posters (in alphabetical order by author)

Posters (in alphabetical order by author)

183. APPLYING GENETICS TO DAILY DIETETICPRACTICE: PRACTICAL CASE STUDIES FROMTHE FIELDMELISSA ADAMSKI, GEORGIE RISTMyGene Pty Ltd, South Yarra, VIC 3181, Australia

Nutritional genomics and genetic testing in dietetics has been a hot topicof late, but how do dietitians apply genetics to their day-to-day practice?Dietitians using genetic tests as part of their practice were interviewed toinvestigate 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 gathergeneral feedback on the use of genetic testing in the field. The responseshave been pooled and sorted into different categories, to create a basicframework for dietitians to refer to when using this technology in dailypractice. 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 patientFrom those interviewed, the results of using genetic testing in dieteticpractice were positive. However, the interviews highlighted the need forclinical guidelines and standards to be developed for dietitians. Theresulting needs/questions uncovered as part of this study could be usedas a starting point to inform the development of guidelines, standardsand education in the future. It is proposed that this data could bepresented by way of discussion accompanied by a series of live casestudies in order for delegates observing the presentation to have greaterconfidence in using this technology with their patients after viewing thispresentation.

Funding source: Research funding from MyGene Pty Ltd

Contact author: Melissa Adamski – [email protected]

174. DIETETIC PRACTICE BY AUSTRALIAN ANDCANADIAN DIETITIANS WITH PEOPLE WITHPARKINSON’S DISEASEJAMIE SHEARD, SUSAN ASHQueensland University of Technology, Kelvin Grove, QLD 4059, Australia

Although Parkinson’s disease (PD) is a complex disease for whichappropriate nutrition management is important, limited evidence iscurrently available to support dietetic practice. Existing PD-specificguidelines do not span all phases of the Nutrition Care Process (NCP).This study aimed to document PD-specific nutrition management prac-tice by Australian and Canadian dietitians. DAA members and PENsubscribers 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 wereused by 52.4% while 53.6% relied on self-initiated literature reviews.Weight loss/malnutrition, protein intake, dysphagia and constipationwere common issues in all NCP phases. Respondents also requestedmore information/evidence for these topics. Malnutrition screening(82.1%) and assessment (85.7%) were routinely performed. One-thirddid not receive referrals for weight loss for overweight/obesity. Proteinintake meeting gender/age recommendations (69.0%), and high energy/high protein diets to manage malnutrition (82.1%) were most com-

monly used. Constipation management was through high fibre diets(86.9%). Recommendations for spacing of meals and PD medicationsvaried 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 limitedPD-specific guidance, dietitians applied best available evidence forother groups with similar issues. Dietitians requested evidence-basedguidelines specifically for the nutritional management of PD. Guidelinedevelopment should focus on those areas reported as commonlyencountered. This process can identify the gaps in evidence to guidefuture research.

Contact author: Jamie Sheard – [email protected]

21. DIETARY PATTERNS OF AUSTRALIANCHILDREN AGED 14 AND 24 MONTHS ANDASSOCIATIONS WITH SOCIO-DEMOGRAPHICFACTORS AND ADIPOSITYLUCINDA K BELL1, REBECCA K GOLLEY2, LYNNE DANIELS3,ANTHEA M MAGAREY1

1Nutrition and Dietetics, Flinders University, Adelaide, SA 5042, Australia2Sansom Institute of Health Research, University of South Australia,Adelaide, SA 5000, Australia3School of Exercise and Nutrition Sciences, Queensland University ofTechnology, Brisbane, QLD 4000, Australia

Previous research has shown, in predominantly European populations,that dietary patterns are evident early in life. However, little is knownabout early-life dietary patterns in Australian children. We aimed todescribe dietary patterns of Australian toddlers and their associationswith socio-demographic characteristics and adiposity. Principal compo-nent 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 oldchildren from two Australian studies, NOURISH and SAIDI. Associa-tions with dietary patterns were investigated using regression analyses.Two distinct patterns were identified at both ages. At 14 months, thefirst pattern was characterised by fruit, bread, vegetables, cheese andeggs and not commercial baby foods (‘core non-baby foods’) and thesecond by bread, milk, spreads, juice and ice-cream (‘basic combination’).Similarly, at 24 months the ‘core foods’ pattern included several corefoods such as vegetables, fruit, low-fat potatoes, meat, dairy and water,whilst the ‘non-core foods’ pattern included sweetened beverages, snackproducts, chocolate and processed meat. Lower maternal age and earlierbreastfeeding 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 solidintroduction, respectively. Patterns were not associated with BMIz-score. In conclusion, dietary patterns in Australian children are iden-tifiable in the second year of life. These findings support the need tointervene early with parents to promote healthy eating in children andcan inform future investigations on the effects of early diet on long-termhealth.

Funding source: National Health and Medical Research Council ofAustralia (426704, NOURISH) and SA Health (SAIDI). RKG issupported by a National Heart Foundation Fellowship.

Contact author: Ms Lucinda Bell – [email protected]

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Nutrition & Dietetics 2013; 70 (Suppl. 1): 26–47

Nutrition & Dietetics 2013; 70 (Suppl. 1): 26–47© 2013 Dietitians Association of Australia

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113. SCALES TIP TOWARDS WEIGHED FOODINTAKE METHODS TO CALCULATE ENERGYAND PROTEIN INTAKE IN HIP FRACTUREPATIENTSJACK BELL1,2, JUDITH BAUER1, SANDRA CAPRA1

1Centre for Dietetics Research, University of Queensland, St Lucia, QLD4067, Australia2The Prince Charles Hospital, Chermside, QLD 4032, Australia

Dietary intake assessment methods vary significantly and the bestmethod of estimating energy and protein intake in acute care remainsunclear. This study aimed to identify a pragmatic method of estimatingenergy and protein intake in patients with acute hip fracture. Retrospec-tive methods including food frequency questionnaire or diet historywere considered inappropriate for evaluating short term intake. Twenty-four hour recall methods were excluded with data demonstrating poorparticipant or surrogate memory of intake, recall bias, and substantialmisreporting in this patient group. An adjusted weighed food recordmethod was developed utilising duplicate (reference) trays matchingindividual patient (test) trays; component intake in grams was calcu-lated by subtracting test-tray component waste from reference compo-nents. Adjusted weighed, direct visual estimate and quartile methodswere then compared to weighed standard meals across a variety oftextures and consumption patterns for 40 trays. Data were collected andevaluated by a single senior dietitian and energy and protein intakeswere analysed using AUSNUT (99) data. The adjusted weighed methodwas more strongly correlated with true energy and protein intakes(Pearsons r = 0.98, 0.96) than the quartile (0.93, 0.91) and direct visualestimate (0.92, 0.90) methods. Agreement between the adjustedweighed method and true energy and protein intakes were confirmedusing Bland-Altman plots (21 � 202 kJ; 0.25 � 3.4 g respectively). Theadjusted weighed method is practical, efficient and easy to apply andshould be considered a useful method of determining energy andprotein intake in routine clinical practice.

Funding source: The Prince Charles Hospital Foundation NoviceResearcher Grant

Contact author: Jack Bell – [email protected]

62. DIABETES CARE PROJECT (DCP) – ATHREE-YEAR PILOT TO TEST NEW WAYS OFPROVIDING MORE FLEXIBLE, BETTERCOORDINATED CARE, TO IMPROVE THEMANAGEMENT OF CARE FOR PEOPLE WITHDIABETESNEHA BHATIADarling Downs South West Queensland Medicare Local (DDSWQMedicare Local), Toowoomba, QLD 4350, Australia

The DCP is a 3-year pilot (delivered in 3 phases; 6 month design, 2-yearimplementation and 6 month evaluation) of a new model of healthcaredelivery designed to improve care for people with diabetes. TheDDSWQ Medicare Local is working closely with the team across areaswhere the pilot will be trialled. In its entirety, the pilot will involve up to150 practices in 3 states, and will compare results between two inter-vention groups of general practices and a control group, to enable arigorous evaluation of the outcomes. The DCP will evaluate the impactof four changes: an integrated information and technology system, anew model of funding, the inclusion of a Care Facilitator in the careteam, and an education and training program that builds capabilitiesrelated to the project and overall care management. For patients, clinicalmeasures, appointment dates, referrals, and other beneficial informationwill be available online or in hard copy. At the end of the pilot imple-mentation phase, the groups will be compared to evaluate whether thesenew 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 scal-able nationally.

Contact author: Neha Bhatia – [email protected]

131. MOM’S THE WORD ... MATERNAL OBESITYMANAGEMENTNICOLE BOYERWest Gippsland Healthcare Group, Warragul, VIC 3820, Australia

Maternal obesity and excessive gestational weight gain (GWG) is agrowing concern in Australia and is associated with increased risk ofbirth complications such as gestational diabetes and caesarean delivery.The Positive Pregnancy Program (PPP) conducted at West GippslandHealthcare Group aims to reduce birth complications for obese pregnantwomen by optimising GWG through individual nutrition counsellingand health coaching. Pregnant women with BMI �35 kg/m2 (n = 91,mean BMI 39.7 � 5.8) were referred for individual assessment anddietary counselling, and those with complete data over two years (n =70) were included in data analysis. A dietitian conducted an initial onehour assessment and education with monthly reviews delivering tai-lored advice around nutrition education and lifestyle behaviours toachieve appropriate weight gain during pregnancy. The intervention wasassociated with a significant reduction (p = 0.009) in gestational weightgain (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 diabeteswere reduced amongst PPP participants when compared with obesecontrol groups in comparable studies. Individual dietetic counselling(PPP) is a cost-effective approach to reducing GWG and birth compli-cations while also promoting healthy eating and lifestyle changes forobese mothers and future generations. These findings support continu-ation of the PPP in the current setting, and suggest potential forimproved maternal outcomes when adopting this program in similarhealthcare settings.

Contact author: Nicole Boyer – [email protected]

70. THE NEW WHOLE GRAIN INGREDIENTCONTENT CLAIM: HOW WILL IT HELP PEOPLEMAKE BETTER FOOD CHOICES?MICHELLE BROOMGrains and Legumes Nutrition Council, North Ryde, NSW 2113, Australia

The new Australian Dietary Guidelines recommend people eat a widevariety of grain foods, mostly whole grain and/or high cereal fibrevarieties. However, choosing whole grain foods can be confusing. Foodscurrently on shelf vary considerably in whole grain content from 1.4 gwhole grain to 75 g whole grain per serve. In addition, manufacturerscurrently communicate the whole grain content a variety of differentways. To help support the Dietary Guidelines the Grains and LegumesNutrition Council (GLNC) sought to develop a whole grain ingredientcontent claim to allow clear, consistent communication of the wholegrain content of foods. The development of the three levels of wholegrain content claim included an assessment of marketplace data, bench-marking against nutrition content claims and international whole grainclaims, qualitative and quantitative consumer research and review by anexpert panel. GLNC has launched the industry standard set of claims andis actively encouraging food manufacturers to adopt the standard. It isthe intention of GLNC that the industry standard will be used across abroad range of food categories to assist consumers recognize, choose andeat foods that will contribute to their Daily Target Intake of whole grain(48 g/day). Dietitians play a key role as consumer research indicates thepublic health benefit can only be fully realized if people understand howthe claim relates to the recommendations for whole grain intake.

Contact author: Michelle Broom – [email protected]

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71. A CROSS SECTIONAL STUDYINVESTIGATING THE EFFECTS OFPOST-OPERATIVE FEEDING PRACTICES OFPATIENTS UNDERGOING BOWEL RESECTIONSURGERYMEGAN CAMERON-LEE1, NAOMI CROCKETT2

1University of Wollongong, Wollongong, NSW 2522, Australia2St George Hospital, Kogarah, NSW 2217, Australia

Recent literature has demonstrated that there are numerous benefits toinitiating early oral feeding (on post-operative day (POD) 0 or 1) inbowel resection patients. This study aimed to describe current post-operative feeding practices and dietitian involvement in these patients inan Australian context, and to determine if there were any associationswith length of stay (LOS) or post-operative complications. A retrospec-tive medical records audit of 39 adult patients who underwent bowelresection surgery at St George Hospital (SGH) between March and May2012 was undertaken. In this cohort, the initial post-operative diet of nilby mouth was usually followed by clear fluids on a median (IQR) of POD1 (1.00–1.25), full fluids on POD 2 (2.00–3.00) and a regular oral dieton POD 4 (3.00–6.00). Only 36% of patients were referred to a dietitian,including just 50% of those with ileostomies, despite SGH protocoldictating automatic referrals in this case. A moderate, positive correlationwas found between LOS and the POD a regular oral diet began (r =0.361) and slower progression to a regular oral diet was associated witha statistically significant increase in post-operative complications (P =0.004). Hence LOS and the incidence of post-operative complicationswere seen to increase when there was slower progression to a regular oraldiet, which indicates that implementation of an early oral feeding guide-line, as well as greater adherence to dietitian referral protocol at SGH,could benefit these patients. However a more comprehensive study, toexamine other influential factors to diet progression, is necessary.

Contact author: Megan Cameron-Lee – [email protected]

201. KIAMA MEALS ON WHEELS SERVICE: WHOIS REFERRING AND WHAT IS ON THE MENU?MELISSA TJONG, KAREN CHARLTON, KAREN WALTONUniversity of Wollongong, Wollongong, NSW 2522, Australia

Meals on Wheels (MOW) is a community service which aims to supportthe nutritional needs of the frail aged, disabled and their carers, and isparticularly useful for those recovering from illness, or after hospitali-sation. This study described the referral patterns, client meal orderingand the nutrient composition of meals from Kiama MOW, New SouthWales. A retrospective chart audit was undertaken with de-identifiedclient information obtained regarding referral sources between 2008and 2012. Menu order forms were collated for a two-week period inSeptember 2012 to determine the five most commonly ordered mealcomponents and meal combinations (MC) thereof. Energy and proteincontent of these MCs were expressed as a percentage of daily estimatedenergy requirements (%E) and recommended dietary intakes for protein(>70 years). A decline in referrals from hospitals was observed between2008 (22%), as compared to 2012 (10%), with accompanying increasesin self/family referrals (55% to 71%). The main meal alone was the mostpopular 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 wouldprovide 39 and 45%E, and 40% and 58% RDI protein, however only 9%of clients ordered three items. Further advocacy and marketing of MOWservices to medical staff in hospitals appears indicated to meet the needsof community based older people. Strategies to increase protein andenergy content of main MOW meals are warranted.

Funding source: The University of Wollongong and Kiama Meals onWheels

Contact author: Karen Charlton – [email protected]

168. VALIDATED NUTRIENT PROFILINGSYSTEMS: A SYSTEMATIC REVIEWSHERI COOPER, FIONA PELLY, JOHN LOWEUniversity of Sunshine Coast, Sippy Downs, QLD 4556, Australia

Nutrient profiling systems categorise foods based on their nutritionalcomposition and form the basis for the scientific algorithm behind manyfront-of-pack nutrition labels. These labels can guide consumers tomake healthy food choices, so it is imperative that profiling systemsprovide an accurate representation of the ‘healthiness’ of food. A signifi-cant number of nutrient profiling systems have been developed andimplemented internationally. However the reliability and validity ofmany of these systems has not been established, thus impacting on theirability to categorise food accurately. Therefore, the aim of this study wasto review the reliability and validity of existing nutrient profilingsystems. A systematic review guided by the PRISMA statement (Pre-ferred Reporting Items for Systematic Reviews and Meta-Analyses) wasconducted using the electronic databases Medline, Scopus and GlobalHealth Database. The search terms food label*, nutrient profil*, point-of-purchase, front-of-pack label*, nutrition label, food scoring systemand nutrient scoring system were utilised. Additional studies were iden-tified by searching bibliographies and web based grey literature. Eligi-bility assessment was performed using a predetermined exclusion andinclusion criteria. To date, a total of 39 nutrient profiling systems havebeen sourced in the literature, however there is currently little publishedevidence of comprehensive validation for the majority of these systems.The results of this study suggest that there is a strong and urgent needfor more reliability and validity testing to be carried out on nutrientprofiling systems to confirm the accuracy of front-of-pack nutritionlabels.

