jane.Kellett@canberra.edu.au

229 What Information about Infant Feeding is Available to Parents with Children at Increased Risk of Coeliac Disease?

SUSANNAH KING, ADRIENNE FORSYTH, SUE SHEPHERD

La Trobe University, Bundoora, VIC 3086, Australia

Children with a biological parent or sibling with diagnosed coeliac disease (CD) are at increased risk of developing CD themselves. Breastfeeding duration, breastfeeding at the time of gluten introduction, and introducing moderate amounts of gluten between four and six months of age appear to be associated with a lower risk of developing CD in these children. It was unknown whether this information is being shared with parents of infants at risk of developing CD. A review of accessible English language content from sites used by Australian health professionals, lay-base internet sites (through a Google search using the terms ‘coeliac disease’ and ‘breastfeeding’) and international coeliac societies was undertaken in October 2012. The Australian Breastfeeding Association (ABA) was the only Australian organisation identified to provide any specific advice regarding breastfeeding infants at increased risk of developing CD: a statement that breastfeeding should continue during the introduction of solid foods. The lack of available local information for both parents and health professionals is a significant issue that needs to be addressed to help advise families of children at higher risk of CD. Recommendations for reducing the risk of food allergy cannot be automatically generalised to CD because they have different pathophysiological mechanisms. Further research is required to establish how both families and health professionals are dealing with the mismatch between the evidence base and the lack of publically accessible and detailed information from the sources they might use such as Dietitians Association of Australia, Coeliac Australia, ABA and the Digestive Health Foundation.

Contact author: Susannah King – susannah.king@latrobe.edu.au

112 Are Hacc Day Centres Feeding the Lonely and Isolated? a Nutritional ‘Snapshot’ of Seniors Attending a Hacc Day Centre

QUEENY LAU1, ERICA GRANDJEAN2, YIN LI2

1Home and Community Care (HACC) Dietitian Community Rehabilitation Team, Hornsby, NSW 2077, Australia

2Student Dietitian, University of Sydney, NSW 2006, Australia

Community-dwelling elderly people who are isolated or have cognitive impairment are at risk of malnutrition. HACC dietitians have observed that when one-on-one aged care services are exhausted, clients can be institutionalised prematurely. HACC funded Day Centres addresses some of these service gaps by providing opportunities for such clients to eat nutritious meals together in a social setting which requires less resources. This study investigates the nutritional health of current clients attending a local day centre to determine program reach and ways the centre can enhance nutrition support in the community. During October 2012, 42 clients (66% response rate) of the centre completed a questionnaire with the assistance of dietetic students. The study found most clients were well-nourished with 92% scoring less than 2 on the Malnutrition Screening Tool (MST) i.e. low nutritional risk and 63% of clients with a Body Mass Index (BMI) between 22–27. Clients consumed on average 33% of recommended calcium intake and 60% of recommended protein intake per day. This is suboptimal given that muscle and bone loss is very prevalent in this subgroup. The study found most clients had a co-resident carer (45%) and lived with someone (61.9%) suggesting that the program may not be reaching those who are most isolated. The centre should consider strategies to reach these clients by forming partnerships with other aged care services. From this study, the centre plans to increase calcium and protein at midmeals. Strategies are still being discussed on how to reach isolated clients.

Contact author: Queeny Lau – qlau@nsccahs.health.nsw.gov.au

146 What Foods is Your Local Senior Day Centre Providing? Time for National Guidelines

QUEENY LAU1, ERICA GRANDJEAN2, YIN LI2

1Home and Community Care (HACC) Dietitian Community Rehabilitation Team, Hornsby, NSW 2077, Australia

2Student Dietitian, University of Sydney, NSW 2006, Australia

HACC funded Day Centres provide opportunities for elderly clients to eat nutritious meals in a social setting; thus reducing strain on aged care services. Previous studies have found significant variations in nutrition provision across different day centres as the National HACC Program Manual does not specify any standards of what foods day centres need to provide. Therefore, a partnership was formed with a local dementia specific day centre to review nutrition practices at the centre. The review found that there were no written nutrition policies resulting in inconsistent food provision. For example, dessert is not served consistently as one staff felt that desserts were not necessary. Meals cooked by staff, although reasonably appropriate, varied greatly in protein content. It was also found that staff ordering the main meal items do not use any checklist or processes to ensure menu variety. Staff also reported that meals are plated according to client's appetite. When a client is only managing a small meal, there is no standard practice of offering extra foods such as dessert to supplement reduced intake. Staff training, the availability of basic nutrition policies and resources could address some of these issues. As a result of this review, the day centre plans to implement a ‘menu variety checklist’, provide staff with a list of nourishing midmeals, desserts and drinks. In the long term, it is recommended that the Commonwealth consider developing resources to guide day centres in providing adequate nutrition with assistance from dietitians.

Contact author: Queeny Lau – qlau@nsccahs.health.nsw.gov.au

195 Evaluation of New Total Parenteral Nutrition Solutions at the Royal Children's Hospital Queensland

ROBYN LITTLEWOOD, JULIA FOX

Royal Children's Hospital, Brisbane, QLD 4029, Australia

In July 2012 new Total Parenteral Nutrition (TPN) solutions and a protocol for administration of these solutions were introduced at the Royal Children's Hospital Queensland. The purpose of this study was to evaluate the new solutions and protocols cost effectiveness and intervention requirement and compare that to the old solutions and protocol. Usage data was collated from Baxter®TPN order forms and pharmacy records for the periods of 1st to 30th September 2011 and 1st to 30th September 2012. The number of TPN bags used, modifications made and costs were calculated per month. Treating team costs were also calculated. The above factors were then cross compared with the two month periods to decipher which month produced a higher cost and required more intervention. 18 patients were prescribed TPN in the old protocol compared to 14 with the new protocol. There were more modifications made to bags with the new protocol than to the old protocol (41.26% vs. 16.47%) so therefore the costs were higher ($13 314 vs. $7500.40). Majority (96%) of modifications where to the sodium and potassium content of the bags. Oncology contributed to a higher cost percentage in both protocols. This study found that there were more modifications and therefore higher costs in our new protocol. However, there were fewer prescriptions made for TPN and fewer bags used overall. As majority of the modifications were made to sodium and potassium content this is something that needs to be re-worked in the solutions or alternative options (other then modifying TPN solutions) need to be considered.

Contact author: Robyn Littlewood – Robyn_Littlewood@health.qld.gov.au

145 A Novel Method of Supplement Delivery Utilising Dietetic Assistants Improves Patient Nutrition Status: The Sam Program

AMANDA LOWE, MERRILYN BANKS, TERESA BROWN, LISA JOLLIFFE, PHILIP JUFFS

Royal Brisbane and Women's Hospital, Herston, QLD 4006, Australia

The prescription of aliquots of nutritionally concentrated supplements, administered by Nurses and documented on the medication chart (‘medpass’) has been demonstrated to improve patient supplement intake. However there are often barriers to implementing this system successfully. The ‘Supplements As Medicine’ (SAM) trial aimed to examine the effectiveness of a modified version of this concept using Dietetic Assistants (DA) to deliver supplement aliquots during their mid meal delivery rounds. The two-month trial took place in an oncology ward. Patients were identified by the Dietitian for SAM if they were unable to meet nutritional goals with normal care (HPHE diet and supplements). They received two 80 mL aliquots of a 2 kcal/mL supplement by the DA (morning and afternoon tea). DAs were trained in SAM procedures and how to encourage supplement consumption. They recorded supplement consumption and communicated this to the Dietitian. Consecutive energy and protein intakes were recorded by the Dietitian during standard care and after commencement of SAM using food charts. The seven patients identified for SAM by the Dietitian (10% of all ward patients) achieved an average increase of 12.5 g protein and 1.9 MJ per day. A survey of DAs involved in the trial (n = 3) agreed SAM improved communication with the Dietitian, increased job satisfaction and sense of value. It is planned to implement the program hospital-wide. These findings identify a way DA roles can be expanded to improve nutrition and an alternative model to prescribing supplements on medication charts.

Contact author: Amanda Lowe – Amanda_Lowe@health.qld.gov.au

127 Does Eating Environment Have an Effect on the Intake of the Elderly?

KARON MARKOVSKI, ARANKA NENOV, AURORA OTTOWAY

Western Health, Williamstown, VIC 3016, Australia

Social and environmental factors are important influences on food intake. Studies demonstrate increases in food intake when there is improvement in the social and environmental surroundings and when people dine together. In 2010, Western Health introduced a supportive community dining environment in the Aged Care sub acute setting. The program “Dining with Friends” commenced at the Williamstown campus 3 days per week (Monday, Wednesday and Friday) and was later initiated in 2011 on the sub acute ward 3B at the Footscray campus. The study aimed to examine the energy and protein intake of the midday meal in two different eating environments – the dining room and the patient's bedside and to obtain feedback on patient experience in both locations. The dietitians surveyed 52 patients over the age of 65 years. Data collected included information on diet codes, Malnutrition risk using the MST, BMI, appetite, gender, cognitive status, length of stay, feeding assistance and preference with dining environment. Each patient was observed consuming the midday meal on two consecutive days and in two eating environments, the dining room (day 1) and their bedside (day 2). The patients intake was recorded as a proportion of the meal consumed and analysed for protein and energy content using the Hospital Food Service Menu ready reckoner. The study found that 34 out of 52 patients (65%) favored eating their meal in the dining room and consumption of a higher proportion of protein( 29 g in dining room compared with 25 g at the bedside) and energy (2321 Kj in the dining room compared with 2050 Kj at the bedside) was observed. The study also found of the 21 patients with a BMI less than 22, 15 (71%) ate better in the dining room, of the 31 patients identified with significant cognitive impairment 24 (77%) ate better in the dining room and of the 29 patients who were identified as being at moderate and high risk of malnutrition 20 (69%) ate better in the dining room. This study supports the contention that a dining room environment can increase opportunities to enjoy the social aspect of meal times, increases food intake and potentially lead to weight gain and improvement in nutritional status and rehabilitation

Contact author: Karon Markovski – karon.markovski@wh.org.au

115 Room Service – the Future of Hospital Meal Ordering and Delivery in Australia?

KIRSTY MAUNDER1,2, CAROL ZEUSCHNER3, CARMEL LAZARUS4

1The University of Wollongong, Wollongong, NSW 2522, Australia

2The CBORD Group, Chatswood, NSW 2067, Australia

3Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia

4St. Vincent's and Mater Health, Darlinghurst, NSW 2010, Australia

Australasian hospital foodservices operate a traditional method of meal ordering via menus in advance, bulk production, and the delivery of plated meals at set times. Approximately 25% of Australasian hospitals utilise software to manage these processes and until now have remained largely unresponsive to change. The United States in contrast have approximately 32% hospitals utilising foodservice software and 38% operating room service (i.e. where patients order when they like from a one-day hotel-style menu). The aim of this study was to investigate the suitability and potential benefits of room service in Australasian hospitals. A study tour of twelve United States hospitals utilising various room service models, a comprehensive literature review, and an in-depth knowledge of over 50 Australasian hospital foodservices enabled a review of meal ordering, production and delivery methods. The findings highlighted significant considerations in relation to menu, kitchen design, IT infrastructure, staffing, hours of operation, delivery methods and cost. Despite the industry being slow to publish room service benefits, there is literature on cost-effectiveness, and improving patient nutritional care and satisfaction have been identified as the key drivers for this transition. In conclusion there is significant value for the healthcare industry to adopt new technology and innovative food delivery methods to improve patient satisfaction and nutritional intake. Individual hospital assessment is crucial to identifying the best combination of methods of foodservice delivery to adopt, so as to tailor the appropriate service delivery with the desired outcomes.