Funding source: Partly funded by The Wiggles

Contact author: Sheri Cooper – [email protected]

186. OUR IDNT IMPLEMENTATION EXPERIENCE:LOCAL CHAMPIONS TAKE UP THE CHALLENGEELESA CROWLEY1, DEANNE HARRIS1, CHASSAGNE MILLER2,HELEN JACKSON3

1Tamworth Rural Referral Hospital, Tamworth, NSW 2348, Australia2Campbelltown Hospital, Campbelltown, NSW 2560, Australia3Cessnock Hospital Cessnock, NSW 2325, Australia

Communication with all health professionals involved in patient care isof paramount importance to Dietitians. Enthusiasm to implement theIDNT standardized language has evolved at Tamworth Rural ReferralHospital. The aim of this quality project is to: (1) Describe the imple-mentation process of IDNT across HNE Local Health District and (2)Evaluate the experiences of champions implementing IDNT at localfacilities. A workshop of nine interested District dietitians was held inMarch 2012. The Hunter New England Local Health District IDNTworking group was then established to support IDNT implementationand practice. Group members meet monthly via phone and computerlink. Over 50 dietitians attended workshops held at the HNE DietitiansProfessional Development Day in July 2012, to further develop skills inIDNT using more complex case studies. A follow up survey of the localchampions across HNE was conducted at the end of 2012 with six outof the nine dietitians completing the survey. Initially, 2 out of 9 feltconfident, 6 out 6 now felt confident or very confident in implementingIDNT at their facility. Confidence in identifying nutrition diagnosis andwriting PES statements increased from 5 out of 9 initially to 6 out of 6at the end of 2012. Barriers to implementing the IDNT at the end of2012 included staff lack of knowledge, time, organisational constraintsand the need for training and support. With further training andsupport for dietitians within the HNE Local Health District the contin-ued rollout of IDNT will enhance medical record communication.

Contact author: Elesa Crowley – [email protected]

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199. STATEWIDE NUTRITION TRAINING FORFOODSERVICES STAFF: REFLECTIONS ON THEQUEENSLAND EXPERIENCEDENISE CRUICKSHANK1, TROY LITZOW1, JACQUELINE HARLE2

1Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia2SunshineCoast Technical and Further Education College, Maroochydore,QLD 4558, Australia

Nutrition training for Foodservices staff was identified as a high priorityin the initial 2007 Queensland survey of foodservices managers anddietitians. This was supported in the 2008 Statewide foodservice train-ing needs survey, where over 80% of foodservice staff at all levelsidentified the need for training in general nutrition and patient diets. In2010 Statewide Foodservices developed the content for 3 nutrition unitsin the national training package HLTNA 302, HLTNA 303, HLTNA 304in a power point format. In partnership with Sunshine Coast Technicaland Further Education College, the units were converted to an onlineformat and made available to Queensland Health foodservices staff for acorporate price. Two cohorts totaling 88 staff from 11 of 17 HealthDistricts enrolled for the training commencing in 2011 and 2012 with77 completing the 3 units. Sixty percent of staff enrolled were cookswith 80% coming from small rural facilities. Sixteen percent of staffidentified as indigenous. Support for training and assessment was pro-vided by Dietitians at the site or by the Statewide Foodservice dietitianif no dietitian was available. Outcomes included improved understand-ing and awareness of nutrition and diet in patient treatment, improvedknowledge of common therapeutic diets and increased confidence incooking and managing diets. Suggested improvements included provid-ing a workbook format for those with limited computer access or poorcomputer skills and improved communication with supervising dieti-tians. A third round of training is being run in 2013.

Contact author: Denise Cruickshank – [email protected]

66. A NOVICES GUIDE TO WORKING WITHCALD GROUPS: INTERPRETING THEAUSTRALIAN DIETARY GUIDELINES FORMUSLIMSLYNN FIELD, LOUISA MATWIEJCZYK, ELIZABETH HOUSE,JANE SCOTTFlinders University, Adelaide, SA 5000, Australia

Since 2001 the number of new arrivals from non-English-speakingcountries has increased substantially. Allied health workers and othersare finding their capacity to develop and deliver nutrition programs thatmeet the specific needs of culturally and linguistically diverse (CALD)groups a challenging task. The development of resources requires morethan merely translating current resources into different languages.Nutrition education programs also need to take into consideration cul-tural eating practices when delivering the healthy eating messages con-tained in the Australian Dietary Guidelines. A picture based nutritioneducation resource has been developed in collaboration with theMuslim Women’s Association in South Australia covering six topics. Thetopic modules cover the basic nutrition needs of CALD groups and aredesigned to be delivered by people without dietetic or nutrition trainingwith the aim of freeing up dietitians/nutritionists for vital service deliv-ery instead of program development. Sessions are delivered via a flipchart with an accompanying script and handbook, which are free todownload. This model has been found to work well in other fields withworkers delivering information to CALD groups on sexual health andfinancial literacy. The initial pilot at three community centres found newarrivals adopted healthier eating behaviours as a result of participatingin the program. This presentation will provide results from the pilot

program and share the reflections of the developers about the challengesof developing resources for CALD groups.

Contact author: Lynn Field – [email protected]

216. USING A DIGITAL PHOTO RESOURCE TOENHANCE THE UNDERSTANDING OF FOODPRODUCTS AND THEIR COMPOSITION IN AUNIVERSITY AND CLINICAL SETTINGMEGHANN FITZPATRICK, KAREN WALTON, ANNE MCMAHON,CHRIS BREWER, CAITLIN LAWSON, MEREDITH KENNEDYUniversity of Wollongong, Wollongong, NSW 2522, Australia

The aim was to determine the views of dietetic students, dietitians andclients of a Diabetes Service, regarding the usefulness of a Digital PhotoResource 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 intolectures and uploaded to UOW eLearning sites. Most responding stu-dents (95.2%) agreed that the resource enhanced their understanding offood composition. 80% of the dietitians agreed the resource would beuseful in a clinical practice for client education while 60% of the clientsfound it assisted their understanding of food composition.

Funding source: A faculty grant from the university of Wollongong

Contact author: Meghann Fitzpatrick – [email protected]

169. INCIDENCE OF MALNUTRITION ANDASSOCIATED ISSUES IN COMMUNITY-LIVINGOLDER ADULTS ACCESSING COMMUNITYNURSING SERVICES IN A RURAL AREACATHERINE FORBES1, ELIZABETH JEFFRIES1, JANICE KWOK2,SABRINA MOK2

1St Vincent’s Health & Community Services, Bathurst, NSW 2795,Australia2University 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 andpolypharmacy put community living older adults at higher risk ofmalnutrition (Skates & Anthony, 2012). It is widely accepted by healthprofessionals that malnutrition has significant health, social and eco-nomic implications yet malnutrition often goes unrecognised anduntreated in the community (Visvanathan, 2003).

This study aimed to determine the incidence of malnutrition andmalnutrition risk among older adults accessing community nursingservices. Over a 1-month period (July 2012) 72 community nursingclients aged 65 years and over were assessed for malnutrition using theMini Nutritional Assessment (MNA®, Nestle). Of the 72 clients assessedtwenty nine percent (29.2%) were identified as at risk of malnutritionand fifteen percent (15.3%) as malnourished. These findings indicatethat malnutrition and risk of malnutrition are significant issues facingcommunity living older adults accessing community nursing servicesand highlights the need for routine nutrition screening in this clientgroup. Discussions between dietetic and community nursing staff whichhave occurred as a result of these findings have resulted in the followingstrategies being implemented: routine nutrition screening and weighingof community nursing clients and monthly meetings and formalisedreferral pathways between dietitians and community nurses.

Contact author: Catherine Forbes – [email protected]

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124. DOES A HIGHER KETOTIC STATE IMPROVEWEIGHT LOSS?ALICE GIBSON1, RADHIKA SEIMON1, LAUREN TOUYZ1,NUALA BYRNE2, IAN CATERSON1,3, TANIA MARKOVIC1,3,AMANDA SAINSBURY1

1University of Sydney, Sydney, NSW 2006, Australia2QueenslandUniversity of Technology, Brisbane, QLD 4000, Australia3Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia

The worldwide prevalence of obesity is increasing at an alarming rateand is a major risk factor for type 2 diabetes and other diseases. Thephysiological adaptation that occurs in response to weight loss viaenergy restriction is multifaceted. Key features of this response includean increase in appetite, reductions in physical activity and metabolicrate, as well as changes in neuroendocrine status and circulating guthormone concentrations. These adaptive responses work together tohinder weight loss maintenance and thereby promote weight regain.The intensity of the adaptive response to energy restriction may beameliorated by ketone bodies, circulating concentrations of which arecharacteristically increased during very low energy diet (VLEDs). Thispaper will present the protocol of a trial investigating whether theconcentration of circulating ketone bodies observed during a VLED isassociated with a reduced adaptive response to energy restriction. Vol-unteers will be participating in a weight loss intervention consisting of12 weeks on a VLED. Circulating ketones and the adaptive response toweight loss (appetite, resting metabolic rate, physical activity and neu-roendocrine status) will be measured at 0 and 12 weeks. If a less intenseadaptive response to weight loss is associated with higher ketotic statesthen strategies to ensure that people using VLEDs maximise levels ofketosis could have important benefits for attaining and maintainingoptimal body composition; and thereby contribute to effective weightloss strategies to combat the obesity epidemic.

Funding source: National Health and Medical Research Council ProjectGrant APP1026005

Contact author: Alice Gibson – [email protected]

156. NUTRITION RISK SCREENING (NRS):IMPLEMENTATION IN A LARGE METROPOLITANHEALTH SERVICEJANET GOLDER, RAISA SHAIKH, MARYANNE SILVERS,ALISON STEWART, PAULINE COOPER, RUBINA RAJA,MARIA APOSTOLIDES, JENNIFER SEQUEIRA, JUNE SAAVASouthern Health (SH), Melbourne, VIC, Australia

A gap analysis against the Draft Victorian Nutrition Standard by theNutrition Risk Committee (NRC) indicated that NRS was the highestpriority for SH. An adhoc approach had previously been adopted withpoor uptake. The project’s aim was to roll out a validated NRS toolacross adult bed-based services with an active implementation strategy.A Dietetics working party was established to finalise a NRS tool, anddevelop an education and implementation plan. The Malnutrition Uni-versal Screening Tool was adopted as the NRS tool and training com-menced for nurses across 35 wards with NRS now implemented on 40%of wards. This project had a strong governance process with directreporting to the CEO led SH National Standards Committee (NSC).Malnutrition was integrated as a high risk into SH clinical and alliedhealth risk registers. The NRC (with executive sponsorship) now reportsdirectly to the SH NSC on NRS, providing NRS data and promoting thesignificance of nutrition risk throughout SH. A cycle of process evalu-ation and feedback to address barriers and maintain sustainability hasbeen incorporated by establishment of quarterly reporting of NRS com-pliance via DASH board, reporting at site based Clinical Risk meetings,ward based screening audits, and provision of ongoing training. NRSrequires commitment from the entire organisation and a clear account-ability pathway to ensure a change in clinical practice is sustained. Astructured implementation process, supported by organisational policy

and active collaboration by dietitians and nurses will indicate animprovement in nutrition risk screening rates. Screening results arepending.

Contact author: Janet Golder – [email protected]

26. NUTRITION-RELATED HOSPITALADMISSIONS OF HEAD AND NECK CANCERPATIENTS WITH PROPHYLACTICPERCUTANEOUS ENDOSCOPIC GASTROSTOMYTUBE PLACED DURING CHEMORADIATIONVIVIENNE GUAN1, NINA BONNER2

1School of Health Sciences, University of Wollongong, Wollongong, NSW2522, Australia2St George Hospital, Kogarah, NSW 2217, Australia

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

Contact author: Vivienne Guan – [email protected]

149. HAS SUGAR CONSUMPTION IN AUSTRALIAREALLY CHANGED OVER TIME? AN UPDATE OFTHE DATA 1999–2011MARY HARRINGTON1, TOM MCNEILL2

1Sugar Australia Pty Limited, Australia2Green Pool Commodity Specialists, Brisbane, QLD, Australia

The media and others perceive that sugar intake has increased signifi-cantly in Australia and parallels the rise in obesity. Current intake levelsare unknown and dietary intake data has not been updated since 1995.In the meantime, per capita consumption data can be used to indicatepopulation trends. The Australian Bureau of Statistics (ABS) collectedper capita consumption data for a range of commodities from 1939, butceased 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 meth-odology, an independent commodity specialist (Green Pool) sourceddata 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. Adjust-ments were made for imports and exports of sugar containing foods,and population growth, resulting in apparent per capita consumption.

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Data was merged with ABS reports and linear regression carried out toexamine the trend. A downward trend in per capita sugar consumptionwas observed over time (R2 = 0.5266).1 ABS reported 48.3 kg/capita in1938 and in 2011 this was estimated to be 42 kg/capita. This analysisprovides an important update from where the ABS left off. The down-ward trend in sugar consumption raises queries about the relationshipwith increasing obesity rates, and suggests focussing on sugar alone maynot be the correct approach. It helps target investigations for the forth-coming dietary survey update.

Reference1. 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 – [email protected]

227. CLINICIANS AND CONSUMERS WORKINGTOGETHER TO IMPROVE PATIENT CARE – THEPARENTERAL NUTRITION PAMPHLET PROJECTTANYA 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, Australia2Parenteral Nutrition Down-Under, Hornsby, NSW 2077, Australia3IBD Support Australia, South Penrith, NSW 2750, Australia4Prince of Wales Hospital, Randwick, NSW 2031, Australia5Sydney Children’s Hospital Network – Westmead Campus, Westmead,NSW 2045, Australia6Bankstown Hospital, Bankstown, NSW 2200, Australia7Dubbo Base Hospital, Dubbo, NSW 2830, Australia8Royal North Shore Hospital, St Leonards, NSW 2065, Australia9Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia

Parenteral nutrition (PN) is a life sustaining therapy that can be con-fronting for patients and their carers. In 2008, the NSW Agency forClinical Innovation (ACI) Nutrition and Gastroenterology Networksbegan developing best practice guidelines for the use of PN in hospitals.Throughout the project, consumer working group members identifiedthe need for a resource specifically for consumers and their carers.Following the launch of the ACI PN Pocketbook the Networksapproached relevant consumer groups to develop a patient and carerresource. With their endorsement, a working group consisting of con-sumer group representatives and clinical experts was formed. Chairedby a consumer, the group created a pamphlet that provides introductoryinformation for patients who are about to commence PN and theircarers. The pamphlet was piloted in 4 NSW hospitals and patients whowere about to commence PN or their carers were invited to participate.Patients or their carers received standard care (no pamphlet duringeducation on PN) or education using the PN pamphlet. They thencompleted a multiple choice questionnaire relating to the education andinformation they received. Results of the pilot were used to revise thepamphlet before making it available to clinicians and consumers acrossNSW. Consumer working group members were involved at all stagesand ensured that the clinical content of the PN pamphlet reflectedconsumer needs. The consumer involvement has evolved the Networks’approach to similar projects by ensuring there is balance between clini-cal content and consumer comprehension for resources to have themaximum effect.

Contact author: Tanya Hazlewood – [email protected]

107. TWITTER TIME! THE USE OF SOCIALMEDIA DURING A PROFESSIONAL EDUCATIONEVENT IN DIETETICSCLANCY HENDERSON, YASMINE PROBSTUniversity of Wollongong, Wollongong, NSW 2522, Australia

Social media platforms such as; Twitter, Facebook, MySpace, Wikis, andBlogs, continue to grow rapidly, with social networking now accountingfor 11% of all time spent on the Internet. Twitter, a micro-blogging tool,has become valuable in both professional and academic settings. Theaim of this study is to investigate the use of social media during aprofessional dietetic education event. The primary objective was toidentify patterns or themes in Twitter postings. Data was captured usingNcapture for Internet Explorer (2012 QSR International) web browserextension and examined in Dedoose analysis application (2011 Socio-Cultural Research Consultants). Following a grounded theory approach,the data was coded into 14 categories and three tones of communica-tion; positive, neutral, and negative. Categories were then analysed inMicrosoft Excel 2010 to ascertain category and tone distributions andvariation over time. The categories, informative (20%) and opinion(17%) were the most prevalent form of tweet, and the majority (81%) oftweets had a neutral tone. Tweeting was most popular on the second dayof the conference and was most likely influenced by the events occur-ring at the conference. Micro-blogging at conferences continues to growas new users embrace the social media phenomenon. The main forms ofcommunication at a dietetic conference were the sharing of facts andopinions with other users. It is apparent that encouragement of the useof social media during in a conference has an impact on the number oftweets, often through online networking.

Contact author: Clancy Henderson – [email protected]

110. IMPLEMENTATION AND EVALUATION OF AFRAMEWORK FOR CLINICAL DIETETICWORKFORCE DEVELOPMENT AND SUPPORTJAN HILL, MERRILYN BANKSRoyal Brisbane & Women’s Hospital, Brisbane, QLD 4029, Australia

Research on clinical dietetic workforces has found that team collegialityand opportunities for professional development assist with job satisfac-tion and retention. The multi-strategy workforce development andsupport program at Royal Brisbane and Women’s Hospital was evaluatedin 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 thedevelopment and implementation of clinical initiatives, and to theoverall strategic direction of the Department. Each dietitian is a memberof a clinical team (medicine, surgery, oncology), and one or morefunctional team/s (research, education, food service, nutrition support).Functional teams are lead by senior clinicians and supported by teamleaders. Each dietitian is expected to maintain APD status and to attendprofessional development regularly (two one hour sessions/week).Coaching with Team Leaders is scheduled monthly. In addition, a struc-tured supervision program with a senior clinician is provided to all newstaff. Evaluation of the framework was undertaken in November 2012.Respondents felt that membership of both clinical and functional teamsallows them to influence decisions about service delivery (overall rating3.9 and 4.0 respectively out of 5), and provides a supportive environ-ment to learn from others (4.3 and 4.2 respectively). Staff agreed thatthe weekly department PD session meets their needs and that they haveaccess to research training and opportunities. Furthermore, staff felt thatboth team leaders and their clinical supervisors provide support toimprove skills and performance (4.0 and 4.1 respectively).

Contact author: Jan Hill – [email protected]

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116. IMPLEMENTATION AND EVALUATION OFHOSPITAL ENTERAL NUTRITION POLICY ANDPROCEDURESTERESA BROWN, JAN HILL, SARAH ANDERSEN,MERRILYN BANKSRoyal Brisbane & Women’s Hospital, Brisbane, QLD 4029, Australia

Policies and procedures to standardise and ensure evidence-based prac-tice with respect to nutrition support for patients were developed in2008 at the Royal Brisbane & Women’s Hospital. Multidisciplinaryworking groups, including medical, nursing, pharmacy, speech pathol-ogy, dietetics, nurse education, safety and quality representatives, wereestablished to review the evidence in the following areas: nutrition riskscreening, assessment and support, medication administration, nasoen-teral tube insertion and management, gastrostomy (PEG) and jejunos-tomy tube management, home enteral nutrition and re-feedingsyndrome. A dedicated Nurse Educator project officer supported imple-mentation of the policies and procedures to the clinical areas focusingon enteral nutrition. An audit in 2009 to review adherence to the newprocedures identified clinical areas requiring further education. Asecond audit was undertaken in 2010. Dietitians audited all patientsreceiving enteral nutrition in a given week (n = 26). Patient character-istics were: 65% nasogastric, 19% gastrostomy, 8% nasojejunal and 8%other, with 54% continuous feeds and 46% bolus feeds. The majority ofpatients 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 inimprovement in processes related to nutrition support. Identified areasfor improvement (<60% adherence) include: monitoring of weight andblood glucose levels, use of pH indicator paper to confirm nasogastrictube placement, labelling feeds with time commenced and the use ofstickers to document tube re/insertion. This informed targeted educa-tion for the wards. Results from a further audit in 2012 are now due.

Contact author: Teresa Brown – [email protected]

81. MOVING HEALTHY EATING POLICY INLOCAL GOVERNMENT BEYOND RHETORICINTO PRACTICEELIZABETH HOUSE, SOPHIE PALYGA, LOUISA MATWIEJCZYK,LYNN FIELD, JANE SCOTTFlinders University, Adelaide, SA 5000, Australia

The development of healthy eating policy (HEP) is gathering momen-tum in local government. One of the key challenges identified is how totranslate policy into practice, specifically in relation to providing healthycatering. To align organisational expectations of healthy catering withwhat caterers can realistically provide, a six-step collaborative processinvolving caterers and local government was developed. The result ofthis process is a list of healthy food items that is specific to each localgovernment and their preferred caterers.

The educative process aimed to establish a common understandingof the types of food and drinks that meet policy guidelines. Theinvolvement of caterers in this process is pivotal as those orderingcatering may have unrealistic expectations of what caterers can provide.The resulting list addresses some of the barriers organisationsexperience when implementing HEP such as alleviating the stress stafffeel when ordering catering. This process was piloted with two localcouncils in South Australia and their preferred caterers, along with staffresponsible for ordering catering. Feedback from councils demonstrateddifferences in council practices and attitudes as a result of the list.Caterers appreciated the opportunity to have input in the process asthey are now receiving more requests to provide healthy catering and arekeen to establish themselves in this growing market. Once policy isestablished, the challenge is to ‘walk the talk’. This presentation detailsthe process used in the pilot and showcases the resources developed toassist councils to move their HEP beyond rhetoric into practice.

Contact author: Elizabeth House – [email protected]

211. ACCESS AND ACCURACY: THE ETERNALCHALLENGE OF WEIGHING PATIENTSRACHEL JAMIESON, ANITA WILTON, JUDI PORTEREastern Health, Box Hill, VIC 3128, Australia

Obtaining an accurate weight measurement is essential for medicationprescription, manual handling and identifying malnutrition risk. Whilstliterature supports the recording of weight during the admissionprocess, little was known of the accessibility and accuracy of weighingscales within our complex multi-site health network. This qualityproject aimed to identify the weighing equipment available across thecontinuum of care, their calibration history, and to plan for the purchaseof new scales. An audit tool was developed for completion by dietitiansand nurse managers across 90 acute, sub-acute, residential facilities andoutpatient services in mid-2012. In total, 199 adult and paediatric scaleswere identified. Thirty-five percent were bathroom scales that wereunable to be calibrated. Another 21% were stand-on scales, 16% wereseated scales and nine percent were baby scales. The remainderswere bed weighing scales, wheelchair scales and hoist scales. Access forbariatric patients was limited with only eight percent of scales weighingto 300 kg. Excluding bathroom scales, six percent of scales had not beenserviced within the last 12 months and 24% of wards indicated noformal cleaning procedures. All facilities had the capability of weighingpatients, although some scales may not be appropriate for the area ofservice. Network guidelines are presently being developed for weighingscale procurement and use that consider the need of bariatric patients,methods of weighing and record keeping.

Contact author: Rachel Jamieson – [email protected]

87. REFLECTING ON THE YEAR PAST – USINGWORKFORCE SURVEYS OF DIETETIC STAFF TOPROVIDE FEEDBACK AND TO PLAN FOR THEFUTUREANITA WILTON, TERRIE JEFFSEastern Health, Box Hill, VIC 3128, Australia

Public hospital dietitians have been reported to be accepting of theirwork environment and have an underlying optimism that they make adifference despite obstacles.1 A workforce survey designed to elicit theopinion and reflections of dietitians working across inpatient, outpatientand ambulatory clinical settings within a large metropolitan multicam-pus health service has been developed and administered annually.Survey questions focus on achievements by the Dietetic service; effec-tiveness of staff meetings; and feedback about quality improvementactivities. Specific questions have been developed for response by staff atdifferent career stages. An opportunity to nominate high achieving stafffor reward and recognition has been included resulting in the naming ofa service “Dietitian of the Year”.

Analysis of the responses indicated staff were satisfied with theirwork and felt appreciated; valued working in teams to complete tasks,enjoyed the stimulation and networking of meetings with theircolleagues, valued professional development and opportunities toparticipate in research and quality improvement; and were becomingmore confident with IDNT. Ineffective and inefficient processes wereidentified with different issues identified by staff at different careerstages. Staff were provided with the collated responses and action planswere formed to address identified issues at an annual staff planningmeeting.

Contact author: Anita Wilton – [email protected]

Reference1. 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

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143. REFLECTIONS ON TOMORROW’S MENU:EVIDENCE FOR INPATIENT MEAL PREFERENCESAT A LARGE TERTIARY PUBLIC HOSPITALPHILIP JUFFS1, JENNIFER ELLICK1, MERRILYN BANKS1,MARY HANNAN-JONES2, ANGELA NEIL2, REBECCA EVANS2,SANDRA CAPRA3

1Royal Brisbane and Women’s Hospital, Herston, QLD 4029, Australia2QueenslandUniversity of Technology, Kelvin Grove, QLD 4059, Australia3TheUniversity of Queensland, St Lucia, QLD 4072, Australia

There are limited studies that describe patient meal preferences inhospital; however this data is critical to develop menus that addresssatisfaction and nutrition whilst balancing resources. This quality studyaimed to determine preferences for meals and snacks to inform a com-prehensive menu revision in a large (929 bed) tertiary public hospital.The method was based on Vivanti et al. (2008) with data collected bytwo final year dietetic students. The first survey comprised 72 questions,achieved a response rate of 68% (n = 192), with the second morefocused at 47 questions achieving a higher response rate of 93% (n =212). Findings showed over half the patients reporting poor or less thannormal 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 thegeneral menu. Soup then toast was most frequently reported as eaten athome when unwell, and whilst most reported not missing any foodswhen in hospital (25%), steak was most commonly missed. Hot break-fasts were desired by the majority (63%), with over half preferring toast(even if cold). In relation to snacks, nearly half (48%) wanted somethingmore substantial than tea/coffee/biscuits, with sandwiches (54%) andsoup (33%) being suggested. Sandwiches at the evening meal were notpopular (6%). Difficulties with using cutlery and meal size selectionwere identified as issues. Findings from this study had high utility andsupported a collaborative and evidenced based approach to a successfulmajor menu change for the hospital.

Contact author: Philip Juffs – [email protected]

24. OUTPATIENT COMPLIANCE WITH SCRIPTEDORAL NUTRITIONAL SUPPLEMENTS (ONS)AMANDA KEATING1, BROOKE STARKEY-LUKE2,MICHELLE SUTER3

1School of Public Health QUT, Kelvin Grove, QLD 4059, Australia2Department of Nutrition and Foodservices Redcliffe Hospital, Redcliffe,QLD, Australia3Department of Nutrition and Foodservices Caboolture Hospital,Caboolture, QLD, Australia

Adherence with oral nutritional supplement (ONS) regimes is notori-ously poor, significantly limiting their effectiveness. No previous litera-ture has investigated compliance in the context of patient access tosupplements. The aim of this study is to be the first to determine thelevel of outpatient compliance with scripted ONS in the context of bothpatient access and patient intake; and to determine factors associatedwith compliance levels. Outpatients who had been prescribed ONSbetween the 1st July 2010 and 1st July 2011 were recruited from Red-cliffe Community Health, Redcliffe hospital and Caboolture CommunityHealth. Medical charts and HENS (Home Enteral Nutrition) recordswere used to identify patients’ current prescription details and medicalhistory. A patient questionnaire investigating factors affecting compli-ance was completed with patients and carers who were referred byprescribing dietitians. Compliance was defined into three variables(adequate access, pickup compliance and adequate intake) and calcu-lated by comparing current prescriptions with pharmacy and question-naire data. These were than tested against potential factors affectingcompliance. 175 patients were included in the study with 43 patientsand carers completing the patient questionnaire. 23.4% (n = 175) ofpatients were found to have adequate access; 48.8% (n = 43) were foundto have adequate intake; and pickup compliance was 78.9% (n = 175).Results from this study support the generally poor levels of compliancefound in previous literature. Patients at risk of experiencing access

issues need to be identified prior to prescription so that strategies can bedevised to increase compliance rates and in turn the effectiveness ofONS prescription.

Contact author: Amanda Keating – [email protected]

188. PREVALENCE OF MALNUTRITIONAMONGST ADULT INPATIENTS AT A TERTIARYTEACHING HOSPITAL IN THE ACT REGIONJANE KELLETT1, CATHERINE ITSIOPOULOS2, GREG KYLE1,NARELLE LUFF3

1University of Canberra, ACT, Australia2LaTrobe University, VIC, Australia3The Canberra Hospital, ACT, Australia

Malnutrition has been identified as a significant clinical problem inhospital settings both nationally and internationally. Malnutritionadversely affects physical well-being, interferes with health treatments,and increases healthcare costs. However, there is no current data onmalnutrition in adults residing in the Australian Capital Territory. Todetermine the prevalence of malnutrition amongst adult inpatientsadmitted to a tertiary teaching hospital in the ACT region, a point-prevalence study was conducted over two consecutive days in June2012. The Patient-Generated Subjective Global Assessment tool wasused to determine the prevalence of malnutrition in 189 adult inpatientsin the aged care, rehabilitation, surgical, medical, critical care, acute careand oncology wards. 47% were classified as well-nourished, 47% asmoderately or suspected of being malnourished, and 6% as severelymalnourished. The prevalence of malnutrition found in this study issimilar to other studies conducted in Australian hospitals. Of thosepatients classified as moderately or suspected of being malnourished orseverely malnourished, 59.4% had not been referred to see a dietitian.This study provided a “snapshot“ of the prevalence of malnutrition inthis population and will help to inform decisions regarding the appro-priate provision of nutrition services to this population.

Contact author: Jane Kellett – [email protected]

229. WHAT INFORMATION ABOUT INFANTFEEDING IS AVAILABLE TO PARENTS WITHCHILDREN AT INCREASED RISK OF COELIACDISEASE?SUSANNAH KING, ADRIENNE FORSYTH, SUE SHEPHERDLa Trobe University, Bundoora, VIC 3086, Australia

Children with a biological parent or sibling with diagnosed coeliacdisease (CD) are at increased risk of developing CD themselves. Breast-feeding duration, breastfeeding at the time of gluten introduction, andintroducing moderate amounts of gluten between four and six monthsof age appear to be associated with a lower risk of developing CD inthese children. It was unknown whether this information is beingshared with parents of infants at risk of developing CD. A review ofaccessible English language content from sites used by Australian healthprofessionals, lay-base internet sites (through a Google search using theterms ‘coeliac disease’ and ‘breastfeeding’) and international coeliacsocieties was undertaken in October 2012. The Australian BreastfeedingAssociation (ABA) was the only Australian organisation identified toprovide any specific advice regarding breastfeeding infants at increasedrisk of developing CD: a statement that breastfeeding should continueduring the introduction of solid foods. The lack of available local infor-mation for both parents and health professionals is a significant issuethat needs to be addressed to help advise families of children at higherrisk of CD. Recommendations for reducing the risk of food allergycannot be automatically generalised to CD because they have differentpathophysiological mechanisms. Further research is required to estab-lish how both families and health professionals are dealing with the

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mismatch between the evidence base and the lack of publically acces-sible and detailed information from the sources they might use such asDietitians Association of Australia, Coeliac Australia, ABA and the Diges-tive Health Foundation.