Funding source: Kirsty Maunder was the recipient of the DAA Fay McDonald Scholarship 2012.

Contact Author: Kirsty Maunder – km932@uowmail.edu.au

209 Utilising a Health Based Framework to Engage Clients with Eating Disorders

SARAH MCMAHON

BodyMatters Australasia, Neutral Bay, NSW 2089, Australia

The Health at Every Size (HAES) paradigm encourages a focus shift away from weight loss and dieting as a means to accomplish health. This is particularly vital when treating people with eating disorders, who are typically preoccupied with weight and often co-opt health based language to justify their behaviour. Research suggests that HAES has the potential to improve health through emphasising body acceptance and embracing a healthy lifestyle. It provides a foundation that works for people who are sitting both above or below their natural body weight and promises the opportunity for bold new directions in eating disorder treatment and beyond. However the adoption of HAES into private practice, particularly with an eating disorder population, is in its infancy. This presentation discusses the implementation of the HAES framework in our practice, when working with people with eating issues. An analysis of strengths, weaknesses, opportunities & threats is provided.

Contact author: Sarah McMahon – sarah@bodymatters.com.au

181 The Mental Health Role Statement – a Statement for all Dietitians

MENTAL HEALTH INTEREST GROUP COMMITTEE

Dietitians Association of Australia, Canberra, ACT, Australia

The rates of mental health problems in Australia are very high, with 45% expected to experience mental illness or disorders in their lifetimes.1 Further, the life expectancy of individuals living with severe and chronic mental illnesses can be reduced by up to 32 years, with greater risks of dying from metabolic diseases.2 Despite this, Australian dietitians feel ill-equipped to manage clients with mental health issues.3 The Mental Health Interest Group (MHIG) Committee developed a Role Statement in accordance with DAA's protocols, aiming to provide Accredited Practising Dietitians (APDs) and other health professionals with a summary of dietitians' professional roles in mental health. The Committee conducted a literature review of mental illnesses, their prevalence and their association with metabolic and medical problems. A list was compiled of tasks regularly performed by and expected of APDs working in clinical and community practice in mental health. Consultation with the wider MHIG membership and the DAA general membership was undertaken. The final Role Statement was endorsed by DAA in December 2012. Even for dietitians who do not formally work in mental health, the chances of their coming across a client with mental health comorbidities are very high. It is essential APDs are prepared and equipped to work with such clients in clinical and community practice.3 The Role Statement will assist APDs in managing clients, liaising with multidisciplinary teams and establishing dietetic positions in mental health.

References

ABS. National Survey of Mental Health and Wellbeing: Summary of Results, Australia 2007. Report 4326.0, 2008.

Lourey C. National Mental Health Commission, 2012: A Contributing Life: the 2012 National Report Card on Mental Health and Suicide Prevention. 2012; Sydney: NMHC.

DAA. Mental Health in Tertiary Curricula for Dietitians Phase 2 Final Project Report. 2009; Canberra: DAA.

Contact author: Dr Nerissa Soh – nsoh@nsccahs.health.nsw.gov.au

119 Inter-Rater Reliability of Malnutrition Screening Tool (MST) Completion by Nutrition Assistants (NA) more than One Year Post Training

KARLY MILLER1, ANGELA VIVANTI1,2

1Princess Alexandra Hospital (PAH), Australia

2School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia

Princess Alexandra Hospital's Nutrition Assistants complete Certificate III in Nutrition and Dietetic Assistance including MST competency assessed by an accredited practicing dietitian (APD). NA's subsequently undertake MST's during daily duties. To determine the long term effectiveness of training they were reassessed more than one year later. Fifty malnutrition screening events by 10 NA's were recorded on 5 different occasions. A single APD also conducted malnutrition screening at the same time, limiting inter-rater variability. Additional clarification required by the APD to complete the screening occurred after NA's had calculated their score. Three NA's were assessed >1 year and 7 NA's were assessed >2 years after certificate training was completed. The percentage agreement and the kappa statistic were considered to determine the inter-rater repeatability. Overall agreement between the NA and APD screening for malnutrition risk or not was 96% (48/50, kappa = 0.91) while individual MST screening scores (0–5) achieved 92% agreement (46/50, kappa = 0.88). The most recently trained NA's obtained 100% agreement (15/15, Kappa 0.1) which reduced to 94% agreement (33/35, Kappa 0.86) with greater time since training. Identified discrepancies resulted from score miscalculations, mishearing patients or not clarifying patients exact weight loss. No critical errors in malnutrition risk identification occurred as discrepancies resulted in the person being screened at risk. Trained NA's and APD's demonstrated good inter-rate reliability. Areas of focus for up skilling included seeking clarification regarding weight loss and care with calculations. Although simple to complete, the highest agreement occurred amongst staff with more recent instruction.

Contact author: Karly Miller – Karly_Miller@health.qld.gov.au

83 Effectiveness of Malnutrition Screening of Oncology Outpatients on Appropriateness of Dietetic Referrals: A Pilot Retrospective Cohort Study

JESSICA NALDER

Royal Hobart Hospital, Hobart, TAS 7000, Australia

Patients with cancer are at high risk of malnutrition related to increased energy requirements, and effects of the cancer and treatment, such as weight loss and gastrointestinal symptoms. Regular nutritional screening of oncology patients helps with early identification of patients at risk of malnutrition, enabling early dietetic intervention, which can improve patients' quality of life and treatment response. This study assesses the effectiveness of nurses conducting malnutrition screening using the validated Malnutrition Screening Tool (MST) in improving appropriate and timely referrals of patients to the dietitian. A retrospective cohort study was conducted using clinical data from adult oncology outpatients at the Royal Hobart Hospital. The study compared the rate, appropriateness and timeliness of dietitian referrals prior to routine screening using the MST, with referral patterns post-implementation of the MST. The results indicate malnutrition screening improved the percentage of referrals assessed as appropriate by 30%.Malnutrition screening ensured all patients at risk of malnutrition were referred to the dietitian in a timely manner. Prior to using the MST, approximately 20% of patients who were at risk of malnutrition were not referred to the dietitian. Routine and ongoing screening using the MST is an effective tool for detecting trends in a patient's nutritional status. Implementing routine and ongoing malnutrition screening helps to detect patients at risk of malnutrition and can improve the appropriateness and timeliness of referrals to the dietitian.

Contact author: Jessica Nalder – Jessica.Nalder@dhhs.tas.gov.au

128 Involvement of Culturally and Linguistically Diverse (CALD) Consumers in Hospital Menu Development

CLARA NEWSOME1, KATE FOX1, STEPHEN TIPPETT2, ELIZABETH DOYLE1, NATALIE SIMMANCE1, KARELLA DEJONGH3

1Nutrition Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

2Food Services, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

3Interpreter Services, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

Malnutrition is common in hospital patients and it is essential that the food provided meets patient's preferences to improve consumption. A patient satisfaction survey conducted in 2012 identified that 49% of culturally and linguistically diverse (CALD) hospital inpatients were not satisfied with food choices. This project aimed to use interpreters to identify patient preferences in the development of a new menu for St Vincent's Hospital, Melbourne. It was a collaborative project between Interpreter Services, Food Services, and the Nutrition Department. A 4 question questionnaire was developed and administered across 6 cultural groups (Asian-Vietnamese, Asian-Chinese, European-Italian, European – Arabic, Mediterranean – Greek, and Western) with the assistance of interpreters when required. A total of 52 patients were surveyed. The most and least favourite dishes were identified for each patient group. The results have been used in menu development and successfully enabled consumer input into nutrition care. The organisation plans to repeat the survey every 6 months and will use this data to further optimise menu planning to meet consumer needs.

Contact author: Clara Newsome – clara.newsome@svhm.org.au

137 Implementation of an Electronically Initiated Meal Time Feeding Assistant Alert

CLARA NEWSOME1, ELIZABETH DOYLE1, SUE WHITE2, NATALIE NEWMAN3, NATALIE SIMMANCE1

1Nutrition Department, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

2Nurse Unit Manager, St Vincent's Hospital, Fitzroy, VIC 3065, Australia

3Improving Care for Older People Project (COAG-LSOP), St Vincent's Hospital, Fitzroy, VIC 3065, Australia

Malnutrition is common in hospital patients. Inadequate assistance at meal times can put patients at risk of a poor nutritional state. In 2009 a meal tray blue dome (MTBD) alert was implemented at St Vincent's to identify patients needing assistance with feeding. The MTBD had to be arranged through the dietitians or dietitian assistants by manually inputting into the Patient Administration Computer System (PAS). In 2012 a new electronic method of arranging a MTBD was added to PAS. This enabled nursing staff, dietitians and dietitian assistants to arrange a MTBD though a one prompt tick box on the PAS Diet Code screen. Use of the MTBD was tracked over time with a monthly count to identify changes in use. Nursing staff, Dietitians and Dietitian Assistants were also asked to complete an anonymous survey (n = 33) to determine their views on the new electronic method of arranging a MTBD. Almost all staff surveyed (97%) felt that the MTBD improved the assistance patients received at meal times. Eighty-two % of staff surveyed felt the electronic process improved their ability to arrange a MTBD. There was a 28% increase in the average MTBD arranged in the 3 months pre compared to post implementation of the electronic ordering method. In conclusion the implementation of an electronic method of arranging a meal time feeding alert appears to have been an effective strategy to improve the use of the MTBD alert.