Contact author: Susannah King – [email protected]

112. ARE HACC DAY CENTRES FEEDING THELONELY AND ISOLATED? A NUTRITIONAL‘SNAPSHOT’ OF SENIORS ATTENDING A HACCDAY CENTREQUEENY LAU1, ERICA GRANDJEAN2, YIN LI2

1Home and Community Care (HACC) Dietitian Community RehabilitationTeam, Hornsby, NSW 2077, Australia2Student Dietitian, University of Sydney, NSW 2006, Australia

Community-dwelling elderly people who are isolated or have cognitiveimpairment are at risk of malnutrition. HACC dietitians have observedthat when one-on-one aged care services are exhausted, clients can beinstitutionalised prematurely. HACC funded Day Centres addressessome of these service gaps by providing opportunities for such clients toeat nutritious meals together in a social setting which requires lessresources. This study investigates the nutritional health of currentclients attending a local day centre to determine program reach andways the centre can enhance nutrition support in the community.During October 2012, 42 clients (66% response rate) of the centrecompleted a questionnaire with the assistance of dietetic students. Thestudy found most clients were well-nourished with 92% scoring lessthan 2 on the Malnutrition Screening Tool (MST) i.e. low nutritional riskand 63% of clients with a Body Mass Index (BMI) between 22–27.Clients consumed on average 33% of recommended calcium intake and60% of recommended protein intake per day. This is suboptimal giventhat muscle and bone loss is very prevalent in this subgroup. The studyfound most clients had a co-resident carer (45%) and lived withsomeone (61.9%) suggesting that the program may not be reachingthose who are most isolated. The centre should consider strategies toreach these clients by forming partnerships with other aged care serv-ices. From this study, the centre plans to increase calcium and protein atmidmeals. Strategies are still being discussed on how to reach isolatedclients.

Contact author: Queeny Lau – [email protected]

146. WHAT FOODS IS YOUR LOCAL SENIOR DAYCENTRE PROVIDING? TIME FOR NATIONALGUIDELINESQUEENY LAU1, ERICA GRANDJEAN2, YIN LI2

1Home and Community Care (HACC) Dietitian Community RehabilitationTeam, Hornsby, NSW 2077, Australia2Student Dietitian, University of Sydney, NSW 2006, Australia

HACC funded Day Centres provide opportunities for elderly clients toeat nutritious meals in a social setting; thus reducing strain on aged careservices. Previous studies have found significant variations in nutritionprovision across different day centres as the National HACC ProgramManual does not specify any standards of what foods day centres needto provide. Therefore, a partnership was formed with a local dementiaspecific day centre to review nutrition practices at the centre. The reviewfound that there were no written nutrition policies resulting in incon-sistent food provision. For example, dessert is not served consistently asone staff felt that desserts were not necessary. Meals cooked by staff,although reasonably appropriate, varied greatly in protein content. Itwas also found that staff ordering the main meal items do not use anychecklist or processes to ensure menu variety. Staff also reported thatmeals are plated according to client’s appetite. When a client is onlymanaging a small meal, there is no standard practice of offering extrafoods such as dessert to supplement reduced intake. Staff training, the

availability of basic nutrition policies and resources could address someof these issues. As a result of this review, the day centre plans toimplement a ‘menu variety checklist’, provide staff with a list of nour-ishing midmeals, desserts and drinks. In the long term, it is recom-mended that the Commonwealth consider developing resources toguide day centres in providing adequate nutrition with assistance fromdietitians.

Contact author: Queeny Lau – [email protected]

195. EVALUATION OF NEW TOTALPARENTERAL NUTRITION SOLUTIONS AT THEROYAL CHILDREN’S HOSPITAL QUEENSLANDROBYN LITTLEWOOD, JULIA FOXRoyal Children’s Hospital, Brisbane, QLD 4029, Australia

In July 2012 new Total Parenteral Nutrition (TPN) solutions and aprotocol for administration of these solutions were introduced at theRoyal Children’s Hospital Queensland. The purpose of this study was toevaluate the new solutions and protocols cost effectiveness and inter-vention requirement and compare that to the old solutions and protocol.Usage data was collated from Baxter®TPN order forms and pharmacyrecords for the periods of 1st to 30th September 2011 and 1st to 30th

September 2012. The number of TPN bags used, modifications madeand costs were calculated per month. Treating team costs were alsocalculated. The above factors were then cross compared with the twomonth periods to decipher which month produced a higher cost andrequired more intervention. 18 patients were prescribed TPN in the oldprotocol compared to 14 with the new protocol. There were moremodifications made to bags with the new protocol than to the oldprotocol (41.26% vs. 16.47%) so therefore the costs were higher($13 314 vs. $7500.40). Majority (96%) of modifications where to thesodium and potassium content of the bags. Oncology contributed to ahigher cost percentage in both protocols. This study found that therewere more modifications and therefore higher costs in our new protocol.However, there were fewer prescriptions made for TPN and fewer bagsused overall. As majority of the modifications were made to sodium andpotassium content this is something that needs to be re-worked in thesolutions or alternative options (other then modifying TPN solutions)need to be considered.

Contact author: Robyn Littlewood – [email protected]

145. A NOVEL METHOD OF SUPPLEMENTDELIVERY UTILISING DIETETIC ASSISTANTSIMPROVES PATIENT NUTRITION STATUS: THESAM PROGRAMAMANDA LOWE, MERRILYN BANKS, TERESA BROWN,LISA JOLLIFFE, PHILIP JUFFSRoyal 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 supplementintake. However there are often barriers to implementing this systemsuccessfully. The ‘Supplements As Medicine’ (SAM) trial aimed toexamine the effectiveness of a modified version of this concept usingDietetic Assistants (DA) to deliver supplement aliquots during their midmeal delivery rounds. The two-month trial took place in an oncologyward. Patients were identified by the Dietitian for SAM if they wereunable to meet nutritional goals with normal care (HPHE diet andsupplements). They received two 80 mL aliquots of a 2 kcal/mL sup-plement by the DA (morning and afternoon tea). DAs were trained inSAM procedures and how to encourage supplement consumption. Theyrecorded supplement consumption and communicated this to the Dieti-tian. Consecutive energy and protein intakes were recorded by the

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Dietitian during standard care and after commencement of SAM usingfood charts. The seven patients identified for SAM by the Dietitian (10%of all ward patients) achieved an average increase of 12.5 g protein and1.9 MJ per day. A survey of DAs involved in the trial (n = 3) agreed SAMimproved communication with the Dietitian, increased job satisfactionand sense of value. It is planned to implement the program hospital-wide. These findings identify a way DA roles can be expanded toimprove nutrition and an alternative model to prescribing supplementson medication charts.

Contact author: Amanda Lowe – [email protected]

127. DOES EATING ENVIRONMENT HAVE ANEFFECT ON THE INTAKE OF THE ELDERLY?KARON MARKOVSKI, ARANKA NENOV, AURORA OTTOWAYWestern Health, Williamstown, VIC 3016, Australia

Social and environmental factors are important influences on foodintake. Studies demonstrate increases in food intake when there isimprovement in the social and environmental surroundings and whenpeople dine together. In 2010, Western Health introduced a supportivecommunity dining environment in the Aged Care sub acute setting. Theprogram “Dining with Friends” commenced at the Williamstowncampus 3 days per week (Monday, Wednesday and Friday) and was laterinitiated in 2011 on the sub acute ward 3B at the Footscray campus. Thestudy aimed to examine the energy and protein intake of the middaymeal in two different eating environments – the dining room and thepatient’s bedside and to obtain feedback on patient experience in bothlocations. The dietitians surveyed 52 patients over the age of 65 years.Data collected included information on diet codes, Malnutrition riskusing the MST, BMI, appetite, gender, cognitive status, length of stay,feeding assistance and preference with dining environment. Eachpatient was observed consuming the midday meal on two consecutivedays and in two eating environments, the dining room (day 1) and theirbedside (day 2). The patients intake was recorded as a proportion of themeal consumed and analysed for protein and energy content using theHospital Food Service Menu ready reckoner. The study found that 34out of 52 patients (65%) favored eating their meal in the dining roomand consumption of a higher proportion of protein( 29 g in dining roomcompared with 25 g at the bedside) and energy (2321 Kj in the diningroom compared with 2050 Kj at the bedside) was observed. The studyalso found of the 21 patients with a BMI less than 22, 15 (71%) atebetter in the dining room, of the 31 patients identified with significantcognitive impairment 24 (77%) ate better in the dining room and of the29 patients who were identified as being at moderate and high risk ofmalnutrition 20 (69%) ate better in the dining room. This study sup-ports the contention that a dining room environment can increaseopportunities to enjoy the social aspect of meal times, increases foodintake and potentially lead to weight gain and improvement in nutri-tional status and rehabilitation

Contact author: Karon Markovski – [email protected]

115. ROOM SERVICE – THE FUTURE OFHOSPITAL MEAL ORDERING AND DELIVERY INAUSTRALIA?KIRSTY MAUNDER1,2, CAROL ZEUSCHNER3, CARMEL LAZARUS4

1The University of Wollongong, Wollongong, NSW 2522, Australia2The CBORD Group, Chatswood, NSW 2067, Australia3Sydney Adventist Hospital, Wahroonga, NSW 2076, Australia4St. Vincent’s and Mater Health, Darlinghurst, NSW 2010, Australia

Australasian hospital foodservices operate a traditional method of mealordering via menus in advance, bulk production, and the delivery ofplated meals at set times. Approximately 25% of Australasian hospitalsutilise software to manage these processes and until now have remainedlargely unresponsive to change. The United States in contrast haveapproximately 32% hospitals utilising foodservice software and 38%

operating room service (i.e. where patients order when they like from aone-day hotel-style menu). The aim of this study was to investigate thesuitability and potential benefits of room service in Australasian hospi-tals. A study tour of twelve United States hospitals utilising variousroom service models, a comprehensive literature review, and anin-depth knowledge of over 50 Australasian hospital foodservicesenabled 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, deliverymethods and cost. Despite the industry being slow to publish roomservice benefits, there is literature on cost-effectiveness, and improvingpatient nutritional care and satisfaction have been identified as the keydrivers for this transition. In conclusion there is significant value for thehealthcare industry to adopt new technology and innovative food deliv-ery methods to improve patient satisfaction and nutritional intake.Individual hospital assessment is crucial to identifying the best combi-nation of methods of foodservice delivery to adopt, so as to tailor theappropriate service delivery with the desired outcomes.

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

Contact Author: Kirsty Maunder – [email protected]

209. UTILISING A HEALTH BASED FRAMEWORKTO ENGAGE CLIENTS WITH EATINGDISORDERSSARAH MCMAHONBodyMatters Australasia, Neutral Bay, NSW 2089, Australia

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

Contact author: Sarah McMahon – [email protected]

181. THE MENTAL HEALTH ROLE STATEMENT –A STATEMENT FOR ALL DIETITIANSMENTAL HEALTH INTEREST GROUP COMMITTEEDietitians 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 chronicmental illnesses can be reduced by up to 32 years, with greater risks ofdying from metabolic diseases.2 Despite this, Australian dietitians feelill-equipped to manage clients with mental health issues.3 The MentalHealth Interest Group (MHIG) Committee developed a Role Statementin accordance with DAA’s protocols, aiming to provide Accredited Prac-tising Dietitians (APDs) and other health professionals with a summaryof dietitians’ professional roles in mental health. The Committee con-ducted a literature review of mental illnesses, their prevalence and theirassociation with metabolic and medical problems. A list was compiled oftasks regularly performed by and expected of APDs working in clinicaland community practice in mental health. Consultation with the widerMHIG membership and the DAA general membership was undertaken.The final Role Statement was endorsed by DAA in December 2012. Even

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for dietitians who do not formally work in mental health, the chances oftheir coming across a client with mental health comorbidities are veryhigh. It is essential APDs are prepared and equipped to work with suchclients in clinical and community practice.3 The Role Statement willassist APDs in managing clients, liaising with multidisciplinary teamsand establishing dietetic positions in mental health.

References1. ABS. National Survey of Mental Health and Wellbeing: Summary of

Results, Australia 2007. Report 4326.0, 2008.2. Lourey C. National Mental Health Commission, 2012: A Contributing

Life: the 2012 National Report Card on Mental Health and Suicide Pre-vention. 2012; Sydney: NMHC.

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

Contact author: Dr Nerissa Soh – [email protected]

119. INTER-RATER RELIABILITY OFMALNUTRITION SCREENING TOOL (MST)COMPLETION BY NUTRITION ASSISTANTS (NA)MORE THAN ONE YEAR POST TRAININGKARLY MILLER1, ANGELA VIVANTI1,2

1Princess Alexandra Hospital (PAH), Australia2School of Human Movement Studies, University of Queensland, Brisbane,Queensland, Australia

Princess Alexandra Hospital’s Nutrition Assistants complete CertificateIII in Nutrition and Dietetic Assistance including MST competencyassessed by an accredited practicing dietitian (APD). NA’s subsequentlyundertake MST’s during daily duties. To determine the long term effec-tiveness of training they were reassessed more than one year later. Fiftymalnutrition screening events by 10 NA’s were recorded on 5 differentoccasions. A single APD also conducted malnutrition screening at thesame time, limiting inter-rater variability. Additional clarificationrequired by the APD to complete the screening occurred after NA’s hadcalculated their score. Three NA’s were assessed >1 year and 7 NA’swere assessed >2 years after certificate training was completed. Thepercentage agreement and the kappa statistic were considered to deter-mine the inter-rater repeatability. Overall agreement between the NAand 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’sobtained 100% agreement (15/15, Kappa 0.1) which reduced to 94%agreement (33/35, Kappa 0.86) with greater time since training. Iden-tified discrepancies resulted from score miscalculations, mishearingpatients or not clarifying patients exact weight loss. No critical errors inmalnutrition risk identification occurred as discrepancies resulted in theperson being screened at risk. Trained NA’s and APD’s demonstratedgood inter-rate reliability. Areas of focus for up skilling included seekingclarification regarding weight loss and care with calculations. Althoughsimple to complete, the highest agreement occurred amongst staff withmore recent instruction.

Contact author: Karly Miller – [email protected]

83. EFFECTIVENESS OF MALNUTRITIONSCREENING OF ONCOLOGY OUTPATIENTS ONAPPROPRIATENESS OF DIETETIC REFERRALS: APILOT RETROSPECTIVE COHORT STUDYJESSICA NALDERRoyal Hobart Hospital, Hobart, TAS 7000, Australia

Patients with cancer are at high risk of malnutrition related to increasedenergy requirements, and effects of the cancer and treatment, such asweight loss and gastrointestinal symptoms. Regular nutritional screen-ing of oncology patients helps with early identification of patients at risk

of malnutrition, enabling early dietetic intervention, which can improvepatients’ quality of life and treatment response. This study assesses theeffectiveness of nurses conducting malnutrition screening using thevalidated Malnutrition Screening Tool (MST) in improving appropriateand timely referrals of patients to the dietitian. A retrospective cohortstudy was conducted using clinical data from adult oncology outpatientsat the Royal Hobart Hospital. The study compared the rate, appropri-ateness and timeliness of dietitian referrals prior to routine screeningusing the MST, with referral patterns post-implementation of the MST.The results indicate malnutrition screening improved the percentage ofreferrals assessed as appropriate by 30%.Malnutrition screening ensuredall patients at risk of malnutrition were referred to the dietitian in atimely manner. Prior to using the MST, approximately 20% of patientswho were at risk of malnutrition were not referred to the dietitian.Routine and ongoing screening using the MST is an effective tool fordetecting trends in a patient’s nutritional status. Implementing routineand ongoing malnutrition screening helps to detect patients at risk ofmalnutrition and can improve the appropriateness and timeliness ofreferrals to the dietitian.

Contact author: Jessica Nalder – [email protected]

128. INVOLVEMENT OF CULTURALLY ANDLINGUISTICALLY DIVERSE (CALD) CONSUMERSIN HOSPITAL MENU DEVELOPMENTCLARA NEWSOME1, KATE FOX1, STEPHEN TIPPETT2,ELIZABETH DOYLE1, NATALIE SIMMANCE1, KARELLA DEJONGH3

1Nutrition Department, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia2Food Services, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia3Interpreter Services, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia

Malnutrition is common in hospital patients and it is essential that thefood provided meets patient’s preferences to improve consumption. Apatient satisfaction survey conducted in 2012 identified that 49% ofculturally and linguistically diverse (CALD) hospital inpatients were notsatisfied with food choices. This project aimed to use interpreters toidentify patient preferences in the development of a new menu for StVincent’s Hospital, Melbourne. It was a collaborative project betweenInterpreter Services, Food Services, and the Nutrition Department. A 4question questionnaire was developed and administered across 6 cul-tural groups (Asian-Vietnamese, Asian-Chinese, European-Italian, Euro-pean – Arabic, Mediterranean – Greek, and Western) with the assistanceof interpreters when required. A total of 52 patients were surveyed. Themost and least favourite dishes were identified for each patient group.The results have been used in menu development and successfullyenabled consumer input into nutrition care. The organisation plans torepeat the survey every 6 months and will use this data to furtheroptimise menu planning to meet consumer needs.