Contact author: Clara Newsome – clara.newsome@svhm.org.au

161 Is it Financially Beneficial to Have a Dietetics Department Volunteer in an Acute Metropolitan Teaching Hospital?

WENDY OPPENHEIMER, JANET GOLDER

Dandenong Hospital – Southern Health, Dandenong, VIC 3175, Australia

Southern Health supports innovative workforce strategies which promote fiscal responsibility. Volunteers provided an estimated $14.6 billion dollars of value to not-for profit organisations in 2006–07 (Australian Bureau of Statistics, 2012). Anecdotally however, supervision requirements, managing non-attendance and retention are perceived barriers to appointing volunteers. This project aimed to assess the benefit of a Dietetic department volunteer in an Australian acute metropolitan hospital. Dietitians were surveyed to develop a list of potential volunteer tasks. Seven surveys were completed and twenty-five administration support tasks were identified.Data on attendance rates, time spent by the dietitian orientating and supervising the volunteer to tasks, and time to complete tasks was collected over a six month period. Satisfaction surveys were also distributed to Dietetic staff and Volunteer upon completion of the trial period. The overall time and cost saved by the dietetics department over six months by having a volunteer complete dietitian's administrative tasks was 33 hours and $1031 respectively. This is an annual cost savings of $2475 based on volunteer attending 3.5 hours per week. Attendance was 72%. Surveys confirmed that 100% of dietitians were satisfied with the volunteer program and that volunteer satisfaction is enhanced when assigned tasks relate to areas of interest. Volunteers can add value to Dietetic departments if the tasks are planned efficiently with flexibility to meet the areas of interests of the individual volunteer to enhance retention. Future work includes potentially increasing volunteer working hours to one day per week which is a potential cost saving of $5374 per annum.

Contact author: Wendy Oppenheimer – wendy.oppenheimer@southernhealth.org.au

69 Enhancing the Role of the Nutrition Assistant at Dandenong Hospital, Southern Health

TERESA ORSINI, JENNIFER SEQUIERA, CELIA DURIE

Dandenong Hospital, Southern Health, Dandenong, VIC 3175, Australia.

To drive fiscal responsibility, Southern Health (SH) has led the way in innovative workforce initiatives. Dandenong Hospital Dietetics department has utilised a Nutrition Assistant (NA) predominantly for nutrition risk screening and consumables management for the past 11 years. With the introduction of National Standards, SH has shifted the nutrition screening function to within the nursing role therefore enabling us to explore potential future roles and responsibilities of our NA. SH recognises the NA as skilled health care workers, who under the supervision of a Dietitian can assist to alleviate Dietitian workload, yet ensure a patient centred care service meeting budget priorities. The NA initially identified tasks that could be undertaken by a NA based on the Draft DAA Scope of practice for support staff in Nutrition & Dietetics 2007. Dietitians were then surveyed to determine time spent on NA appropriate tasks and to identify potential future tasks for the NA that were strategically aligned to SH operational and Dietetic department goals. Nine surveys were completed. Results showed Dietitians were spending 75 min/day doing NA appropriate tasks. Functions such as anthropometry reviews, providing patients basic dietary education and monitoring of supplement tolerance were tasks Dietitians would find most useful with 89%, 80% and 70% agreement respectively. Benchmarking NA roles, development of a NA competency and training package, and review of the NA Position description is now underway. Final results pending.

Contact author: Teresa Orsini – Teresa.Orsini@southernhealth.org.au

214 Take Away Games: A Play Based Healthy Eating Initiative in Community Preschools

SARAH PINN, PETER HILL

Southern Primary Health, Noarlunga Centre, SA 5168, Australia

The preschool years are a time of rapid development during which food preferences and eating habits are established. Young children's eating habits are largely shaped by parents. Supporting parents in connecting with their children to create positive healthy food experiences through imaginative play is an important step towards healthy eating habits. The aim of the Take Away Games (TAG's) program is to enable families to engage with their children in imaginative play to increase familiarity, to stimulate meaningful dialogue and to create positive experiences with healthy food, predominantly fruit and vegetables, in a non-threatening environment. Preschools are ideally placed within communities to reach children and families. 14 preschools were each provided with 8 healthy eating themed TAG packs. Integrated into existing literacy pack loan systems, TAG's were offered to parents for overnight loan. Preschool staff also used TAG's to compliment healthy eating curriculum themes. A parent survey revealed 75% of parents felt that games stimulated dialogue with their children about food, and 50% report a positive change in their child's attitude to food. In a focus group parents report a high level of enthusiasm and interest in their children using TAG's, and an increased knowledge of fruit and vegetables. Preschool staff value TAG's as a tool to integrate nutrition themes into the preschool environment and the curriculum and as a means of connecting families with the preschool. TAG's are an innovative, low cost, sustainable tool for creating positive experiences, engaging families in meaningful dialogue and increasing children's exposure to healthy eating themes.

Contact author: Sarah Pinn – Sarah.Pinn@health.sa.gov.au

222 Developing Nutrition Standards for Mental Health Facilities

JAN PLAIN1, MEG VICKERY2, TANYA HAZELWOOD3

1Macquarie Hospital, North Ryde, NSW 2113, Australia

2Bloomfield Hospital, Orange, NSW 2800, Australia

3NSW Agency of Clinical Innovation, Chatswood, NSW 2067, Australia

The Agency for Clinical Innovation (ACI) Nutrition Standards and Therapeutic Diet Specifications for adult inpatients in NSW hospitals were released in December 2011, with a focus on addressing the risk of malnutrition in acute hospitals. Dietitians raised concerns that they did not cater for patients in mental health facilities and units, who are on average younger and stay in hospital longer than patients' in acute hospitals and are at high risk of obesity and cardio-metabolic co-morbidities and lower risk of malnutrition. They also raised concerns that the current food service in these facilities inadequately meets the nutrition needs of patients and their food preferences, including for taste, quantity, variety and quality.

In response, the ACI formed the Nutrition and Mental Health working group to develop nutrition standards for NSW mental health facilities and units. A literature review identified that people with mental illness have poorer physical health, poor diets and reduced physical activity than the general population and a reduced life expectancy up to 32 years, with cardiovascular disease being the major cause and on average twice the incidence chronic diseases, including Metabolic syndrome, Diabetes and Obesity. Psychotropic medications significantly affect appetite and the gastrointestinal function, resulting in disordered eating, fast eating syndrome and dysphagia. Consumer audits conducted in collaboration with the Official Visitors Program in NSW mental health facilities and units, confirmed patient and staff issues with the current food provided. A project is identifying nutrition goals, minimum menu standards, test menus and therapeutic diet specifications as required.

Contact author: Jan Plain – jplain@nsccahs.health.nsw.gov.au

154 Development of a Food Image Database: A Stepping Stone to the Creation of a Novel Dietary Assessment Tool

YASMINE PROBST1, CLARE FERGUSON1, WANQING LI1, MEGAN ROLLO2

1University of Wollongong, Wollongong, NSW 2522, Australia

2University of Newcastle, Callaghan, NSW 2308, Australia

It has long been recognised that traditional pen and paper methods of dietary assessment are prone to error. Emerging technologies, particularly smart phones, may offer solutions by providing new platforms for dietary assessment, potentially improving both the accuracy and efficiency of assessment. The aim of this study was to develop a database comprised of food images linked to Australian food composition data for use with a novel mobile phone based assessment tool, the eFood Traka. A three tier filing hierarchy for the organisation of three pre-existing collections of food photographs was created using the AUSNUT 2007 food group classification system. Professional judgement was used to identify foods from the photographs and match them to data from AUSNUT 2007, NUTTAB 2010 or AUSNUT 1999 food composition databases. Multiple images of the same food were entered individually, assigned a numeric identification code, filed accordingly, and mapped in an Excel spreadsheet. The final database consisted of 21, 122 and 678 first, second and third level food groups, respectively, containing a total of 2317 food images (393 excluding multiples). The database included values for all 37 nutrients in AUSNUT 2007, with the exception of 32 images matched to NUTTAB 2010 or AUSNUT 1999 data. Input of professional judgment and incorporation of Australian food composition data within the database will optimise the accuracy of intake estimates when using the proposed tool. Ultimately, it is anticipated that the eFood traka will provide a more efficient and accurate means of dietary assessment in clinical and research settings.

Contact author: Clare Ferguson – cef150@uowmail.edu.au

63 Supporting an Environmentally Sustainable Food Supply: Results of the Eco-Friendly Food Group Challenge

BARBARA RADCLIFFE1, LARA BORGES2, NICCI WATT2

1Nutrition Promotion Unit, Metro South Hospital& Health Service, Eight Mile Plains, QLD 4113, Australia

2QueenslandUniversity of Technology, Kelvin Grove, QLD 4509, Australia

Climate change is an immerging issue relating to food security worldwide, while the food system contributes around 25% of Australia's greenhouse gas emissions. The Eco-friendly Food Challenge assists individuals to minimise their food-related environmental impact by participating in four, one week challenges. These focus on reducing food-related waste contributing to landfill, eating seasonal and locally produced fruit and vegetables, buying more Australian produced pantry items and consuming more sustainable protein sources. The challenge is published on the Eco-friendly Food Website. The 2012 Eco-friendly Food Group Challenge targeted DAA members, QUT nutrition and dietetics students, Queensland Nutritionists and visitors to the Eco-Friendly Food website and Facebook page. This project included a literature review, resource kit development and the creation of registration and post challenge evaluation surveys, weekly e-mails and blogs. A total of 270 people registered, with 84 completing the Post Challenge Evaluation Survey. Feedback on the overall challenge was positive, with 76% of respondents reporting that they enjoyed the experience. The same percentage reported they would enrol for a similar food challenge in the future. Behaviour change was also reported. For example, 96% of those participating in the Week 1 Challenge reported reductions in weekly landfill waste, with a mean volume decrease of 44%. Eighty-five percent of respondents reported a high or very high likelihood of maintaining these reductions. The Eco-friendly Food Group Challenge was an efficient and effective way to reduce the food-related environmental impact of interested individuals. Incorporating the Challenge into university nutrition and dietetics curriculum is recommended.

Contact author: Barbara Radcliffe – Barbara_Radcliffe@health.qld.gov.au

160 Looking Back, Looking Forward: Meeting the Future Challenges of Providing High Quality Student Placements in Community Nutrition

BARBARA RADCLIFFE1, LEIGH BRAMWELL1, DANIELLE GALLEGOS2

1Nutrition Promotion Unit, Metro South Hospital & Health Service, Eight Mile Plains, QLD 4113, Australia

2Queensland University of Technology, Kelvin Grove, QLD 4509, Australia

Community nutrition placements are a mandatory element in the pre-entry training of dietitian-nutritionists. As student numbers grow, the future challenge is to provide high quality placements that improve organisational productivity, are efficient in terms of resource use, and enhance the supervisors' long term capacity. The Nutrition Promotion Unit in Metro South Hospital Health Service supervises approximately 20 students per year. The aim of this ongoing project is to use a continuous quality improvement framework to evaluate and improve student placements in partnership with university colleagues. Methods used included a literature review, ethics approval, a visioning exercise by staff on all aspects of student placements and the development and piloting of evaluation tools. These included Survey Monkey surveys post placement for students, supervisors and external project partners, student interviews and an Excel database. Data for 2012 were analysed for frequency of response, while the answers to open questions were collated and arranged into themes.

Student satisfaction levels were high with over 85% of respondents reporting they felt valued and welcome members of the unit, found student resources useful, and believed that supervisors provided adequate feedback and fair assessment. Large increases in the proportion of students considering work in community nutrition occurred over the placement period. Feedback from students and supervisors identified specific improvements required to student placement orientation and perceived gaps in students' knowledge and skills. Supervisor and external project partner satisfaction levels were high. This project provides a model for improving student placements and enhancing communication between universities and placement providers.

Contact author: Barbara Radcliffe – Barbara_Radcliffe@health.qld.gov.au

176 Who is Seeing the Dietitian? We are only Seeing the Tip of the Iceberg

REBECCA RAMSEY, PETER COLLINS, DANIELLE GALLEGOS

Nutrition & Dietetics, School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD 4059, Australia

Poor dietary choices are associated with overweight and obesity and the development of chronic conditions. Over 12 million (∼60%) Australians are currently overweight or obese. Accredited Practicing Dietitians (APDs) are the experts in nutrition and diet therapy, equipped to provide services and counselling to assist individuals in making dietary modifications to prevent or manage diet-related conditions. However, no existing research has investigated the proportion or characteristics of the Australian population that may be accessing APDs. Data from 25,906 participants in the 2004/05 National Health Survey (NHS) were analysed using logistic regression to identify the sociodemographic and health characteristics of individuals accessing an APD or Nutritionist. Only 0.4% (n = 105) of the sample reported accessing a Dietitian or Nutritionist, this was half the amount accessing a Naturopath. Diabetes Mellitus, cardiovascular disease and obesity were all significantly associated with having seen a Dietitian, and over 90% of those accessing services had a long-term condition. Of the total sample only 10% of those with a diet-related condition had seen an APD or Nutritionist. Household income and education were not associated with accessing an APD. Exploration around the barriers to referral and accessing services may be warranted to assist in enhancing the profile of APDs among the population and other healthcare professionals. The current number of approximately 5000 registered APDs is unlikely to be able to service the proportion of the population who require dietary intervention; further avenues for prevention, rather than acute treatment, and novel strategies for service provision also need to be explored.

Contact author: Rebecca Ramsey – rebecca.ramsey@qut.edu.au

165 Phase 1 Feasibility Study to Determine Whether Patients can Consume Both the Carbohydrate (CHO) Loaded Drink, Preop® and the Immune-Nutrition Drink, Impact® Pre-Operatively as Part of the Eras Pathway

CANDICE RAY1, CELIA DURIE1, TERESA ORSINI1, LORETTA BUFALINO2

1Dandenong Hospital, Southern Health, Dandenong, VIC 3175, Australia

2John Fawkner Private Hospital, Healthscope, Coburg, VIC 3044, Australia

Major colorectal surgery (CRS) decreases immune function placing patients at risk of post-operative inflammation and infection. The established Enhanced Recovery After Surgery (ERAS) program at Dandenong hospital aims to modulate peri-operative and post-operative care in an attempt to minimise metabolic stress, accelerate recovery and reduce hospital length of stay (LOS). ERAS also aims to decrease peri-operative fasting with the use of PreOp® CHO loading drinks, allowing early re-establishment of post-op oral feeding. Recent research has focused on pre-operative oral immune-nutrition (IMPACT®) and the benefit of improving the body's response after surgery. There is yet to be research that assesses IMPACT® and PreOp® in combination, and its influence on patient outcomes postoperatively such as complication rates and LOS. Phase 1 of this 3 tier study was to determine if it was feasible for CRS patients to consume pre-operatively both IMPACT® and PreOp®, establish compliance rates and refine methodology in preparation for the phase 2, pilot study. Dietitians assessed patients in the surgical review clinic and provided instructions about the pre-operative nutritional supplements; doctors were advised to request for nutrition related blood tests. Results indicated that 60% patients given both IMPACT® and PreOp® (n = 10) were able to consume all drinks provided and 50% had protein levels checked. Qualitative analysis indicated that patients can consume both pre-operative supplements however; unclear pre-admission instructions were one of the major reasons to non-adherence to protocol. Refining the study methodology with key stakeholders will be a primary aim prior to the commencement of the pilot study.

Contact author: Candice Ray – candice.ray@southernhealth.org.au

25 Improving the Dietetic Referral Pathway for Oncology Outpatients

JENNA RILEY, HELEN SHEEHAN

Peninsula Health, Frankston, VIC 3199, Australia

Malnutrition is a major problem particularly in high risks groups such as oncology; a recent study in Peninsula Health showed a malnutrition rate of 41% in oncology patients.

There is high level evidence which has demonstrated that early dietetic intervention promotes better patient outcomes by assisting in the prevention of the development of cachexia and associated malnutrition. The current nutrition oncology clinic at Peninsula Health is underutilised due to poor referral processes and a lack of awareness of the clinic. The aim of this project is to improve the referral process to the nutrition oncology clinic to enable screening of all high-risk patients, prior to commencing treatment. The current process for admission of oncology outpatients was mapped out using a Visual Stream Map (VSM). Through regular meetings with various stakeholders, the most effective time, location, process and referral pathway for nutrition oncology clinic was determined, using data from the VSM. The Nutrition Oncology Clinic is now running weekly on a Friday morning in conjunction with the medical oncology clinic. A referral flowchart has been developed and disseminated through MDT meetings and discussion with stakeholders. Effective use of this clinic through improved referral processes should allow earlier dietetic intervention for oncology outpatients. Referral rates, malnutrition prevalence, level of dietetic input and clinic attendance will be evaluated after a 9 month period.

Contact author: Jenna Riley – jennariley85@gmail.com

152 The Impact of the Caloric Intake Prescribed during Refeeding on Weight Restoration in Children and Adolescent Inpatients with Anorexia Nervosa: A Systematic Review of the Evidence

TETYANA ROCKS1, FIONA PELLY1, PAUL WILKINSON2

1University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia

2Dietitians Association of Australia, Canberra, ACT 2600, Australia

Weight restoration of underweight children and adolescents with anorexia nervosa (AN) is one of the principal priorities in inpatient settings. However, the empirical evidence for the most effective method of weight rehabilitation in this group is lacking. Thus, the aim of this study was to systematically review, assess and summarize the available evidence on the effect of differing caloric intakes prescribed during refeeding on weight restoration in hospitalised children and adolescents aged 19 years and younger with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, complimented by a search of the reference lists of key publications. Seven observational studies of various study design and methodology, investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed caloric intakes varied from 1000 kcal to over 1900 kcal per day regardless of the feeding modality and were progressively increased during the course of hospitalization leading to weight recovery in most patients. It appeared that additional tube feeding increased the maximum caloric intake and led to greater interim or discharge weight, however this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research is crucial to establish the best practice approach to treatment of this population.

Contact author: Tetyana Rocks – tetyanarocks@gmail.com

92 Addressing Malnutrition in the Elderly: Reflections on the Challenges of Planning Multidisciplinary Research from Hospital to Home

LAUREN ROGERS1, ADRIENNE YOUNG1,2, ALISON MUDGE1,3, MERRILYN BANKS1,2, ELIZABETH ISENRING3,4, LYNDA ROSS1, TESS CLARK1

1Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

2QueenslandUniversity of Technology, Kelvin Grove, QLD 4059, Australia

3University of Queensland, St Lucia, QLD 4067, Australia

4Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia

Malnutrition is common in the elderly and hospital admissions provide an opportunity for identification and treatment. However, an aging population, decreasing lengths of stay and increasing need for community-based care challenges the delivery of high quality nutrition services from hospital to home. The aim is to evaluate the process of a Hospital to Home Outreach for Malnourished Elders (HHOME) program. An action research approach (‘LOOK, THINK, ACT’ stages) was applied to engage a steering committee in planning HHOME. Bimonthly meetings with representatives from the research team, managers and clinicians across hospital and community services (nursing, medical, dietetic and consumer groups) were facilitated by the project officer over 12 months. Reflection on planning process – LOOK: engaging steering committee in mapping existing hospital, community and discharge planning services identified significant gaps at the hospital-community interface, and generated desire for change by clinicians and managers. THINK: comprehensive mapping process informed the design of HHOME (interdisciplinary nutrition discharge planning, telephone outreach to patient/carer by the hospital dietitian, increased communication and referral to community for nutrition-related services). Potential barriers to effective implementation were identified and addressed early through regular and targeted communication. The gradual and systematic approach has facilitated acceptance of new processes by staff. ACT: implementation and evaluation of nutritional and clinical outcomes during 2013. Developing a new model of care with broad engagement and input from stakeholders helps build relationships and support for change. An action research approach provides a practical framework for understanding complex systems and facilitating change to clinical routines.

Funding sources: Grants from Queensland Health (Allied Health Workforce Advice and Coordination Unit Model of Care funding) and Royal Brisbane and Women's Hospital Foundation

Contact author: Lauren Rogers – lauren_rogers@health.qld.gov.au

93 Confident to Change: Malnutrition Education and Evaluation for Community Nurses and Personal Care Workers

LAUREN ROGERS1, CAMILLA DAVENPORT2, ADRIENNE YOUNG1,2, ALISON MUDGE1,3, MERRILYN BANKS1,2, LYNDA ROSS1, ELIZABETH ISENRING3,4, TESS CLARK1, STEPHANIE SMRECNIK5, ANN-MARIE WARHAM5

1Royal Brisbane and Women's Hospital, Herston, QLD 4029, Australia

2Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

3University of Queensland, St Lucia, QLD 4067, Australia

4Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia

5Blue Care Northside, Everton Hills, QLD 4053, Australia

Malnourished older adults often receive home care from community organisations after hospital discharge. Nurses and personal care workers (PCWs) help clients undertake a range of nutrition related activities such as meal preparation, feeding and shopping assistance, but may not receive training in malnutrition and nutrition care. This project aimed to develop, implement and evaluate an education strategy tailored for community nurses and PCWs as part of the Hospital to Home Outreach for Malnourished Elders (HHOME) program. Learning needs assessment surveys were completed by community nurses (n = 5) and PCWs (n = 30) from two non-government community organisations. The surveys were designed to determine perceived staff confidence in relation to malnutrition and nutrition related activities, using a 5-point Likert scale. Results informed development of separate group education sessions for community nurses and PCWs. The education sessions used contemporary adult learning principles and an interactive format (identifying knowledge gaps, group discussion and reflection on practice) rather than didactic teaching. A dietitian project officer conducted 5 education sessions with PCWs (n = 66) and 2 with community nurses (n = 14). All staff repeated the survey following the education session. Median levels of confidence improved in the nursing group, except where nurses were already “confident” in the pre-education survey. Median confidence levels in the PCWs group improved for all questions from “some-what confident” to “confident” post education. Use of a formal learning needs analysis, adult education principles and evaluation of learning outcomes has provided an effective format for education as an implementation strategy for a new care model.