Contact author: Clara Newsome – [email protected]

137. IMPLEMENTATION OF ANELECTRONICALLY INITIATED MEAL TIMEFEEDING ASSISTANT ALERTCLARA NEWSOME1, ELIZABETH DOYLE1, SUE WHITE2,NATALIE NEWMAN3, NATALIE SIMMANCE1

1Nutrition Department, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia2Nurse Unit Manager, St Vincent’s Hospital, Fitzroy, VIC 3065, Australia3Improving Care for Older People Project (COAG-LSOP), St Vincent’sHospital, Fitzroy, VIC 3065, Australia

Malnutrition is common in hospital patients. Inadequate assistance atmeal times can put patients at risk of a poor nutritional state. In 2009 ameal tray blue dome (MTBD) alert was implemented at St Vincent’s toidentify patients needing assistance with feeding. The MTBD had to bearranged through the dietitians or dietitian assistants by manually input-ting into the Patient Administration Computer System (PAS). In 2012 a

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new electronic method of arranging a MTBD was added to PAS. Thisenabled nursing staff, dietitians and dietitian assistants to arrange aMTBD though a one prompt tick box on the PAS Diet Code screen. Useof the MTBD was tracked over time with a monthly count to identifychanges in use. Nursing staff, Dietitians and Dietitian Assistants werealso asked to complete an anonymous survey (n = 33) to determine theirviews on the new electronic method of arranging a MTBD. Almost allstaff surveyed (97%) felt that the MTBD improved the assistancepatients received at meal times. Eighty-two % of staff surveyed felt theelectronic process improved their ability to arrange a MTBD. There wasa 28% increase in the average MTBD arranged in the 3 months precompared to post implementation of the electronic ordering method. Inconclusion the implementation of an electronic method of arranging ameal time feeding alert appears to have been an effective strategy toimprove the use of the MTBD alert.

Contact author: Clara Newsome – [email protected]

161. IS IT FINANCIALLY BENEFICIAL TO HAVEA DIETETICS DEPARTMENT VOLUNTEER IN ANACUTE METROPOLITAN TEACHING HOSPITAL?WENDY OPPENHEIMER, JANET GOLDERDandenong Hospital – Southern Health, Dandenong, VIC 3175, Australia

Southern Health supports innovative workforce strategies whichpromote fiscal responsibility. Volunteers provided an estimated $14.6billion dollars of value to not-for profit organisations in 2006–07 (Aus-tralian Bureau of Statistics, 2012). Anecdotally however, supervisionrequirements, managing non-attendance and retention are perceivedbarriers to appointing volunteers. This project aimed to assess thebenefit of a Dietetic department volunteer in an Australian acute met-ropolitan hospital. Dietitians were surveyed to develop a list of potentialvolunteer tasks. Seven surveys were completed and twenty-five admin-istration support tasks were identified.Data on attendance rates, timespent 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 Volunteerupon completion of the trial period. The overall time and cost saved bythe dietetics department over six months by having a volunteer com-plete dietitian’s administrative tasks was 33 hours and $1031 respec-tively. This is an annual cost savings of $2475 based on volunteerattending 3.5 hours per week. Attendance was 72%. Surveys confirmedthat 100% of dietitians were satisfied with the volunteer program andthat volunteer satisfaction is enhanced when assigned tasks relate toareas of interest. Volunteers can add value to Dietetic departments if thetasks are planned efficiently with flexibility to meet the areas of interestsof the individual volunteer to enhance retention. Future work includespotentially increasing volunteer working hours to one day per weekwhich is a potential cost saving of $5374 per annum.

Contact author: Wendy Oppenheimer – [email protected]

69. ENHANCING THE ROLE OF THE NUTRITIONASSISTANT AT DANDENONG HOSPITAL,SOUTHERN HEALTHTERESA ORSINI, JENNIFER SEQUIERA, CELIA DURIEDandenong Hospital, Southern Health, Dandenong, VIC 3175, Australia.

To drive fiscal responsibility, Southern Health (SH) has led the way ininnovative workforce initiatives. Dandenong Hospital Dietetics depart-ment has utilised a Nutrition Assistant (NA) predominantly for nutritionrisk screening and consumables management for the past 11 years. Withthe introduction of National Standards, SH has shifted the nutritionscreening function to within the nursing role therefore enabling us toexplore potential future roles and responsibilities of our NA. SH recog-nises the NA as skilled health care workers, who under the supervision

of a Dietitian can assist to alleviate Dietitian workload, yet ensure apatient centred care service meeting budget priorities. The NA initiallyidentified tasks that could be undertaken by a NA based on the DraftDAA Scope of practice for support staff in Nutrition & Dietetics 2007.Dietitians were then surveyed to determine time spent on NA appro-priate tasks and to identify potential future tasks for the NA that werestrategically aligned to SH operational and Dietetic department goals.Nine surveys were completed. Results showed Dietitians were spending75 min/day doing NA appropriate tasks. Functions such as anthropom-etry reviews, providing patients basic dietary education and monitoringof supplement tolerance were tasks Dietitians would find most usefulwith 89%, 80% and 70% agreement respectively. Benchmarking NAroles, development of a NA competency and training package, andreview of the NA Position description is now underway. Final resultspending.

Contact author: Teresa Orsini – [email protected]

214. TAKE AWAY GAMES: A PLAY BASEDHEALTHY EATING INITIATIVE IN COMMUNITYPRESCHOOLS.SARAH PINN, PETER HILLSouthern Primary Health, Noarlunga Centre, SA 5168, Australia

The preschool years are a time of rapid development during which foodpreferences and eating habits are established. Young children’s eatinghabits are largely shaped by parents. Supporting parents in connectingwith their children to create positive healthy food experiences throughimaginative play is an important step towards healthy eating habits. Theaim of the Take Away Games (TAG’s) program is to enable families toengage with their children in imaginative play to increase familiarity, tostimulate meaningful dialogue and to create positive experiences withhealthy food, predominantly fruit and vegetables, in a non-threateningenvironment. Preschools are ideally placed within communities to reachchildren and families. 14 preschools were each provided with 8 healthyeating themed TAG packs. Integrated into existing literacy pack loansystems, TAG’s were offered to parents for overnight loan. Preschoolstaff also used TAG’s to compliment healthy eating curriculum themes.A parent survey revealed 75% of parents felt that games stimulateddialogue with their children about food, and 50% report a positivechange in their child’s attitude to food. In a focus group parents reporta high level of enthusiasm and interest in their children using TAG’s,and an increased knowledge of fruit and vegetables. Preschool staffvalue TAG’s as a tool to integrate nutrition themes into the preschoolenvironment and the curriculum and as a means of connecting familieswith the preschool. TAG’s are an innovative, low cost, sustainable toolfor creating positive experiences, engaging families in meaningful dia-logue and increasing children’s exposure to healthy eating themes.

Contact author: Sarah Pinn – [email protected]

222. DEVELOPING NUTRITION STANDARDS FORMENTAL HEALTH FACILITIESJAN PLAIN1, MEG VICKERY2, TANYA HAZELWOOD3

1Macquarie Hospital, North Ryde, NSW 2113, Australia2Bloomfield Hospital, Orange, NSW 2800, Australia3NSW Agency of Clinical Innovation, Chatswood, NSW 2067, Australia

The Agency for Clinical Innovation (ACI) Nutrition Standards andTherapeutic Diet Specifications for adult inpatients in NSW hospitalswere released in December 2011, with a focus on addressing the risk ofmalnutrition in acute hospitals. Dietitians raised concerns that they didnot cater for patients in mental health facilities and units, who are onaverage younger and stay in hospital longer than patients’ in acutehospitals and are at high risk of obesity and cardio-metabolicco-morbidities and lower risk of malnutrition. They also raised concernsthat the current food service in these facilities inadequately meets thenutrition needs of patients and their food preferences, including fortaste, quantity, variety and quality.

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In response, the ACI formed the Nutrition and Mental Healthworking group to develop nutrition standards for NSW mental healthfacilities and units. A literature review identified that people with mentalillness have poorer physical health, poor diets and reduced physicalactivity than the general population and a reduced life expectancy up to32 years, with cardiovascular disease being the major cause and onaverage twice the incidence chronic diseases, including Metabolicsyndrome, Diabetes and Obesity. Psychotropic medications significantlyaffect appetite and the gastrointestinal function, resulting in disorderedeating, fast eating syndrome and dysphagia. Consumer auditsconducted in collaboration with the Official Visitors Program in NSWmental health facilities and units, confirmed patient and staff issues withthe current food provided. A project is identifying nutrition goals,minimum menu standards, test menus and therapeutic dietspecifications as required.

Contact author: Jan Plain – [email protected]

154. DEVELOPMENT OF A FOOD IMAGEDATABASE: A STEPPING STONE TO THECREATION OF A NOVEL DIETARY ASSESSMENTTOOLYASMINE PROBST1, CLARE FERGUSON1, WANQING LI1,MEGAN ROLLO2

1University of Wollongong, Wollongong, NSW 2522, Australia2University of Newcastle, Callaghan, NSW 2308, Australia

It has long been recognised that traditional pen and paper methods ofdietary assessment are prone to error. Emerging technologies, particu-larly smart phones, may offer solutions by providing new platforms fordietary assessment, potentially improving both the accuracy and effi-ciency of assessment. The aim of this study was to develop a databasecomprised of food images linked to Australian food composition datafor use with a novel mobile phone based assessment tool, the eFoodTraka. A three tier filing hierarchy for the organisation of three pre-existing collections of food photographs was created using the AUSNUT2007 food group classification system. Professional judgement was usedto identify foods from the photographs and match them to data fromAUSNUT 2007, NUTTAB 2010 or AUSNUT 1999 food compositiondatabases. Multiple images of the same food were entered individually,assigned a numeric identification code, filed accordingly, and mapped inan Excel spreadsheet. The final database consisted of 21, 122 and 678first, second and third level food groups, respectively, containing a totalof 2317 food images (393 excluding multiples). The database includedvalues for all 37 nutrients in AUSNUT 2007, with the exception of 32images matched to NUTTAB 2010 or AUSNUT 1999 data. Input ofprofessional judgment and incorporation of Australian food composi-tion data within the database will optimise the accuracy of intakeestimates when using the proposed tool. Ultimately, it is anticipated thatthe eFood traka will provide a more efficient and accurate means ofdietary assessment in clinical and research settings.

Contact author: Clare Ferguson – [email protected]

63. SUPPORTING AN ENVIRONMENTALLYSUSTAINABLE FOOD SUPPLY: RESULTS OF THEECO-FRIENDLY FOOD GROUP CHALLENGEBARBARA RADCLIFFE1, LARA BORGES2, NICCI WATT2

1Nutrition Promotion Unit, Metro South Hospital& Health Service, EightMile Plains, QLD 4113, Australia2QueenslandUniversity of Technology, Kelvin Grove, QLD 4509, Australia

Climate change is an immerging issue relating to food security world-wide, while the food system contributes around 25% of Australia’sgreenhouse gas emissions. The Eco-friendly Food Challenge assistsindividuals to minimise their food-related environmental impact byparticipating in four, one week challenges. These focus on reducing

food-related waste contributing to landfill, eating seasonal and locallyproduced fruit and vegetables, buying more Australian produced pantryitems and consuming more sustainable protein sources. The challenge ispublished on the Eco-friendly Food Website. The 2012 Eco-friendlyFood Group Challenge targeted DAA members, QUT nutrition anddietetics students, Queensland Nutritionists and visitors to the Eco-Friendly Food website and Facebook page. This project included aliterature review, resource kit development and the creation of registra-tion and post challenge evaluation surveys, weekly e-mails and blogs. Atotal of 270 people registered, with 84 completing the Post ChallengeEvaluation Survey. Feedback on the overall challenge was positive, with76% of respondents reporting that they enjoyed the experience. Thesame percentage reported they would enrol for a similar food challengein the future. Behaviour change was also reported. For example, 96% ofthose participating in the Week 1 Challenge reported reductions inweekly landfill waste, with a mean volume decrease of 44%. Eighty-fivepercent of respondents reported a high or very high likelihood ofmaintaining these reductions. The Eco-friendly Food Group Challengewas an efficient and effective way to reduce the food-related environ-mental impact of interested individuals. Incorporating the Challengeinto university nutrition and dietetics curriculum is recommended.

Contact author: Barbara Radcliffe – [email protected]

160. LOOKING BACK, LOOKING FORWARD:MEETING THE FUTURE CHALLENGES OFPROVIDING HIGH QUALITY STUDENTPLACEMENTS IN COMMUNITY NUTRITIONBARBARA RADCLIFFE1, LEIGH BRAMWELL1,DANIELLE GALLEGOS2

1Nutrition Promotion Unit, Metro South Hospital & Health Service, EightMile Plains, QLD 4113, Australia2Queensland 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, thefuture challenge is to provide high quality placements that improveorganisational productivity, are efficient in terms of resource use, andenhance the supervisors’ long term capacity. The Nutrition PromotionUnit in Metro South Hospital Health Service supervises approximately20 students per year. The aim of this ongoing project is to use acontinuous quality improvement framework to evaluate and improvestudent placements in partnership with university colleagues. Methodsused included a literature review, ethics approval, a visioning exercise bystaff on all aspects of student placements and the development andpiloting of evaluation tools. These included Survey Monkey surveyspost placement for students, supervisors and external project partners,student interviews and an Excel database. Data for 2012 were analysedfor frequency of response, while the answers to open questions werecollated and arranged into themes.

Student satisfaction levels were high with over 85% of respondentsreporting they felt valued and welcome members of the unit, foundstudent resources useful, and believed that supervisors providedadequate feedback and fair assessment. Large increases in theproportion of students considering work in community nutritionoccurred over the placement period. Feedback from students andsupervisors identified specific improvements required to studentplacement orientation and perceived gaps in students’ knowledge andskills. Supervisor and external project partner satisfaction levels werehigh. This project provides a model for improving student placementsand enhancing communication between universities and placementproviders.

Contact author: Barbara Radcliffe – [email protected]

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176. WHO IS SEEING THE DIETITIAN? WE AREONLY SEEING THE TIP OF THE ICEBERGREBECCA RAMSEY, PETER COLLINS, DANIELLE GALLEGOSNutrition & Dietetics, School of Exercise & Nutrition Sciences, Faculty ofHealth, Queensland University of Technology, Brisbane, QLD 4059,Australia

Poor dietary choices are associated with overweight and obesity and thedevelopment of chronic conditions. Over 12 million (~60%) Australiansare currently overweight or obese. Accredited Practicing Dietitians(APDs) are the experts in nutrition and diet therapy, equipped toprovide services and counselling to assist individuals in making dietarymodifications to prevent or manage diet-related conditions. However,no existing research has investigated the proportion or characteristics ofthe Australian population that may be accessing APDs. Data from25,906 participants in the 2004/05 National Health Survey (NHS) wereanalysed using logistic regression to identify the sociodemographic andhealth characteristics of individuals accessing an APD or Nutritionist.Only 0.4% (n = 105) of the sample reported accessing a Dietitian orNutritionist, this was half the amount accessing a Naturopath. DiabetesMellitus, cardiovascular disease and obesity were all significantly asso-ciated with having seen a Dietitian, and over 90% of those accessingservices had a long-term condition. Of the total sample only 10% ofthose with a diet-related condition had seen an APD or Nutritionist.Household income and education were not associated with accessing anAPD. Exploration around the barriers to referral and accessing servicesmay be warranted to assist in enhancing the profile of APDs among thepopulation and other healthcare professionals. The current number ofapproximately 5000 registered APDs is unlikely to be able to service theproportion of the population who require dietary intervention; furtheravenues for prevention, rather than acute treatment, and novel strategiesfor service provision also need to be explored.