Funding sources: Grants from Queensland Health (Allied Health Workforce Advice and Coordination Unit Model of Care funding) and Royal Brisbane and Women's Hospital Foundation

Contact author: Lauren Rogers – lauren_rogers@health.qld.gov.au

85 Use of a Photographic Food Diary Method to Document Dietary Intake in People with Parkinson's Disease

MEGAN ROLLO1, JAMIE SHEARD2, SUSAN ASH2

1University of Newcastle, Newcastle, NSW 2308, Australia

2Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

Cognitive impairment and physical disability are common in Parkinson's disease (PD). As a result diet can be difficult to measure. This study aimed to evaluate the use of a photographic dietary record (PhDR) in people with PD. During a 12-week nutrition intervention study, 19 individuals with PD kept 3-day PhDRs on three occasions using point-and-shoot digital cameras. Details on food items present in the PhDRs and those not photographed were collected retrospectively during an interview. Following the first use of the PhDR method, the photographer completed a questionnaire (n = 18). In addition, the quality of the PhDRs was evaluated at each time point. The person with PD was the sole photographer in 56% of the cases, with the remainder by the carer or combination of person with PD and the carer. The camera was rated as easy to use by 89%, keeping a PhDR was considered acceptable by 94% and none would rather use a “pen and paper” method. Eighty-three percent felt confident to use the camera again to record intake. Of the photos captured (n = 730), 89% were of adequate quality (items visible, in-focus), while only 21% could be used alone (without interview information) to assess intake. Over the study, 22% of eating/drinking occasions were not photographed. PhDRs were considered an easy and acceptable method to measure intake among individuals with PD and their carers. The majority of PhDRs were of adequate quality, however in order to quantify intake the interview was necessary to obtain sufficient detail and capture missing items.

Contact author: Megan Rollo – megan.rollo@newcastle.edu.au

140 Feed and Feed Pump Compatibility Can Compromise Nutrition Support and Increase Costs to the ICU

JUSTIN SINGLETON1, KATIE SYLVESTER2

1John Hunter Hospital, Newcastle, NSW 2305, Australia

2University of Newcastle, Callaghan, NSW 2308, Australia

Nursing staff in the John Hunter Hospital (JHH) ICU reported increased occurrence of pump alarms when feeding patients with Promote (ready to hang) since the introduction of the Covidien ePump. A 4-day audit of feed delivery to ICU patients was conducted to quantify the prevalence, frequency and impact on nutrition support of pump alarms. A trial of an alternate feed, Nutrison Protein Plus Multi Fibre (PPMF) was conducted to evaluate its suitability as a replacement for Promote. Patients receiving Promote (n = 19 patient feed days) had on average 5 pump alarms per day, lost 51 minutes per day of feeding time from pump errors alone and consumed 2 pump sets per day. These patients received on average 81% of the daily energy goal and 89% of the daily protein goal. Patients receiving PPMF (n = 19 patient feed days) had no pump alarms, lost no feeding time associated with pump alarms and on average consumed 1 pump set per day. These patients received on average 93% of the daily energy goal and 87% of the daily protein goal. There were no major differences in the tolerance of the feeds in terms of gastric aspirates, bowel frequency and vomiting. Analyses of the cost associated with delivering nutrition support to patients receiving Promote were estimated at $19.23 per day compared to $10.94 per day for patients receiving PPMF. The introduction of PPMF to replace Promote when used with the ePump is a cost effective strategy to improve nutrition support goals.

Funding source: Feeds supplied by Nutricia Australia

Contact author: Justin Singleton – Justin.Singleton@hnehealth.nsw.gov.au

64 Innovative Community Engagement Building Tomorrows Dietitians

KELLY SQUIRES, LEANNE BROWN

The University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia

The University of Newcastle's Department Of Rural Health (UoNDRH) introduced community engagement projects as an extension of traditional placement experiences in 2011. The introduction of multidisciplinary collaboration with community groups demonstrated a high demand for dietetic involvement. A dietetics academic was employed to coordinate dietetic students' community engagement activities during their placement. This paper reports on experiences and feedback from community groups and students. Dietetics students undertaking a year-long placement option were able to volunteer to conduct a monthly activity with a community group. Half day activities were incorporated into short term placements. Session content was developed by the dietetics academic and students led the activities which were not formally assessed. As part of the quality project, students completed an online evaluation at the end of placement. Written and oral feedback from community groups was also obtained. In 2012, 96% of students (n = 25) on placement participated in community engagement activities, contributing approximately 165 hours, an increase from 125 hours in 2011. Qualitative data indicated students valued interacting with community groups and identified the activities were one of the most enjoyable parts of placement. Feedback from community groups was positive with requests for more cooking sessions. Groups also reported encouraging aspects including increased exposure to health professionals and an increased awareness of health. This program has increased capacity to provide relevant community engagement activities for dietetic students that adds value to placement. Formal evaluations plan to further explore the benefits to the community.

Contact author: Kelly Squires – kelly.squires@hnehealth.nsw.gov.au

206 An Evaluation of Fasting Practices Around Surgery in Critically Ill Patients with Burn Injuries

LAUREN STRIBLEY1, ROSALIE YANDELL2, STEPHANIE O'CONNOR3, SELENA OOI2, ALISON SHANKS2, JOHN GREENWOOD4, MARIANNE CHAPMAN3

1Flinders University, Bedford Park, SA 5042, Australia

2Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

3Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

4Adult Burns Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

Critically ill patients with burn injuries have increased energy and protein requirements for optimal wound healing and recovery. This patient group often requires numerous surgical procedures for skin grafts and wound excisions. Although enteral feeding is traditionally ceased some time prior to operative procedures, recent data suggest that it is safe to feed up to, and even during, an operation when no airway procedures are required. A nutrition therapy protocol was implemented following consultation with intensivists and anaesthetists in this ICU 4 years ago, in which it is recommended to cease feeding only immediately prior to a patient going to the operating theatre. The aim of this study was to investigate fasting procedures practised on patients with burns following implementation of this protocol. A case note and database audit was conducted for 14 patients (13 M, age 44 ± 4 years) admitted to the ICU with 24 theatre excursions. Primary outcome measures were total time (hours) spent fasting pre, during and post theatre, and energy (kcal) and protein (g) deficit due to enteral nutrition interruptions for theatre excursions. This study found the median (IQR) time spent fasting was 9.5 hours (10) per trip to theatre, amassing a 1350 kcal (1616) energy and 57 g (73) protein deficit. This study demonstrates that patients continue to be fasted unnecessarily despite a nutrition therapy protocol being in place. This is potentially due to inconsistency of Specialists' orders that disagree with the protocol. Ongoing education and auditing may improve protocol adherence and reduce avoidable fasting.

Contact author: Lauren Stribley – stri0034@flinders.edu.au

139 Challenges of Implementing a Peer-Led Nutrition Intervention Program in Primary Schools

CALLI STRONGYLOS

Southern Primary Health, Southern Adelaide Local Health Network, Noarlunga, SA 5168, Australia

There is considerable evidence that supports the effectiveness of nutrition peer-led programs in schools however there are challenges in embedding them within primary schools. It is imperative to identify the levers and potential strategies to overcome these challenges to enable successful integration of healthy eating interventions in the school environment. The eat well peer leadership program involved training upper primary students from 10 schools in the southern area of Adelaide to become student leaders in healthy eating and lead activities with their peers with the support of a designated teacher and a Dietitian. Feedback was sought from a sample of teachers that were involved in the program via semi-structured interviews and school observations. Identified levers were the Eat Well SA Schools and Preschools Healthy Eating Guidelines and the Health Promoting Schools Framework which promote collaborative partnerships between the health and education sectors. The challenges were variable leadership support, teacher capacity, cost of implementing food based activities and the voluntary nature of the above-mentioned documents. These challenges can be addressed by generating support for nutrition from the school leadership team, aligning the program objectives with school priority areas, identifying teachers that value nutrition and have some non-instruction time in their role and creating fundraising opportunities. Another highly valued strategy was the collaborative partnership with the health service to hold professional development days for teachers with opportunities to network and share resources. Despite the challenges, teachers articulated a strong commitment to promoting healthy eating initiatives and the health and wellbeing of students.

Contact author: Calli Strongylos – Calli.Strongylos@health.sa.gov.au

40 Intervention Study Participants: It's Not Just a Weight Issue

REBECCA THORNE, YASMINE PROBST, LINDA TAPSELL

Smart Foods Centre, University of Wollongong, NSW 2522, Australia

In 2012, the Australian Health Survey reported that 63.4% of Australian adults are overweight or obese1 and therefore have an increased risk of developing lifestyle related diseases such as coronary heart disease and type 2 diabetes mellitus.2 Metabolic syndrome (MetS) is a condition used to group individuals with a cluster of risk factors including central obesity, high blood pressure, raised fasting glucose and dyslipidaemia.3 This retrospective study aimed to determine the occurrence of MetS in participants of four intervention study datasets from the Illawarra region of NSW. Individuals were grouped using the International Diabetes Federation (IDF) worldwide definition for MetS.3 Anthropometric (waist circumference, weight and height), blood pressure and blood (fasting glucose, triglycerides and HDL cholesterol) data collected at baseline (t = 0) for each study and analysed using SPSS for Windows. Data for n = 408 (female n = 281, male n = 127) participants were classified as overweight or obese (BMI ≥ 25 kg/m2; mean = 29.95 ± 3.77) according to WHO. The mean waist circumference for males and females was 103.0 (±10.8) cm and 96.6 (±12.1) cm, respectively. Central obesity was the predominant risk factor occurring in the study population, with 90.9% (n = 371) of all participants meeting the criteria. Of all participants, 32.4% (n = 132) were identified as having MetS, with only 5.4% (n = 22) having no risk factors for MetS. This research highlights the vast numbers of the overweight/obese population who may be suffering from more than a weight issue, with around one third of this study population identified as having MetS placing them at a heightened risk of developing lifestyle related diseases.2

Funding sources: NHMRC (Project #514631 and #354111), Cereal Partners Worldwide Limited and Horticulture Australia.