Contact author: Rebecca Ramsey – [email protected]

165. PHASE 1 FEASIBILITY STUDY TODETERMINE WHETHER PATIENTS CANCONSUME BOTH THE CARBOHYDRATE (CHO)LOADED DRINK, PREOP® AND THEIMMUNE-NUTRITION DRINK, IMPACT®PRE-OPERATIVELY AS PART OF THE ERASPATHWAYCANDICE RAY1, CELIA DURIE1, TERESA ORSINI1,LORETTA BUFALINO2

1Dandenong Hospital, Southern Health, Dandenong, VIC 3175, Australia2John Fawkner Private Hospital, Healthscope, Coburg, VIC 3044, Australia

Major colorectal surgery (CRS) decreases immune function placingpatients at risk of post-operative inflammation and infection. The estab-lished Enhanced Recovery After Surgery (ERAS) program at Dandenonghospital aims to modulate peri-operative and post-operative care in anattempt to minimise metabolic stress, accelerate recovery and reducehospital length of stay (LOS). ERAS also aims to decrease peri-operativefasting with the use of PreOp® CHO loading drinks, allowing earlyre-establishment of post-op oral feeding. Recent research has focused onpre-operative oral immune-nutrition (IMPACT®) and the benefit ofimproving the body’s response after surgery. There is yet to be researchthat assesses IMPACT® and PreOp® in combination, and its influenceon patient outcomes postoperatively such as complication rates andLOS. Phase 1 of this 3 tier study was to determine if it was feasible forCRS patients to consume pre-operatively both IMPACT® and PreOp®,establish compliance rates and refine methodology in preparation forthe phase 2, pilot study. Dietitians assessed patients in the surgicalreview clinic and provided instructions about the pre-operative nutri-tional supplements; doctors were advised to request for nutrition relatedblood 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 thatpatients can consume both pre-operative supplements however; unclearpre-admission instructions were one of the major reasons to non-adherence to protocol. Refining the study methodology with key stake-holders will be a primary aim prior to the commencement of the pilotstudy.

Contact author: Candice Ray – [email protected]

25. IMPROVING THE DIETETIC REFERRALPATHWAY FOR ONCOLOGY OUTPATIENTSJENNA RILEY, HELEN SHEEHANPeninsula Health, Frankston, VIC 3199, Australia

Malnutrition is a major problem particularly in high risks groups suchas oncology; a recent study in Peninsula Health showed a malnutritionrate of 41% in oncology patients.

There is high level evidence which has demonstrated that earlydietetic intervention promotes better patient outcomes by assisting inthe prevention of the development of cachexia and associatedmalnutrition. The current nutrition oncology clinic at Peninsula Healthis underutilised due to poor referral processes and a lack of awareness ofthe clinic. The aim of this project is to improve the referral process to thenutrition oncology clinic to enable screening of all high-risk patients,prior to commencing treatment. The current process for admission ofoncology outpatients was mapped out using a Visual Stream Map(VSM). Through regular meetings with various stakeholders, the mosteffective time, location, process and referral pathway for nutritiononcology clinic was determined, using data from the VSM. TheNutrition Oncology Clinic is now running weekly on a Friday morningin conjunction with the medical oncology clinic. A referral flowchart hasbeen developed and disseminated through MDT meetings anddiscussion with stakeholders. Effective use of this clinic throughimproved referral processes should allow earlier dietetic intervention foroncology outpatients. Referral rates, malnutrition prevalence, level ofdietetic input and clinic attendance will be evaluated after a 9 monthperiod.

Contact author: Jenna Riley – [email protected]

152. THE IMPACT OF THE CALORIC INTAKEPRESCRIBED DURING REFEEDING ON WEIGHTRESTORATION IN CHILDREN ANDADOLESCENT INPATIENTS WITH ANOREXIANERVOSA: A SYSTEMATIC REVIEW OF THEEVIDENCETETYANA ROCKS1, FIONA PELLY1, PAUL WILKINSON2

1University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia2Dietitians Association of Australia, Canberra, ACT 2600, Australia

Weight restoration of underweight children and adolescents with ano-rexia nervosa (AN) is one of the principal priorities in inpatient settings.However, the empirical evidence for the most effective method of weightrehabilitation in this group is lacking. Thus, the aim of this study was tosystematically review, assess and summarize the available evidence onthe effect of differing caloric intakes prescribed during refeeding onweight restoration in hospitalised children and adolescents aged 19years and younger with diagnosed AN. Searches were conducted inScopus, Web of Science, Global Health (CABI), PubMed, and theCochrane 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. Therange of prescribed caloric intakes varied from 1000 kcal to over1900 kcal per day regardless of the feeding modality and were progres-sively increased during the course of hospitalization leading to weightrecovery in most patients. It appeared that additional tube feeding

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increased the maximum caloric intake and led to greater interim ordischarge weight, however this was also associated with a higher inci-dence of adverse effects. Overall, the level of available evidence waspoor, and therefore consensus on the most effective and safe treatmentfor weight restoration in inpatient children and adolescents with AN isnot currently feasible. Further research is crucial to establish the bestpractice approach to treatment of this population.

Contact author: Tetyana Rocks – [email protected]

92. ADDRESSING MALNUTRITION IN THEELDERLY: REFLECTIONS ON THE CHALLENGESOF PLANNING MULTIDISCIPLINARY RESEARCHFROM HOSPITAL TO HOMELAUREN 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, Australia2QueenslandUniversity of Technology, Kelvin Grove, QLD 4059, Australia3University of Queensland, St Lucia, QLD 4067, Australia4Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia

Malnutrition is common in the elderly and hospital admissions providean opportunity for identification and treatment. However, an agingpopulation, decreasing lengths of stay and increasing need forcommunity-based care challenges the delivery of high quality nutritionservices from hospital to home. The aim is to evaluate the process of aHospital 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, man-agers and clinicians across hospital and community services (nursing,medical, dietetic and consumer groups) were facilitated by the projectofficer over 12 months. Reflection on planning process – LOOK: engag-ing steering committee in mapping existing hospital, community anddischarge planning services identified significant gaps at the hospital-community interface, and generated desire for change by clinicians andmanagers. THINK: comprehensive mapping process informed thedesign of HHOME (interdisciplinary nutrition discharge planning, tel-ephone outreach to patient/carer by the hospital dietitian, increasedcommunication and referral to community for nutrition-related serv-ices). Potential barriers to effective implementation were identified andaddressed early through regular and targeted communication. Thegradual and systematic approach has facilitated acceptance of new proc-esses by staff. ACT: implementation and evaluation of nutritional andclinical outcomes during 2013. Developing a new model of care withbroad engagement and input from stakeholders helps build relation-ships and support for change. An action research approach provides apractical framework for understanding complex systems and facilitatingchange to clinical routines.

Funding sources: Grants from Queensland Health (Allied HealthWorkforce Advice and Coordination Unit Model of Care funding) andRoyal Brisbane and Women’s Hospital Foundation

Contact author: Lauren Rogers – [email protected]

93. CONFIDENT TO CHANGE: MALNUTRITIONEDUCATION AND EVALUATION FORCOMMUNITY NURSES AND PERSONAL CAREWORKERSLAUREN 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, Australia2Queensland University of Technology, Kelvin Grove, QLD 4059, Australia3University of Queensland, St Lucia, QLD 4067, Australia4Princess Alexandra Hospital, Woolloongabba, QLD 4102, Australia5Blue Care Northside, Everton Hills, QLD 4053, Australia

Malnourished older adults often receive home care from communityorganisations after hospital discharge. Nurses and personal care workers(PCWs) help clients undertake a range of nutrition related activitiessuch as meal preparation, feeding and shopping assistance, but may notreceive training in malnutrition and nutrition care. This project aimed todevelop, implement and evaluate an education strategy tailored forcommunity nurses and PCWs as part of the Hospital to Home Outreachfor Malnourished Elders (HHOME) program. Learning needs assess-ment surveys were completed by community nurses (n = 5) and PCWs(n = 30) from two non-government community organisations. Thesurveys were designed to determine perceived staff confidence in rela-tion to malnutrition and nutrition related activities, using a 5-pointLikert scale. Results informed development of separate group educationsessions for community nurses and PCWs. The education sessions usedcontemporary adult learning principles and an interactive format (iden-tifying knowledge gaps, group discussion and reflection on practice)rather than didactic teaching. A dietitian project officer conducted 5education 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, exceptwhere nurses were already “confident” in the pre-education survey.Median confidence levels in the PCWs group improved for all questionsfrom “some-what confident” to “confident” post education. Use of aformal learning needs analysis, adult education principles and evalua-tion of learning outcomes has provided an effective format for educationas an implementation strategy for a new care model.

Funding sources: Grants from Queensland Health (Allied HealthWorkforce Advice and Coordination Unit Model of Care funding) andRoyal Brisbane and Women’s Hospital Foundation

Contact author: Lauren Rogers – [email protected]

85. USE OF A PHOTOGRAPHIC FOOD DIARYMETHOD TO DOCUMENT DIETARY INTAKE INPEOPLE WITH PARKINSON’S DISEASEMEGAN ROLLO1, JAMIE SHEARD2, SUSAN ASH2

1University of Newcastle, Newcastle, NSW 2308, Australia2Queensland University of Technology, Kelvin Grove, QLD 4059, Australia

Cognitive impairment and physical disability are common in Parkin-son’s disease (PD). As a result diet can be difficult to measure. This studyaimed to evaluate the use of a photographic dietary record (PhDR) inpeople with PD. During a 12-week nutrition intervention study, 19individuals with PD kept 3-day PhDRs on three occasions using point-and-shoot digital cameras. Details on food items present in the PhDRsand those not photographed were collected retrospectively during aninterview. Following the first use of the PhDR method, the photographercompleted a questionnaire (n = 18). In addition, the quality of thePhDRs was evaluated at each time point. The person with PD was thesole photographer in 56% of the cases, with the remainder by the careror combination of person with PD and the carer. The camera was ratedas easy to use by 89%, keeping a PhDR was considered acceptable by94% and none would rather use a “pen and paper” method. Eighty-three

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percent felt confident to use the camera again to record intake. Of thephotos captured (n = 730), 89% were of adequate quality (items visible,in-focus), while only 21% could be used alone (without interviewinformation) to assess intake. Over the study, 22% of eating/drinkingoccasions were not photographed. PhDRs were considered an easy andacceptable method to measure intake among individuals with PD andtheir carers. The majority of PhDRs were of adequate quality, however inorder to quantify intake the interview was necessary to obtain sufficientdetail and capture missing items.

Contact author: Megan Rollo – [email protected]

140. FEED AND FEED PUMP COMPATIBILITYCAN COMPROMISE NUTRITION SUPPORT ANDINCREASE COSTS TO THE ICUJUSTIN SINGLETON1, KATIE SYLVESTER2

1John Hunter Hospital, Newcastle, NSW 2305, Australia2University of Newcastle, Callaghan, NSW 2308, Australia

Nursing staff in the John Hunter Hospital (JHH) ICU reported increasedoccurrence of pump alarms when feeding patients with Promote (readyto hang) since the introduction of the Covidien ePump. A 4-day audit offeed delivery to ICU patients was conducted to quantify the prevalence,frequency and impact on nutrition support of pump alarms. A trial of analternate feed, Nutrison Protein Plus Multi Fibre (PPMF) was conductedto evaluate its suitability as a replacement for Promote. Patients receiv-ing Promote (n = 19 patient feed days) had on average 5 pump alarmsper day, lost 51 minutes per day of feeding time from pump errors aloneand consumed 2 pump sets per day. These patients received on average81% of the daily energy goal and 89% of the daily protein goal. Patientsreceiving PPMF (n = 19 patient feed days) had no pump alarms, lost nofeeding time associated with pump alarms and on average consumed 1pump set per day. These patients received on average 93% of the dailyenergy goal and 87% of the daily protein goal. There were no majordifferences in the tolerance of the feeds in terms of gastric aspirates,bowel frequency and vomiting. Analyses of the cost associated withdelivering nutrition support to patients receiving Promote were esti-mated at $19.23 per day compared to $10.94 per day for patientsreceiving PPMF. The introduction of PPMF to replace Promote whenused with the ePump is a cost effective strategy to improve nutritionsupport goals.

Funding source: Feeds supplied by Nutricia Australia

Contact author: Justin Singleton – [email protected]

64. INNOVATIVE COMMUNITY ENGAGEMENTBUILDING TOMORROWS DIETITIANSKELLY SQUIRES, LEANNE BROWNThe 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 tradi-tional placement experiences in 2011. The introduction of multidisci-plinary collaboration with community groups demonstrated a highdemand for dietetic involvement. A dietetics academic was employed tocoordinate dietetic students’ community engagement activities duringtheir placement. This paper reports on experiences and feedback fromcommunity groups and students. Dietetics students undertaking a year-long placement option were able to volunteer to conduct a monthlyactivity with a community group. Half day activities were incorporatedinto short term placements. Session content was developed by thedietetics academic and students led the activities which were not for-mally assessed. As part of the quality project, students completed anonline evaluation at the end of placement. Written and oral feedbackfrom 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 in2011. Qualitative data indicated students valued interacting with com-munity groups and identified the activities were one of the most enjoy-able parts of placement. Feedback from community groups was positivewith requests for more cooking sessions. Groups also reported encour-aging aspects including increased exposure to health professionals andan increased awareness of health. This program has increased capacityto provide relevant community engagement activities for dietetic stu-dents that adds value to placement. Formal evaluations plan to furtherexplore the benefits to the community.

Contact author: Kelly Squires – [email protected]

206. AN EVALUATION OF FASTING PRACTICESAROUND SURGERY IN CRITICALLY ILLPATIENTS WITH BURN INJURIESLAUREN STRIBLEY1, ROSALIE YANDELL2,STEPHANIE O’CONNOR3, SELENA OOI2, ALISON SHANKS2,JOHN GREENWOOD4, MARIANNE CHAPMAN3

1Flinders University, Bedford Park, SA 5042, Australia2Department of Nutrition and Dietetics, Royal Adelaide Hospital, Adelaide,SA 5000, Australia3Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA 5000,Australia4Adult Burns Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia

Critically ill patients with burn injuries have increased energy and proteinrequirements for optimal wound healing and recovery. This patient groupoften requires numerous surgical procedures for skin grafts and woundexcisions. Although enteral feeding is traditionally ceased some timeprior to operative procedures, recent data suggest that it is safe to feed upto, and even during, an operation when no airway procedures arerequired. A nutrition therapy protocol was implemented following con-sultation with intensivists and anaesthetists in this ICU 4 years ago, inwhich it is recommended to cease feeding only immediately prior to apatient going to the operating theatre. The aim of this study was toinvestigate fasting procedures practised on patients with burns followingimplementation of this protocol. A case note and database audit wasconducted for 14 patients (13 M, age 44 � 4 years) admitted to the ICUwith 24 theatre excursions. Primary outcome measures were total time(hours) spent fasting pre, during and post theatre, and energy (kcal) andprotein (g) deficit due to enteral nutrition interruptions for theatreexcursions. This study found the median (IQR) time spent fasting was 9.5hours (10) per trip to theatre, amassing a 1350 kcal (1616) energy and57 g (73) protein deficit. This study demonstrates that patients continueto be fasted unnecessarily despite a nutrition therapy protocol being inplace. This is potentially due to inconsistency of Specialists’ orders thatdisagree with the protocol. Ongoing education and auditing may improveprotocol adherence and reduce avoidable fasting.