Corresponding author: Rebecca Thorne – beck@uow.edu.au

References

ABS. Australian Health Survey: First Results, 2011–2012. Canberra 2012.

Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005; 112: 27352752.

Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome – A new world-wide definition. A consensus statement from the International Diabetes Federation. Diabetic Medicine. 2006; 23: 469480.

90 An Exploration of Dietetic Student Learning Through Participation in a University Run Weight Management Clinic

JUDITH TWEEDIE, ELIZABETH SWANEPOEL, JUDITH MAHER

University of the Sunshine Coast, Sippy Downs, QLD 4567, Australia

University based nutrition and dietetic clinics are being developed in Australia to provide work-based practical experience and develop placement capacity. It is important to understand the contexts in which these clinics operate and the impact of these on student learning. In 2011 the University of the Sunshine Coast commenced a curriculum based weight management clinic, to provide Bachelor of Nutrition and Dietetics students with an experiential learning opportunity to practice diet history interview skills on “real” clients, prior to clinical placement. This study aimed to explore the impact of participating in the weight management clinic on student's confidence and recognition of skills needed for practice, and explore students overall experience of attending the clinic. Using a qualitative study design of focus group discussions thirteen students (43% of total enrolments) participated in this study. Thematic analysis revealed that the clinic increased their perceived confidence to perform diet histories, in particular for future interviewing of real clients. Constructive feedback from the clinic supervisor, student self-reflection, and role modeling by the clinic supervisor enabled students to recognise skills required for practice, such as interpersonal communication, relationship building and food knowledge. Other key themes that emerged were the impact on student's professional identity, identification of the nuances of “real” client-health practitioner interactions and the application of learned theory in a real-life context. These findings support the evidence that dietetic curriculum should provide opportunities for students to acquire people-related skills early in their course and develop confidence in those skills that are crucial to practice.

Contact author: Judith Tweedie – jtweedie@usc.edu.au

155 Development and Relative Validity of a New Field Instrument for Detection of Geriatric Cachexia: Preliminary Analysis in Hip Fracture Patients

ANTHONY M VILLANI1, MICHELLE D MILLER1, IAN D CAMERON2, SUSAN KURRLE3, CRAIG WHITEHEAD4, MARIA CROTTY4

1Department of Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, SA 5001, Australia

2Rehabilitation Studies Unit, University of Sydney, NSW, Australia

3Hornsby Ku-Ring-Gai Hospital, NSW, Australia

4Department of Rehabilitation and Aged Care, Flinders University, Adelaide, SA 5001, Australia

Geriatric cachexia is distinct from other age-related muscle wasting syndromes however detection and therefore treatment is challenging without the availability of valid instruments suitable for application in the clinical setting. This study assessed the sensitivity and specificity of a newly developed screening instrument utilising portable assessments against previously defined and commonly accepted diagnostic criteria for detection of geriatric cachexia. Cross-sectional analyses from 71 older adults post-surgical fixation for hip fracture were performed. The diagnostic criteria required measures of appendicular skeletal muscle (ASM) index derived from dual-energy X-ray absorptiometry (DEXA) and anorexia assessed by ≤70% of estimated energy requirements. These assessments were replaced with mid-upper arm muscle circumference (MUAMC) and the Simplified Nutritional Appetite Questionnaire (SNAQ) respectively to create a field instrument suitable for screening geriatric cachexia. Sensitivity, specificity, positive and negative predictive values were calculated.

The current diagnostic algorithm identified few patients as cachectic (4/71; 5.6%). The sensitivity and specificity of the geriatric cachexia screening tool was 75% and 97% respectively. The screening tool had a positive predictive value of 60% and a negative predictive value of 99%. Given the unexpected prevalence of cachexia in such a vulnerable group, these results may suggest problems in operationalizing of the consensus definition and diagnostic criteria. Although the application a newly developed screening tool using portable field measures looks promising, the authors recommend additional research to identify the prevalence of geriatric cachexia which captures all diagnostic criteria from the consensus definition. Future investigation may then be positioned to explore the predictive validity of screening tools using portable field measures which potentially achieve higher sensitivity.

Funding source: National Health and Medical Research Council

Contact author: Associate Professor Michelle Miller – michelle.miller@flinders.edu.au

121 Exploring New Frontiers: Using International Dietetic and Nutrition Terminology (IDNT) and PES (Problem, Etiology, Signs and Symptoms) Diagnoses Statements within Dietetic Group Formats

ANGELA VIVANTI1,2, EMILY POWER1, ANNABELLE STACK1

1Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD.

2School of Human Movement Studies, University of Queensland, Brisbane, Queensland, Australia

The Dietitians Association of Australia adopted IDNT as the standard Australian nutrition care approach in 2009. Dietetic service provision in groups is both cost effective and enables valuable patient support through shared experiences. This study explored IDNT diagnoses implementation into multidisciplinary outpatient group interventions. Over three years, the authors implemented and refined processes for generating individuals PES statements during weight management and healthy lifestyle modification groups. Program content and outcome measures were assessed to determine potentially appropriate PES statements. Increasingly simplified processes were trialled, refined and implemented utilising existing program content and state-wide outcome measures for determining individual's PES within a multidisciplinary group setting. Iterations produced a simple, efficient and practical means of completing individual PES within healthy lifestyle groups. Key success strategies included the reduction from several possible ‘problems’ to a single universal diagnosis of Overweight/obesity (NC3.3) with the patients' self identified contributors to their obesity (eg inadequate physical activity, behavioural issues) documented as aetiology. Waist:hip ratio and weight measurements were simple and sustainable “signs” for outcome evaluation. These refinements enabled feasible and simplified medical chart entries incorporating PES. Persistence accomplished a final product that successfully attained timely chart entries; eliminated extra data collection, maintained standardised state-wide patient generated outcome measures and remained consistent with the multidisciplinary program's philosophy of counselling vs education through incorporating patient identified aetiology. We have demonstrated for the first time that with trial and error and collaboration, PES statements can be successfully applied to individuals within group interventions utilising existing data and program content.

Contact author: Angela Vivanti – angela_vivanti@health.qld.gov.au

178 Secondbite's Fresh Food Training Creates Valuable Links Between Practitioners, Community Food Programs and Food Insecure Individuals throughout Australia

LIZA WALLIS1, REBECCA LINDBERG1, RUSSELL SHIELDS1, ANISHYA GANGADHARAN2, ALEXIS LETTERS-HAYDOCK2

1SecondBite, Kensington, VIC 3031, Australia

2Monash University, Notting Hill, VIC 3168, Australia

SecondBite's fresh food training, developed in partnership with the Tasmanian Community Nutrition Unit, aims to support staff and volunteers from the community sector, welfare organisations, schools and/or health services who Community Food Programs that provide subsidised or free food to people in need. SecondBite's training consists of theory and practical tools related to food security, nutrition, food safety, food preparation and food service monitoring. As SecondBite expands its fresh food rescue operations across the nation, so too does the opportunity to offer this training throughout Australia. In August 2012, with the support of the Dietitians Association of Australia, SecondBite disseminated a national survey to Dietitians and Nutritionists to determine the feasibility of a train-the-trainer model of delivery for this fresh food training. Of the 114 respondents, representing each state and territory, 71% stated they do not currently work in collaboration with Community Food Programs in any capacity, and 79% revealed a need to improve the nutritional quality of food provided to individuals experiencing food insecurity. 68% of respondents sought a blended approach of face-to-face and online training and respondents suggested that facilitators could include dietitians, nutritionists, health promotion officers, Aboriginal health workers and other suitable practitioners. Interviews conducted with 12 online survey participants provided further insight into methods for involving facilitators without a strong nutrition background and those working in rural and regional areas. Base on this evidence, SecondBite will develop a train-the-trainer program, encouraging links between practitioners, their local Community Food Programs and ultimately, food insecure individuals throughout Australia.

Contact author: Liza Wallis – liza@secondbite.org

180 Secondbite Fills a Critical Training Need for Staff and Volunteers to Provide Healthy, Safe and Culturally Inclusive Food to People in Need

REBECCA LINDBERG1, SARAH CONNALLY2, LIZA WALLIS1, PAT BURTON1, CARMEL GRUBB2

1SecondBite, Kensington, VIC 3031, Australia

2Community Nutrition Unit, Department of Health and Human Services, Hobart, TAS 7001, Australia

In 2011, SecondBite and the Tasmanian Community Nutrition Unit (CNU) partnered to complete a situational analysis of Community Food Programs throughout Tasmania. Community Food Programs are initiatives that provide free or subsidised food to individuals experiencing food insecurity. An online organisational survey (n 35), face-to-face consultations with expert stakeholders (n 4) and consultations with the Community Food Program workforce (n 11) were conducted. Results revealed an unmet need to build food skills and nutrition capacity in the staff and volunteers who provide food to people in need throughout Tasmania. In response, SecondBite and the CNU developed a fresh food training program consisting of theory and practical tools related to food security, nutrition, food safety, food preparation and food service monitoring. Evaluation from 12 Community Food Programs involved in the two-year pilot revealed that participants have adopted new practices to improve the nutritional quality of food served, the utilisation of fruit and vegetables increased and food service delivery statistics are being reported according to the core food groups. In 2013, integrating recommendations from pilot participants, SecondBite's training will be rolled our nationally. A train-the-trainer model will increase the capacity of the Australian community and health workforce to collaborate with their local Community Food Programs and food insecure community members. Evidence suggests that staff and volunteers operating Community Food Programs want to provide more than food to their community. They want the tools and capacity to become intervention sites which will ultimately improve the long-term health outcomes of Australian's experiencing food insecurity.