Contact author: Lauren Stribley – [email protected]

139. CHALLENGES OF IMPLEMENTING APEER-LED NUTRITION INTERVENTIONPROGRAM IN PRIMARY SCHOOLSCALLI STRONGYLOSSouthern Primary Health, Southern Adelaide Local Health Network,Noarlunga, SA 5168, Australia

There is considerable evidence that supports the effectiveness of nutri-tion peer-led programs in schools however there are challenges inembedding them within primary schools. It is imperative to identify thelevers and potential strategies to overcome these challenges to enablesuccessful integration of healthy eating interventions in the school envi-ronment. The eat well peer leadership program involved training upperprimary students from 10 schools in the southern area of Adelaide to

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become student leaders in healthy eating and lead activities with theirpeers with the support of a designated teacher and a Dietitian. Feedbackwas sought from a sample of teachers that were involved in the programvia semi-structured interviews and school observations. Identified leverswere the Eat Well SA Schools and Preschools Healthy Eating Guidelinesand the Health Promoting Schools Framework which promote collabo-rative partnerships between the health and education sectors. The chal-lenges were variable leadership support, teacher capacity, cost ofimplementing food based activities and the voluntary nature of theabove-mentioned documents. These challenges can be addressed bygenerating support for nutrition from the school leadership team, align-ing the program objectives with school priority areas, identifying teach-ers that value nutrition and have some non-instruction time in their roleand creating fundraising opportunities. Another highly valued strategywas the collaborative partnership with the health service to hold pro-fessional development days for teachers with opportunities to networkand share resources. Despite the challenges, teachers articulated a strongcommitment to promoting healthy eating initiatives and the health andwellbeing of students.

Contact author: Calli Strongylos – [email protected]

40. INTERVENTION STUDY PARTICIPANTS: IT’SNOT JUST A WEIGHT ISSUEREBECCA THORNE, YASMINE PROBST, LINDA TAPSELLSmart Foods Centre, University of Wollongong, NSW 2522, Australia

In 2012, the Australian Health Survey reported that 63.4% of Australianadults are overweight or obese1 and therefore have an increased risk ofdeveloping lifestyle related diseases such as coronary heart disease andtype 2 diabetes mellitus.2 Metabolic syndrome (MetS) is a conditionused to group individuals with a cluster of risk factors including centralobesity, high blood pressure, raised fasting glucose and dyslipidaemia.3

This retrospective study aimed to determine the occurrence of MetS inparticipants of four intervention study datasets from the Illawarra regionof NSW. Individuals were grouped using the International DiabetesFederation (IDF) worldwide definition for MetS.3 Anthropometric(waist circumference, weight and height), blood pressure and blood(fasting glucose, triglycerides and HDL cholesterol) data collected atbaseline (t = 0) for each study and analysed using SPSS for Windows.Data for n = 408 (female n = 281, male n = 127) participants wereclassified as overweight or obese (BMI � 25 kg/m2; mean = 29.95 �3.77) according to WHO. The mean waist circumference for males andfemales was 103.0 (�10.8) cm and 96.6 (�12.1) cm, respectively.Central obesity was the predominant risk factor occurring in the studypopulation, with 90.9% (n = 371) of all participants meeting the crite-ria. 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 researchhighlights the vast numbers of the overweight/obese population whomay be suffering from more than a weight issue, with around one thirdof this study population identified as having MetS placing them at aheightened risk of developing lifestyle related diseases.2

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

Corresponding author: Rebecca Thorne – [email protected]

References1. ABS. Australian Health Survey: First Results, 2011–2012. Canberra

2012.2. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and manage-

ment of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute scientific statement.Circulation. 2005; 112: 2735–52.

3. Alberti KGMM, Zimmet P, Shaw J. Metabolic syndrome – A newworld-wide definition. A consensus statement from the InternationalDiabetes Federation. Diabetic Medicine. 2006; 23: 469–80.

90. AN EXPLORATION OF DIETETIC STUDENTLEARNING THROUGH PARTICIPATION IN AUNIVERSITY RUN WEIGHT MANAGEMENTCLINICJUDITH TWEEDIE, ELIZABETH SWANEPOEL, JUDITH MAHERUniversity of the Sunshine Coast, Sippy Downs, QLD 4567, Australia

University based nutrition and dietetic clinics are being developed inAustralia to provide work-based practical experience and develop place-ment capacity. It is important to understand the contexts in which theseclinics operate and the impact of these on student learning. In 2011 theUniversity of the Sunshine Coast commenced a curriculum basedweight management clinic, to provide Bachelor of Nutrition and Dietet-ics students with an experiential learning opportunity to practice diethistory interview skills on “real” clients, prior to clinical placement. Thisstudy aimed to explore the impact of participating in the weight man-agement clinic on student’s confidence and recognition of skills neededfor practice, and explore students overall experience of attending theclinic. Using a qualitative study design of focus group discussions thir-teen students (43% of total enrolments) participated in this study.Thematic analysis revealed that the clinic increased their perceivedconfidence to perform diet histories, in particular for future interview-ing of real clients. Constructive feedback from the clinic supervisor,student self-reflection, and role modeling by the clinic supervisorenabled students to recognise skills required for practice, such as inter-personal communication, relationship building and food knowledge.Other key themes that emerged were the impact on student’s profes-sional identity, identification of the nuances of “real” client-health prac-titioner interactions and the application of learned theory in a real-lifecontext. These findings support the evidence that dietetic curriculumshould provide opportunities for students to acquire people-relatedskills early in their course and develop confidence in those skills that arecrucial to practice.

Contact author: Judith Tweedie – [email protected]

155. DEVELOPMENT AND RELATIVE VALIDITYOF A NEW FIELD INSTRUMENT FORDETECTION OF GERIATRIC CACHEXIA:PRELIMINARY ANALYSIS IN HIP FRACTUREPATIENTSANTHONY M VILLANI1, MICHELLE D MILLER1,IAN D CAMERON2, SUSAN KURRLE3, CRAIG WHITEHEAD4,MARIA CROTTY4

1Department of Nutrition and Dietetics, School of Medicine, FlindersUniversity, Adelaide, SA 5001, Australia2Rehabilitation Studies Unit, University of Sydney, NSW, Australia3Hornsby Ku-Ring-Gai Hospital, NSW, Australia4Department of Rehabilitation and Aged Care, Flinders University,Adelaide, SA 5001, Australia

Geriatric cachexia is distinct from other age-related muscle wastingsyndromes however detection and therefore treatment is challengingwithout the availability of valid instruments suitable for application inthe clinical setting. This study assessed the sensitivity and specificity ofa newly developed screening instrument utilising portable assessmentsagainst previously defined and commonly accepted diagnostic criteriafor detection of geriatric cachexia. Cross-sectional analyses from 71older adults post-surgical fixation for hip fracture were performed. Thediagnostic 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 circum-ference (MUAMC) and the Simplified Nutritional Appetite Question-naire (SNAQ) respectively to create a field instrument suitable forscreening geriatric cachexia. Sensitivity, specificity, positive and negativepredictive values were calculated.

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

Funding source: National Health and Medical Research Council

Contact author: Associate Professor Michelle Miller – [email protected]

121. EXPLORING NEW FRONTIERS: USINGINTERNATIONAL DIETETIC AND NUTRITIONTERMINOLOGY (IDNT) AND PES (PROBLEM,ETIOLOGY, SIGNS AND SYMPTOMS) DIAGNOSESSTATEMENTS WITHIN DIETETIC GROUPFORMATSANGELA 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 standardAustralian nutrition care approach in 2009. Dietetic service provision ingroups is both cost effective and enables valuable patient supportthrough shared experiences. This study explored IDNT diagnosesimplementation into multidisciplinary outpatient group interventions.Over three years, the authors implemented and refined processes forgenerating individuals PES statements during weight management andhealthy lifestyle modification groups. Program content and outcomemeasures were assessed to determine potentially appropriate PES state-ments. Increasingly simplified processes were trialled, refined andimplemented utilising existing program content and state-wide outcomemeasures for determining individual’s PES within a multidisciplinarygroup setting. Iterations produced a simple, efficient and practicalmeans of completing individual PES within healthy lifestyle groups. Keysuccess strategies included the reduction from several possible ‘prob-lems’ to a single universal diagnosis of Overweight/obesity (NC3.3) withthe patients’ self identified contributors to their obesity (eg inadequatephysical activity, behavioural issues) documented as aetiology. Waist:hipratio and weight measurements were simple and sustainable “signs” foroutcome evaluation. These refinements enabled feasible and simplifiedmedical chart entries incorporating PES. Persistence accomplished afinal product that successfully attained timely chart entries; eliminatedextra data collection, maintained standardised state-wide patient gener-ated outcome measures and remained consistent with the multidiscipli-nary program’s philosophy of counselling vs education throughincorporating patient identified aetiology. We have demonstrated for thefirst time that with trial and error and collaboration, PES statements canbe successfully applied to individuals within group interventions utilis-ing existing data and program content.

Contact author: Angela Vivanti – [email protected]

178. SECONDBITE’S FRESH FOOD TRAININGCREATES VALUABLE LINKS BETWEENPRACTITIONERS, COMMUNITY FOODPROGRAMS AND FOOD INSECURE INDIVIDUALSTHROUGHOUT AUSTRALIALIZA WALLIS1, REBECCA LINDBERG1, RUSSELL SHIELDS1,ANISHYA GANGADHARAN2, ALEXIS LETTERS-HAYDOCK2

1SecondBite, Kensington, VIC 3031, Australia2Monash University, Notting Hill, VIC 3168, Australia

SecondBite’s fresh food training, developed in partnership with theTasmanian Community Nutrition Unit, aims to support staff and vol-unteers from the community sector, welfare organisations, schoolsand/or health services who Community Food Programs that providesubsidised or free food to people in need. SecondBite’s training consistsof theory and practical tools related to food security, nutrition, foodsafety, food preparation and food service monitoring. As SecondBiteexpands its fresh food rescue operations across the nation, so too doesthe opportunity to offer this training throughout Australia. In August2012, with the support of the Dietitians Association of Australia, Sec-ondBite disseminated a national survey to Dietitians and Nutritionists todetermine the feasibility of a train-the-trainer model of delivery for thisfresh food training. Of the 114 respondents, representing each state andterritory, 71% stated they do not currently work in collaboration withCommunity Food Programs in any capacity, and 79% revealed a need toimprove the nutritional quality of food provided to individuals experi-encing food insecurity. 68% of respondents sought a blended approachof face-to-face and online training and respondents suggested that facili-tators could include dietitians, nutritionists, health promotion officers,Aboriginal health workers and other suitable practitioners. Interviewsconducted with 12 online survey participants provided further insightinto methods for involving facilitators without a strong nutrition back-ground and those working in rural and regional areas. Base on thisevidence, SecondBite will develop a train-the-trainer program, encour-aging links between practitioners, their local Community Food Pro-grams and ultimately, food insecure individuals throughout Australia.

Contact author: Liza Wallis – [email protected]

180. SECONDBITE FILLS A CRITICAL TRAININGNEED FOR STAFF AND VOLUNTEERS TOPROVIDE HEALTHY, SAFE AND CULTURALLYINCLUSIVE FOOD TO PEOPLE IN NEEDREBECCA LINDBERG1, SARAH CONNALLY2, LIZA WALLIS1,PAT BURTON1, CARMEL GRUBB2

1SecondBite, Kensington, VIC 3031, Australia2Community 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 FoodPrograms throughout Tasmania. Community Food Programs are initia-tives that provide free or subsidised food to individuals experiencingfood insecurity. An online organisational survey (n 35), face-to-faceconsultations with expert stakeholders (n 4) and consultations with theCommunity Food Program workforce (n 11) were conducted. Resultsrevealed an unmet need to build food skills and nutrition capacity in thestaff and volunteers who provide food to people in need throughoutTasmania. In response, SecondBite and the CNU developed a fresh foodtraining program consisting of theory and practical tools related to foodsecurity, nutrition, food safety, food preparation and food service moni-toring. Evaluation from 12 Community Food Programs involved in thetwo-year pilot revealed that participants have adopted new practices toimprove the nutritional quality of food served, the utilisation of fruit andvegetables increased and food service delivery statistics are beingreported according to the core food groups. In 2013, integrating rec-ommendations from pilot participants, SecondBite’s training will berolled our nationally. A train-the-trainer model will increase the capacity

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of the Australian community and health workforce to collaborate withtheir local Community Food Programs and food insecure communitymembers. Evidence suggests that staff and volunteers operating Com-munity Food Programs want to provide more than food to their com-munity. They want the tools and capacity to become intervention siteswhich will ultimately improve the long-term health outcomes of Aus-tralian’s experiencing food insecurity.

Contact author: Liza Wallis – [email protected]

68. INFLUENCES ON OPENABILITY OFHOSPITAL FOOD AND BEVERAGE PACKAGINGBY THE ELDERLY: THE ROLE OF DEXTERITYAND POSTUREKATE MORSON, ALISON BELL, KAREN WALTONSchool of Health Sciences, University of Wollongong, Wollongong, NSW2522, Australia

Food and beverage packaging has been identified as a contributingfactor to malnutrition among elderly patients in hospitals. This studyaimed to determine whether there is a correlation between dexterity andthe ability to open ‘problematic’ packaging and examine the effect ofbeing in a hospital bed on dexterity and this. A total of 37 participantswere randomly allocated to begin the research in either a lying or seatedposture. Dexterity and grip strength were measured, then participantswere asked to open up to 7 assorted hospital food and beverage items ineach posture. SPSS statistical program was used to analyse the data.Spearman Rho correlation data showed that there was a moderatenegative correlation between dexterity and ‘time to open’ food packagesconsistently for the tetra packs and boxed cereal and a strong negativecorrelation for the custard. For other food items there was no/weakcorrelation. Wilcoxon Signed Ranks Tests showed that although therewas a significant difference in dexterity scores between the seating andlying postures there was no statistically significant difference, in bothtime and attempts to open each product, between the two positions. Itis seen that dexterity levels can impact on an elderly person’s abilityopen certain food packages. However, lying in a hospital bed does notappear to impact on this. These results could be used to advise foodpackaging designers in order to make food more accessible to individu-als with lower dexterity levels which could improve nutrition to the over65 year population.

Contact author: Kate Morson – [email protected]

129. IMPROVING NUTRITION THROUGH ASOCIAL INCLUSION FRAMEWORKALISON WARD, JULIE WILLIAMS, SARAH CONNALLYPopulation Health, Department of Health and Human Services Tasmania,Hobart, TAS 7000, Australia

There is a strong association between level of socio economic disadvan-tage and prevalence of food insecurity. Tasmania has high level ofdisadvantage compared to other states. The development of the Food forAll Tasmanians: A food security strategy for Tasmania, by the TasmanianFood Security Council (TFSC) through a cross sectorial collaborativeapproach aims to provide a frame work to strategically address thedeterminants of food security. The opportunity for the Physical andCommunity Unit from the Department of Health and Human Services towork collaboratively with Department of Premier and Cabinet’s SocialInclusion Unit has allowed for ongoing relationships to be established.So far this has delivered more strategic investment to address communityfood security through a community grant round. Delivering better foodaccessibility and affordability particularly of fresh produce and buildingcommunity capacity through community driven solutions provides theopportunity to improve nutritional well-being and social inclusion.

Contact author: Alison Ward – [email protected]

200. INTERPRETATION AND PRACTICALAPPLICATION OF THE NEW AUSTRALIANDIETARY GUIDELINES FOR EARLY CHILDHOODSERVICESJEMMA WATKINS, MARGARET ROZMAN, JESSICA KEMPLERNutrition Australia Victorian Division, Carlton, VIC 3053, Australia.

Supporting children’s nutrition needs in early childhood is crucial tolong term health outcomes. To address this, the Healthy Together Vic-toria – Healthy Eating Advisory Service (HEAS) was established as partof the Victorian Healthy Together Communities strategy, to providehealthy eating advice for early childhood services, primary and second-ary schools, hospitals and workplaces. One component of the HEASincludes supporting staff in long day care services to provide food anddrink consistent with the nutrition needs of children. This is also anaccreditation requirement of the National Quality Standard for earlychildhood services. Since the release of the revised Australian DietaryGuidelines (draft 2011), current menu planning guidelines have notbeen available to support staff providing food for long day care services.To fill this gap, the HEAS has developed Menu planning guidelines for longday care, which are consistent with the revised Australian Dietary Guide-lines and the Australian Guide to Healthy Eating. A review of Australianliterature and current programs targeting food provision in long day carewas undertaken. The findings support the provision of at least half ofchildren’s daily nutrition needs at morning and afternoon tea and lunch.The HEAS’s Menu planning guidelines reflect this and provide a frame-work for staff to create menus that are nutritionally sound, and promotefood variety and cultural diversity. Applying the Australian DietaryGuidelines was not easy. Challenges have included interpreting appro-priate serving sizes for children and the practicalities associated with theamount of food required to meet children’s needs.