Contact author: Liza Wallis – liza@secondbite.org

68 Influences on Openability of Hospital Food and Beverage Packaging by the Elderly: The Role of Dexterity and Posture

KATE MORSON, ALISON BELL, KAREN WALTON

School of Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

Food and beverage packaging has been identified as a contributing factor to malnutrition among elderly patients in hospitals. This study aimed to determine whether there is a correlation between dexterity and the ability to open ‘problematic’ packaging and examine the effect of being in a hospital bed on dexterity and this. A total of 37 participants were randomly allocated to begin the research in either a lying or seated posture. Dexterity and grip strength were measured, then participants were asked to open up to 7 assorted hospital food and beverage items in each posture. SPSS statistical program was used to analyse the data. Spearman Rho correlation data showed that there was a moderate negative correlation between dexterity and ‘time to open’ food packages consistently for the tetra packs and boxed cereal and a strong negative correlation for the custard. For other food items there was no/weak correlation. Wilcoxon Signed Ranks Tests showed that although there was a significant difference in dexterity scores between the seating and lying postures there was no statistically significant difference, in both time and attempts to open each product, between the two positions. It is seen that dexterity levels can impact on an elderly person's ability open certain food packages. However, lying in a hospital bed does not appear to impact on this. These results could be used to advise food packaging designers in order to make food more accessible to individuals with lower dexterity levels which could improve nutrition to the over 65 year population.

Contact author: Kate Morson – kmorson@hotmail.com

129 Improving Nutrition Through a Social Inclusion Framework

ALISON WARD, JULIE WILLIAMS, SARAH CONNALLY

Population Health, Department of Health and Human Services Tasmania, Hobart, TAS 7000, Australia

There is a strong association between level of socio economic disadvantage and prevalence of food insecurity. Tasmania has high level of disadvantage compared to other states. The development of the Food for All Tasmanians: A food security strategy for Tasmania, by the Tasmanian Food Security Council (TFSC) through a cross sectorial collaborative approach aims to provide a frame work to strategically address the determinants of food security. The opportunity for the Physical and Community Unit from the Department of Health and Human Services to work collaboratively with Department of Premier and Cabinet's Social Inclusion Unit has allowed for ongoing relationships to be established. So far this has delivered more strategic investment to address community food security through a community grant round. Delivering better food accessibility and affordability particularly of fresh produce and building community capacity through community driven solutions provides the opportunity to improve nutritional well-being and social inclusion.

Contact author: Alison Ward – Alison.ward@dhhs.tas.gov.au

200 Interpretation and Practical Application of the New Australian Dietary Guidelines for Early Childhood Services

JEMMA WATKINS, MARGARET ROZMAN, JESSICA KEMPLER

Nutrition Australia Victorian Division, Carlton, VIC 3053, Australia.

Supporting children's nutrition needs in early childhood is crucial to long term health outcomes. To address this, the Healthy Together Victoria – Healthy Eating Advisory Service (HEAS) was established as part of the Victorian Healthy Together Communities strategy, to provide healthy eating advice for early childhood services, primary and secondary schools, hospitals and workplaces. One component of the HEAS includes supporting staff in long day care services to provide food and drink consistent with the nutrition needs of children. This is also an accreditation requirement of the National Quality Standard for early childhood services. Since the release of the revised Australian Dietary Guidelines (draft 2011), current menu planning guidelines have not been available to support staff providing food for long day care services. To fill this gap, the HEAS has developed Menu planning guidelines for long day care, which are consistent with the revised Australian Dietary Guidelines and the Australian Guide to Healthy Eating. A review of Australian literature and current programs targeting food provision in long day care was undertaken. The findings support the provision of at least half of children's daily nutrition needs at morning and afternoon tea and lunch. The HEAS's Menu planning guidelines reflect this and provide a framework for staff to create menus that are nutritionally sound, and promote food variety and cultural diversity. Applying the Australian Dietary Guidelines was not easy. Challenges have included interpreting appropriate serving sizes for children and the practicalities associated with the amount of food required to meet children's needs.

Funding source: Department of Health, Victoria.

Contact author: Jemma Watkins – jwatkins@nutritionaustralia.org

203 Between the Idea and the Reality, between the Motion and the Act – Falls the Shadow – Implementing Nutrition Standards for Adult and Paediatric Inpatients in Nsw Hospitals

CHERYL WATTERSON

John Hunter Hospital Nutrition and Dietetics Department, Newcastle, NSW, Australia

NSW Agency for Clinical Innovation Nutrition Standards for adult and paediatric inpatients in NSW Hospitals are the centrepiece of the mandatory NSW Health Nutrition Care Policy (PD 2011_078) dated 2011. The overall goal of the Standards is that “Hospitals in NSW will provide safe, nutritious and appetising high-quality meals of sufficient variety that meets the needs and expectations of patients.” Menu design must be based on the needs of the local hospital population. The standard menu must meet nutrient goals appropriate for age. The menu must offer patients adequate, age-appropriate choice and variety in food selection. The implementation of these standards and specifications is being rolled out by NSW Health Shared Business Services Food Service Implementation Project (FSIP) with a fully compliant menu. At present a menu compliant to the NSW Health Nutrition Standards is being implemented at a large tertiary hospital John Hunter Hospital (JHH) in Newcastle NSW. John Hunter Hospital shares a common menu with John Hunter Childrens Hospital. The patient population ranges across all ages and stages, across acutely unwell to rehabilitation patients.

This paper presents an evaluation of the proposed new compliant menu against the Nutrition Standards specifications. Whilst the evaluation finds that the standard default menu for adults meets most nutrients goals, it is a concern that it has 37% excess sodium, 14% less fibre, and 90% more saturated fat than specified. For the hospital's paediatric population the standard menu fails to meet the specifications for variety and age appropriate foods.

Contact author: Cheryl Watterson – cheryl.watterson@hnehealth.nsw.gov.au

98 Does Grip and Pinch Strength Affect the Openability of Packages in the Over 65 Year Old? a Comparison between 2 Postures

NICOLA WESTBLADE1, ALISON BELL1, KAREN WALTON1, JACQUELINE CHEVIS2, KATE MORSON1

1School of Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

2Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, NSW 2521, Australia

Malnutrition in hospitals has been widely recognised as a significant burden to the patient and health system. Literature shows that physical barriers such as food packaging and positioning, can limit a patients' ability to access their food in hospital. This study aimed to identify whether lying in a hospital bed has an effect on strength and the ability to open problematic hospital food packaging in a well, independent living elderly population. Each participant was tested in both a seated and lying position. Grip and pinch strength were tested in both positions; participants then opened seven packaged food items commonly found in the hospital. Statistical analysis was used to determine any significant differences between the data in the two positions and the strength of association between all continuous variables.

Analysis showed a significant decrease in all pinch strength tests when lying in the hospital bed. Correlations were consistently found with the foil sealed water and the inner bag of the cereal box, particularly for pinch strength when lying in the hospital bed. The most problematic packages to open in both postures were the tetra pack, honey sachet, the boxed cereal and the cheese portion. Pinch strength was found to be an important factor when opening hospital food packages and was affected by the position of the patient. Further research in this area is recommended in a more vulnerable population which may be more representative of hospital demographics. Changes to package design are recommended to help improve access to food in hospitals.

Funding source: Faculty Research Grant, University of Wollongong

Contact author: Nicola Westblade – ncw928@uowmail.edu.au

142 Novel Preschool Program Improves Young Children's Attitudes to Vegetables in Southern Adelaide

CATHY WHITELEY

Southern Primary Health, Southern Adelaide Local Health Network, Alexander Kelly Drive Noarlunga Centre, SA 5168, Australia

Only 3% of 4–8 year old children meet vegetable intake guidelines (excluding potatoes) according to the 2007 Australian National Children's Nutrition and Physical Activity Survey. Familiarity strongly influences young children's choice of foods therefore early childhood is a crucial time for interventions that provide exposure to vegetables that will influence lifelong tastes. The Vegie Fun for Everyone pre-school based program aims to develop a positive attitude towards vegetables for young children in a non-threatening and play based format. The six week program encourages children to explore vegetables leading to positive experiences, self-directed tasting and increases dialogue about vegetables between staff, children and families. During 2011–2012, 10 programs were implemented at 7 preschools in low socio economic areas reaching almost 300 children. From the 122 parents surveyed it was reported that over 70% of children were asking for and eating more vegetables as a result of the program. Almost all of the children were reported to have had a positive experience and were more knowledgeable about vegetables. All 25 of the preschool educators surveyed believed the program was useful to children and over 90% reported children were more familiar and more knowledgeable about vegetables with an improved attitude to trying vegetables. The importance of targeting young children with positive healthy eating programs is paramount in the current obesogenic environment. This unique sustainable program and package for educators was embraced by the early childhood sector and proved to be a successful way to engage difficult to reach families to promote vegetables.

Contact author: Cathy Whiteley – cathy.whiteley@health.sa.gov.au

89 Timely Mealtime Assistance Improves Patient Nutritional Intake in an Acute Care Hospital

GAIL WHITELOCK, ALISON SHANKS

Royal Adelaide Hospital, Adelaide, SA 5000, Australia

Malnutrition is prevalent in acute care hospitals and often goes unrecognised and untreated despite being associated with a number of adverse clinical consequences. Lack of mealtime assistance has been reported as a potential barrier to an adequate nutritional intake in hospitalised patients. Seventy observations of nutritional care were made before and during mealtimes for patients previously identified by nurses as requiring mealtime assistance in an acute care hospital between September 2011 and January 2012. Patient nutritional intake was determined by means of visual estimations of plate waste and compared with hospital standardised serves. Patients were categorised into four groups. Group A (n = 31) patients received mealtime assistance within 10 minutes of meal delivery; group B (n = 15) patients received mealtime assistance ≥10 minutes of meal delivery; group C (n = 16) patients received the incorrect type or no mealtime assistance and group D (n = 8) patients ate independently. Mean energy intake (SEM) per meal in group A = 1290 kJ (106) which was significantly greater than group B = 817kJ (152) and group C = 375kJ (143), (p = 0.013, and p < 0.001, respectively). Mean protein intake (SEM) per meal for group A = 16.7 g (1.43) which was significantly greater than group B = 8.7 g (2.06) and group C = 4.2 g, (1.93), (p = 0.0022 and p < 0.001, respectively). The results indicate timely mealtime assistance significantly improves patient energy and protein intake.

Funding from the Allied Health, Pharmacy and Nursing Grant Committee, Royal Adelaide Hospital assisted in conducting this study.

Contact author: Gail Whitelock – Gail.Whitelock@health.sa.gov.au

99 The Efficacy, Tolerability and Compliance of Three Ketogenic Diets

CINTHYA WIBISONO1, NATALIE ROWE2, MICHAEL CARDAMONE2,3, ERIN BEAVIS2, HELEN KEPREOTES2, FIONA E MACKIE2, JOHN A LAWSON2,3

1School of Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia

2Sydney Children's Hospital, Randwick, NSW 2031, Australia

3School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW 2052, Australia

The ketogenic diet (KD) is a high fat, low carbohydrate and moderate protein regimen for intractable epilepsy. This study evaluated the efficacy, tolerability and compliance of three KDs, the classical, medium-chain triglyceride (MCT) and modified Atkins diet (MAD).