Funding source: Department of Health, Victoria.

Contact author: Jemma Watkins – [email protected]

203. BETWEEN THE IDEA AND THE REALITY,BETWEEN THE MOTION AND THE ACT – FALLSTHE SHADOW – IMPLEMENTING NUTRITIONSTANDARDS FOR ADULT AND PAEDIATRICINPATIENTS IN NSW HOSPITALSCHERYL WATTERSONJohn Hunter Hospital Nutrition and Dietetics Department, Newcastle,NSW, Australia

NSW Agency for Clinical Innovation Nutrition Standards for adult andpaediatric inpatients in NSW Hospitals are the centrepiece of the man-datory NSW Health Nutrition Care Policy (PD 2011_078) dated 2011.The overall goal of the Standards is that “Hospitals in NSW will providesafe, nutritious and appetising high-quality meals of sufficient varietythat meets the needs and expectations of patients.” Menu design must bebased on the needs of the local hospital population. The standard menumust meet nutrient goals appropriate for age. The menu must offerpatients adequate, age-appropriate choice and variety in food selection.The implementation of these standards and specifications is being rolledout by NSW Health Shared Business Services Food Service Implemen-tation Project (FSIP) with a fully compliant menu. At present a menucompliant to the NSW Health Nutrition Standards is being implementedat a large tertiary hospital John Hunter Hospital (JHH) in NewcastleNSW. John Hunter Hospital shares a common menu with John HunterChildrens Hospital. The patient population ranges across all ages andstages, across acutely unwell to rehabilitation patients.

This paper presents an evaluation of the proposed new compliantmenu against the Nutrition Standards specifications. Whilst theevaluation finds that the standard default menu for adults meets mostnutrients goals, it is a concern that it has 37% excess sodium, 14% lessfibre, and 90% more saturated fat than specified. For the hospital’s

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paediatric population the standard menu fails to meet the specificationsfor variety and age appropriate foods.

Contact author: Cheryl Watterson – [email protected]

98. DOES GRIP AND PINCH STRENGTH AFFECTTHE OPENABILITY OF PACKAGES IN THE OVER65 YEAR OLD? A COMPARISON BETWEEN 2POSTURESNICOLA WESTBLADE1, ALISON BELL1, KAREN WALTON1,JACQUELINE CHEVIS2, KATE MORSON1

1School of Health Sciences, University of Wollongong, Wollongong, NSW2522, Australia2Wollongong Hospital, Illawarra Shoalhaven Local Health District,Wollongong, NSW 2521, Australia

Malnutrition in hospitals has been widely recognised as a significantburden to the patient and health system. Literature shows that physicalbarriers such as food packaging and positioning, can limit a patients’ability to access their food in hospital. This study aimed to identifywhether lying in a hospital bed has an effect on strength and the abilityto open problematic hospital food packaging in a well, independentliving elderly population. Each participant was tested in both a seatedand lying position. Grip and pinch strength were tested in both posi-tions; participants then opened seven packaged food items commonlyfound in the hospital. Statistical analysis was used to determine anysignificant differences between the data in the two positions and thestrength of association between all continuous variables.

Analysis showed a significant decrease in all pinch strength testswhen lying in the hospital bed. Correlations were consistently foundwith the foil sealed water and the inner bag of the cereal box,particularly for pinch strength when lying in the hospital bed. The mostproblematic packages to open in both postures were the tetra pack,honey sachet, the boxed cereal and the cheese portion. Pinch strengthwas found to be an important factor when opening hospital foodpackages and was affected by the position of the patient. Furtherresearch in this area is recommended in a more vulnerable populationwhich may be more representative of hospital demographics. Changesto package design are recommended to help improve access to food inhospitals.

Funding source: Faculty Research Grant, University of Wollongong

Contact author: Nicola Westblade – [email protected]

142. NOVEL PRESCHOOL PROGRAM IMPROVESYOUNG CHILDREN’S ATTITUDES TOVEGETABLES IN SOUTHERN ADELAIDECATHY WHITELEYSouthern 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 Chil-dren’s Nutrition and Physical Activity Survey. Familiarity strongly influ-ences young children’s choice of foods therefore early childhood is acrucial time for interventions that provide exposure to vegetables thatwill influence lifelong tastes. The Vegie Fun for Everyone pre-school basedprogram aims to develop a positive attitude towards vegetables foryoung children in a non-threatening and play based format. The sixweek program encourages children to explore vegetables leading topositive experiences, self-directed tasting and increases dialogue aboutvegetables between staff, children and families. During 2011–2012, 10programs were implemented at 7 preschools in low socio economicareas reaching almost 300 children. From the 122 parents surveyed itwas reported that over 70% of children were asking for and eating more

vegetables as a result of the program. Almost all of the children werereported to have had a positive experience and were more knowledge-able about vegetables. All 25 of the preschool educators surveyedbelieved the program was useful to children and over 90% reportedchildren were more familiar and more knowledgeable about vegetableswith an improved attitude to trying vegetables. The importance oftargeting young children with positive healthy eating programs is para-mount in the current obesogenic environment. This unique sustainableprogram and package for educators was embraced by the early child-hood sector and proved to be a successful way to engage difficult toreach families to promote vegetables.

Contact author: Cathy Whiteley – [email protected]

89. TIMELY MEALTIME ASSISTANCE IMPROVESPATIENT NUTRITIONAL INTAKE IN AN ACUTECARE HOSPITALGAIL WHITELOCK, ALISON SHANKSRoyal Adelaide Hospital, Adelaide, SA 5000, Australia

Malnutrition is prevalent in acute care hospitals and often goes unrec-ognised and untreated despite being associated with a number ofadverse clinical consequences. Lack of mealtime assistance has beenreported as a potential barrier to an adequate nutritional intake inhospitalised patients. Seventy observations of nutritional care weremade before and during mealtimes for patients previously identified bynurses as requiring mealtime assistance in an acute care hospitalbetween September 2011 and January 2012. Patient nutritional intakewas determined by means of visual estimations of plate waste andcompared with hospital standardised serves. Patients were categorisedinto four groups. Group A (n = 31) patients received mealtime assistancewithin 10 minutes of meal delivery; group B (n = 15) patients receivedmealtime assistance �10 minutes of meal delivery; group C (n = 16)patients received the incorrect type or no mealtime assistance and groupD (n = 8) patients ate independently. Mean energy intake (SEM) permeal in group A = 1290 kJ (106) which was significantly greater thangroup 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 signifi-cantly improves patient energy and protein intake.

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

Contact author: Gail Whitelock – [email protected]

99. THE EFFICACY, TOLERABILITY ANDCOMPLIANCE OF THREE KETOGENIC DIETSCINTHYA 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, NSW2522, Australia2Sydney Children’s Hospital, Randwick, NSW 2031, Australia3School of Women’s and Children’s Health, Faculty of Medicine, Universityof New South Wales, Kensington, NSW 2052, Australia

The ketogenic diet (KD) is a high fat, low carbohydrate and moderateprotein regimen for intractable epilepsy. This study evaluated the effi-cacy, 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 epilepsyreceiving the KD at a single centre between 2003–2012 was conducted.Patient demographics, epilepsy history, nutritional managementand side-effects were collated. The value of potassium citrate

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supplementation in decreasing incidences of nephrolithiasis was alsoreviewed.

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 durationor KD type did not predict seizure reductions (P = 0.381; P = 0.272).Hyperlipidemia (n = 33, 69%) and constipation (n = 31, 65%) were themost prevalent side-effects. Food refusal (n = 3, 6%) and poor parentalcompliance (n = 5, 10%) were among reasons cited for KD cessation.Nephrolithiasis was reported in one patient and another developedhypercalciuria; both patients were not compliant to potassium citratesupplementation. The classical, MCT and MAD were comparablyeffective in seizure control and generally well tolerated. Side-effectswere mostly not a deterrent to compliance. Potassium citratesupplementation appeared to be an effective prophylactic supplementfor the prevention of nephrolithiasis.

Contact author: Cinthya Wibisono – [email protected]

187. RELATIONSHIPS FIRST: WORKING INPARTNERSHIP TO ADDRESS HEALTHYLIFESTYLES IN ONE RURAL ABORIGINALCOMMUNITYANNABELLE WILSON1, SANDY WILSON2, JENNADENE SMITH2,SHARON PERKINS3

1Flinders University of South Australia, Adelaide, SA 5001, Australia2Aboriginal Primary Health Care Unit, Murray Bridge, SA 5253, Australia3Country Health SA Local Health Network, Murray Bridge, SA 5253,Australia

Working in partnership is a key element for addressing Aboriginalhealth and closing the gap, and is a challenge for today, tomorrow andthe future. This paper describes the partnership between anon-Aboriginal dietitian and an Aboriginal health service, and the learningsthat arose. The Aboriginal Primary Health Care Unit (APHCU) inMurray Bridge, South Australia, sought the services of a dietitian towork one day/ week with the local Aboriginal community. Existingrelationships between one dietitian and APHCU were initially utilised todevelop the position. The dietitian worked in partnership with Aborigi-nal staff to continue key programs, including the Ngarrindjeri Kids’ Caféfor primary school students which involved cooking and discussionsabout traditional Aboriginal food, and a cooking group for local women,where healthy lifestyles were discussed informally over food. For theAboriginal staff, the partnership reinforced the characteristics andapproaches that can be used by non-Aboriginal staff to work well inAboriginal health, including listening, working at the community’space and working in partnership. For the dietitian, it highlightedthe importance of developing relationships with Aboriginal peoplebefore addressing healthy lifestyles, ensuring programs are based oncommunity-identified, having time to build relationships and sharingthe same office space as other members of the APHCU team.

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

Contact author: Annabelle Wilson – [email protected]

190. TRUST MAKERS, BREAKERS AND BROKERS:BUILDING TRUST IN THE AUSTRALIAN FOODSYSTEMANNABELLE WILSON1, JOHN COVENEY1, JULIE HENDERSON1,SAMANTHA MEYER1, TREVOR WEBB2, MICHAEL CALNAN3,MARTIN CARAHER4, PAUL WARD1

1Flinders University of South Australia, Adelaide, SA 5001, Australia2Food Standards Australia and New Zealand, Canberra, ACT 7186,Australia3University of Kent, Canterbury, Kent CT2 7NF, United Kingdom4City University, Northampton Square, London EC1V OHB, UnitedKingdom

Trust in the food system influences food choice. Food scares have thepotential to disrupt consumer trust is food and therefore alter foodchoice; hence minimising the disruption of trust is important. Thepurpose of this paper is to identify and actors who can influenceconsumer trust in food and why this is important. Previous researchabout food and trust demonstrated that most Australian consumers trustthe food supply because they have no reason to distrust it. Key actorsinfluencing consumer trust were farmers, supermarkets, politicians andthe media. In this study, a literature review was undertaken to explorethe previous research in the context of food scares. Key words searchedwere food, trust, scare, and incident. The literature review supportedprevious research, suggesting a powerful role for media with the poten-tial to break consumer trust in food, especially during food scares (trustbreakers). The role of regulatory bodies and policy makers in formingtrust (trust makers) and public relations and consumer organisations inrepairing trust (trust brokers) was identified.

However, how these different actors support or erode public trust inthe food supply is unclear. Thus, further investigation into themechanisms of how different actors attempt to make, break or brokerpublic trust in food and the food system is important to allowdevelopment of practical and timely responses that minimise thedisruption of public trust in the case of food incidents, andconsequently minimal impact on consumer food choice. This is aparticularly relevant challenge for tomorrow, considering the impact ofglobalisation on the food supply, with the potential for global foodincidents to affect Australia and hence consumer trust in food.

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

Contact author: Annabelle Wilson – [email protected]

217. DO 1-HOUR BLOOD GLUCOSE VALUESMATTER? AN AUDIT OF PREGNANCYOUTCOMESCHARLOTTE 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, Australia2Joondalup 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 diagnosticcriteria for GDM currently used in practice. This audit examinedwhether women with elevated 1 h OGTT, but normal fasting and 2 hresults, had increased risk of adverse maternal or neonatal outcomes. Ina retrospective audit of clinical notes from 160 women attending Joon-dalup Health Campus Antenatal Clinic between 2006 and 2011, sub-jects 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 foetaloutcomes were collected. All women received regular antenatal care;those with GDM received additional individualised dietary advice. GDM

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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 wassimilar between groups (NGT 3416 � 545 g, 1 h 3512 � 511 g, GDM3275 � 425 g, p = 0.092). Preliminary analysis found no difference inoutcomes in those with 1 h, however, we cannot exclude differencesremaining undetected due to insufficient sample size. Compared tothose with NGT, women with GDM had similar sized infants, butshorter gestation and more admissions to special care nursery. Provisionof individualised dietary advice to women with GDM may benefit mater-nal rather than neonatal outcomes. Due to a small 1 h sample evidenceof increased risk of adverse maternal or neonatal outcomes remainsinconclusive.

Contact author: Hayley Parker – [email protected]

123. AUSTRALIA’S FIRST NATIONAL NUTRITIONPOLICY (NNP) (1978)BEVERLEY WOOD, HELEN RINGROSEConsultant, Carlton, VIC 3053, Australia

The Australian Association of Dietitians (AAD) was the first formalnational professional body for Australian Dietitians. At the time (1975),there was also increasing concern about the nutrition of Australians, andresources 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 gov-ernment, industry, academic, research, individuals and the media wereinvited through presentation and participation. This important leader-ship by the fledgling AAD was outlined in The Medical Journal ofAustralia (1979) and achieved media coverage. The Seminar recom-mended that AAD set up a Working Party to develop a Policy throughwide community and media consultation. This was finalised in 12months. The first set of nine dietary guidelines to provide guidance forAustralians was published – “Stop and think before you eat and drink”.Inclusion of a national nutrition education policy was also needed. Thiswork and advocacy by AAD and others prompted the CommonwealthDepartment of Health to act. Eight dietary goals were published forconsideration. The first Australian National Nutrition Policy was pub-lished in 1981 and the first set of eight Australian Dietary Guidelines in1982. Shortly afterwards, concerns began about some of the unexpectedoutcomes of the dietary guidelines – such as medicalisation of food, and

interpretation of the guidelines. It was also most unfortunate that it wasnot until 1989 that the NHMRC published the report “Implementingthe Dietary guidelines for Australians.

Contact author: Beverley Wood – [email protected]

202. ‘START RIGHT EAT RIGHT’; LEARNING’SFROM OVER 10 YEARS IN THE CHILD CARESECTORPAULA WOOD1, KATHERINE SIMPSON-GORE1,LOUISA MATWIEJCZYK2

1Southern Primary Health, Southern Area Local Health Network, MorphettVale, SA 5162, Australia2Southern Primary Health, Southern Area Local Health Network, Aldinga,SA 5173, Australia

‘Start Right Eat Right’ (SRER) is a South Australian state wide nutritionincentive award scheme which strengthens good nutrition practices inchild care centres and is now over 10 years old. Since the initiativebegan 313 of 355 (88%) SA long day child care centres have engagedwith SRER, and currently more than 70% are involved. This multi-strategy initiative has demonstrated that it can increase the capacity ofchild care staff to improve nutrition practices, provide healthy foodconsistent with national guidelines and provide a safe, supportive eatingenvironment. Mixed methodology, particularly qualitative methods, hasbeen used over the years to evaluate the effectiveness of SRER. A recentreview of these evaluations and studies has identified the enablers whichhave contributed to SRER’s longevity and success, particularly the strat-egies used to embed it within the early child hood sector. It has alsoidentified the challenges and barriers, and the solutions used overSRER’s history. SRER now faces its biggest challenge as state governmentfunded health promotion initiatives are being cut in the contractingeconomic climate, prompting the need for innovative solutions. Thisreview of a well-established and effective multi strategy initiativepresents a number of learning’s which will be of interest to any practi-tioner working in the early child hood realm or who are embarking onlarge initiatives which will occur over a number of years.

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

Contact author: Paula Wood – [email protected]

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