A retrospective chart audit of 48 patients with intractable epilepsy receiving the KD at a single centre between 2003–2012 was conducted. Patient demographics, epilepsy history, nutritional management and side-effects were collated. The value of potassium citrate supplementation in decreasing incidences of nephrolithiasis was also reviewed.

Median age of KD initiation was 3.4 years (Inter-quartile range: 2.25–6.75). Three (6%) patients were seizure free, 35 (73%) reported >50 to >90% reduction, 10 (21%) had 0–50% reduction. Diet duration or KD type did not predict seizure reductions (P = 0.381; P = 0.272). Hyperlipidemia (n = 33, 69%) and constipation (n = 31, 65%) were the most prevalent side-effects. Food refusal (n = 3, 6%) and poor parental compliance (n = 5, 10%) were among reasons cited for KD cessation. Nephrolithiasis was reported in one patient and another developed hypercalciuria; both patients were not compliant to potassium citrate supplementation. The classical, MCT and MAD were comparably effective in seizure control and generally well tolerated. Side-effects were mostly not a deterrent to compliance. Potassium citrate supplementation appeared to be an effective prophylactic supplement for the prevention of nephrolithiasis.

Contact author: Cinthya Wibisono – cw426@uowmail.edu.au

187 Relationships First: Working in Partnership to Address Healthy Lifestyles in One Rural Aboriginal Community

ANNABELLE WILSON1, SANDY WILSON2, JENNADENE SMITH2, SHARON PERKINS3

1Flinders University of South Australia, Adelaide, SA 5001, Australia

2Aboriginal Primary Health Care Unit, Murray Bridge, SA 5253, Australia

3Country Health SA Local Health Network, Murray Bridge, SA 5253, Australia

Working in partnership is a key element for addressing Aboriginal health and closing the gap, and is a challenge for today, tomorrow and the future. This paper describes the partnership between anon-Aboriginal dietitian and an Aboriginal health service, and the learnings that arose. The Aboriginal Primary Health Care Unit (APHCU) in Murray Bridge, South Australia, sought the services of a dietitian to work one day/ week with the local Aboriginal community. Existing relationships between one dietitian and APHCU were initially utilised to develop the position. The dietitian worked in partnership with Aboriginal staff to continue key programs, including the Ngarrindjeri Kids' Café for primary school students which involved cooking and discussions about traditional Aboriginal food, and a cooking group for local women, where healthy lifestyles were discussed informally over food. For the Aboriginal staff, the partnership reinforced the characteristics and approaches that can be used by non-Aboriginal staff to work well in Aboriginal health, including listening, working at the community's pace and working in partnership. For the dietitian, it highlighted the importance of developing relationships with Aboriginal people before addressing healthy lifestyles, ensuring programs are based on community-identified, having time to build relationships and sharing the same office space as other members of the APHCU team.

Learnings from this experience are likely to be useful to other Aboriginal and non-Aboriginal health professionals seeking to work together to contribute to healthy lifestyles in their local communities.

Contact author: Annabelle Wilson – annabelle.wilson@flinders.edu.au

190 Trust Makers, Breakers and Brokers: Building Trust in the Australian Food System

ANNABELLE WILSON1, JOHN COVENEY1, JULIE HENDERSON1, SAMANTHA MEYER1, TREVOR WEBB2, MICHAEL CALNAN3, MARTIN CARAHER4, PAUL WARD1

1Flinders University of South Australia, Adelaide, SA 5001, Australia

2Food Standards Australia and New Zealand, Canberra, ACT 7186, Australia

3University of Kent, Canterbury, Kent CT2 7NF, United Kingdom

4City University, Northampton Square, London EC1V OHB, United Kingdom

Trust in the food system influences food choice. Food scares have the potential to disrupt consumer trust is food and therefore alter food choice; hence minimising the disruption of trust is important. The purpose of this paper is to identify and actors who can influence consumer trust in food and why this is important. Previous research about food and trust demonstrated that most Australian consumers trust the food supply because they have no reason to distrust it. Key actors influencing consumer trust were farmers, supermarkets, politicians and the media. In this study, a literature review was undertaken to explore the previous research in the context of food scares. Key words searched were food, trust, scare, and incident. The literature review supported previous research, suggesting a powerful role for media with the potential to break consumer trust in food, especially during food scares (trust breakers). The role of regulatory bodies and policy makers in forming trust (trust makers) and public relations and consumer organisations in repairing trust (trust brokers) was identified.

However, how these different actors support or erode public trust in the food supply is unclear. Thus, further investigation into the mechanisms of how different actors attempt to make, break or broker public trust in food and the food system is important to allow development of practical and timely responses that minimise the disruption of public trust in the case of food incidents, and consequently minimal impact on consumer food choice. This is a particularly relevant challenge for tomorrow, considering the impact of globalisation on the food supply, with the potential for global food incidents to affect Australia and hence consumer trust in food.

Funding source: This project is funded by an Australian Research Council Linkage Grant (LP120100405) and by industry partners SA Health and Food Standards Australia and New Zealand.

Contact author: Annabelle Wilson – annabelle.wilson@flinders.edu.au

217 Do 1-Hour Blood Glucose Values Matter? An Audit of Pregnancy Outcomes

CHARLOTTE WILSON1, HAYLEY PARKER2, IDA KRISTIANSEN1, AMANDA DEVINE1, PHILIPPA LYONS-WALL1, THERESE O'SULLIVAN1, FOROUGH TABA2, IVONE TATHAM2, TRACEY ROBINSON2, SIVANTHI SENARATNE2

1Edith Cowan University, Perth, WA 6027, Australia

2Joondalup Health Campus, Joondalup, WA 6027, Australia

Pregnant women with an elevated 1 h oral glucose tolerance test (OGTT) and normal fasting and 2 h OGTT do not meet diagnostic criteria for GDM currently used in practice. This audit examined whether women with elevated 1 h OGTT, but normal fasting and 2 h results, had increased risk of adverse maternal or neonatal outcomes. In a retrospective audit of clinical notes from 160 women attending Joondalup Health Campus Antenatal Clinic between 2006 and 2011, subjects were classified into three groups: normal glucose tolerance (NGT) (n = 69); elevated 1 h OGTT with normal fasting and 2 h OGTT (1 h) (n = 22); and elevated 2 h OGTT (GDM) (n = 69). Maternal and foetal outcomes were collected. All women received regular antenatal care; those with GDM received additional individualised dietary advice. GDM infants were of younger gestational age than NGT infants (NGT 39.3 ± 1.37 weeks, 1 h 38.9 ± 2.48 weeks, GDM 38.5 ± 1.35 weeks, p < 0.01). Admission to special care nursery was higher in GDM than NGT (NGT 8.7%, 1 h 18.2%, GDM 31.9%, p < 0.01). Birth weight was similar between groups (NGT 3416 ± 545 g, 1 h 3512 ± 511 g, GDM 3275 ± 425 g, p = 0.092). Preliminary analysis found no difference in outcomes in those with 1 h, however, we cannot exclude differences remaining undetected due to insufficient sample size. Compared to those with NGT, women with GDM had similar sized infants, but shorter gestation and more admissions to special care nursery. Provision of individualised dietary advice to women with GDM may benefit maternal rather than neonatal outcomes. Due to a small 1 h sample evidence of increased risk of adverse maternal or neonatal outcomes remains inconclusive.

Contact author: Hayley Parker – parkerh@ramsayhealth.com.au

123 Australia's First National Nutrition Policy (NNP) (1978)

BEVERLEY WOOD, HELEN RINGROSE

Consultant, Carlton, VIC 3053, Australia

The Australian Association of Dietitians (AAD) was the first formal national professional body for Australian Dietitians. At the time (1975), there was also increasing concern about the nutrition of Australians, and resources were inadequate. In response to perceived need for policy, AAD held a Seminar in 1978 – ‘Towards a National Nutrition Policy’. The AAD State Branches contributed comments and the views of government, industry, academic, research, individuals and the media were invited through presentation and participation. This important leadership by the fledgling AAD was outlined in The Medical Journal of Australia (1979) and achieved media coverage. The Seminar recommended that AAD set up a Working Party to develop a Policy through wide community and media consultation. This was finalised in 12 months. The first set of nine dietary guidelines to provide guidance for Australians was published – “Stop and think before you eat and drink”. Inclusion of a national nutrition education policy was also needed. This work and advocacy by AAD and others prompted the Commonwealth Department of Health to act. Eight dietary goals were published for consideration. The first Australian National Nutrition Policy was published in 1981 and the first set of eight Australian Dietary Guidelines in 1982. Shortly afterwards, concerns began about some of the unexpected outcomes of the dietary guidelines – such as medicalisation of food, and interpretation of the guidelines. It was also most unfortunate that it was not until 1989 that the NHMRC published the report “Implementing the Dietary guidelines for Australians.

Contact author: Beverley Wood – woodbe4@bigpond.com

202 ‘Start Right Eat Right’; Learning's from Over 10 Years in the Child Care Sector

PAULA WOOD1, KATHERINE SIMPSON-GORE1, LOUISA MATWIEJCZYK2

1Southern Primary Health, Southern Area Local Health Network, Morphett Vale, SA 5162, Australia

2Southern Primary Health, Southern Area Local Health Network, Aldinga, SA 5173, Australia

‘Start Right Eat Right’ (SRER) is a South Australian state wide nutrition incentive award scheme which strengthens good nutrition practices in child care centres and is now over 10 years old. Since the initiative began 313 of 355 (88%) SA long day child care centres have engaged with SRER, and currently more than 70% are involved. This multi-strategy initiative has demonstrated that it can increase the capacity of child care staff to improve nutrition practices, provide healthy food consistent with national guidelines and provide a safe, supportive eating environment. Mixed methodology, particularly qualitative methods, has been used over the years to evaluate the effectiveness of SRER. A recent review of these evaluations and studies has identified the enablers which have contributed to SRER's longevity and success, particularly the strategies used to embed it within the early child hood sector. It has also identified the challenges and barriers, and the solutions used over SRER's history. SRER now faces its biggest challenge as state government funded health promotion initiatives are being cut in the contracting economic climate, prompting the need for innovative solutions. This review of a well-established and effective multi strategy initiative presents a number of learning's which will be of interest to any practitioner working in the early child hood realm or who are embarking on large initiatives which will occur over a number of years.

Funding source: Grant funded from Health Promotion Branch, SA Health, Dept Health & Ageing, South Australia

Contact author: Paula Wood – paula.wood@health.sa.gov.au

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