OBJECTIVES:To (1) explore the experiences and perceptions of older adults accessing an Australian Government Home Care Package (HCP), (2) understand how recipients prioritise their package expenditure, (3) understand the value that recipients place on food and nutrition services, and (4) understand the barriers and facilitators to spending on these services. METHODS:Semi-structured interviews were conducted with 15 HCP recipients aged 65 years or older located across Australia. Transcripts were analysed using Braun and Clarke's six-phase reflexive thematic analysis. RESULTS:Four themes were developed from 15 interviews: (1) Care, By Name or By Nature; (2) We Know What We Need, Just Listen; (3) The Struggles of Prioritising and Spending; and (4) Nutritional (Im)Balance. Participants experienced a lack of person-centred care in the HCP program, making it difficult to obtain services that met their care needs and preferences. For many, their package budget was insufficient, causing recipients to compromise on services required for safe, independent living. Nutrition was important to HCP recipients but was often not their main priority when prioritising their limited package funding. Nutrition was valued by HCP recipients but often deprioritised for more immediate care needs. CONCLUSION:It is apparent that changes to home care programs are required so recipients are at the centre of their care and have access to resources to help maintain their nutritional health and remain living independently at home. These insights can inform program and policy changes to better support older adults to age-in-place.

OBJECTIVES:The global population of people aged 60 years and above is growing. With this, there is a rising need for home care services and demand for online health information to facilitate the decision-making among older adults and promote consumer-directed care. This exploratory study aimed to examine how aged care provider websites present and structure information about Home Care Packages (HCPs) to support consumer decision-making. METHODS:A web-based content analysis of Australian provider websites was conducted by accessing websites using Google Chrome in incognito mode and using an evaluation tool that assessed language readability (Flesch Reading Ease and Flesch-Kincaid Grade Level scores), usability features Web Content (Accessibility Guidelines V2.0) and the relevance and depth of HCP information. Descriptive statistics were calculated using SPSSv.29. Qualitative data were analysed using deductive content analysis. Data were extracted into Microsoft Excel and deductively coded using the structured evaluation tool developed for this study. Coded content was then narratively synthesised, augmented by researcher notes and illustrative quotes. RESULTS:From 25 systematically sampled websites, the median Flesch Reading Ease score was 52.5 (IQR 12.52) corresponding to a high school reading level of 10th-12th grade. Most sites featured small text (n = 21) and inconsistent information regarding services, pricing and case management. None of the websites in this analysis was found to be both user-friendly and comprehensive in their HCP content. CONCLUSIONS:Poor usability and inconsistent information may limit older adults' ability to access and understand HCP details, reducing engagement with these online resources.

Objectives To explore the perceptions and experiences of healthcare professionals (HCPs) caring for older adults with cancer regarding dietary advice provision and dietetic referral. Methods Qualitative descriptive study providing rich descriptions of the experiences of multidisciplinary HCPs in providing care to older adults with cancer, excluding dietitians or nutritionists. Purposive and snowball sampling methods were used for recruitment. Semi-structured interviews and a focus group session were conducted. Data was analysed using qualitative content analysis. Inductive codes were generated, and codes representing factors influencing HCPs’ referral to dietetics and dietary advice provision were then mapped to domains in the Tailored Implementation of Chronic Diseases (TICD) checklist using a deductive approach. Results Twenty HCPs across various Australian healthcare settings participated, with a broad range of working experience (1.5 to 53 years) being interviewed. Most participants perceived their role in the provision of general dietary advice, and there was a consensus that nutrition is important. Key barriers (e.g. lack of time and resources, perceived lack of knowledge, scope of practice), including unique patient-related barriers (e.g. co-morbidities, fatalistic mindset), and key facilitators (e.g. need for education, evidence-based resources, multidisciplinary team approach) to dietary advice provision fell within five TICD domains (intervention, health professional factors, patient factors, professional interactions, incentives and resources). Common barriers (e.g. disconnections in multidisciplinary care, lack of structured referral pathways) and facilitators (e.g. clear referral pathways) to referral fell within four TICD domains (intervention, health professional factors, professional interactions, incentives and resources). Conclusion The barriers and facilitators to referral and provision of dietary advice by HCPs suggest the need for system-level changes via a multi-pronged approach. Simple and accessible nutrition resources, stronger nutrition education for HCPs, improved referral pathways and role clarity are required to support a multidisciplinary approach to nutritional care. More qualitative research on patient-level factors involving older adults with cancer is warranted.

AIMS:To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice. DESIGN:Multi-method study informed by participatory action principles. METHODS:Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October-December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis. RESULTS:Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the 'Context of Care' dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology. CONCLUSION:Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels-individual, team, unit/ward, organisational-identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery. IMPACT:Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings. REPORTING METHOD:This study is reported using the CROSS and SRQR guidelines. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

Age-related changes in physiological function and an older person's physical, social and economic environment can impact their nutritional intake and overall health. While it is well-established that social isolation and loneliness can contribute to decreased food intake, the evidence quantifying the association between nutritional and physical outcomes of older adults eating alone, versus with others, has yet to be synthesised. Therefore, this systematic review aimed to answer the question, "What is the association between nutritional and physical outcomes of community-dwelling older adults (aged ≥65 years) who eat alone, versus with others?" This systematic review followed the PRISMA guidelines. Four databases (MEDLINE, CINAHL, Scopus, PsycINFO) were searched to February 2025 to identify relevant publications. From 3759 articles identified, 24 fulfilled the inclusion criteria. These cross-sectional (n = 19), cohort (n = 4) or case-control (n = 1) studies were mostly of neutral methodological quality and reported on nutritional status, dietary intake, appetite, body mass index, weight loss, muscle mass and/or frailty. Five studies reported no negative associations between eating alone and these outcomes. The remaining studies reported significant negative outcomes for those who ate alone: (1) poorer diet quality and food diversity; (2) lower fruit, vegetable and meat intake; and (3) an increased risk of weight loss and frailty. Strategies targeting shared mealtimes for community-dwelling older people should be investigated to reduce the experience of eating alone and associated negative outcomes. Implications for dietetic practice, primary and preventative healthcare include screening of mealtime habits to determine nutritional risk, and monitoring of outcomes identified in this review.

Background/Objective: Low muscle mass and sarcopenia have been explored as risk factors for poor outcomes following vascular surgery. The findings have been variable. The use of a diverse range of techniques to identify low muscle mass is a confounder in establishing the true relationship between low muscle mass, sarcopenia and outcomes. Our aim was to establish if different scoring methods identified the same patients as sarcopenic. We also explored which method best predicted outcomes. Method: 70 patients undergoing vascular surgery were prospectively assessed for sarcopenia using dual-energy x-ray absorptiometry (DEXA) scan, grip strength and gait speed. These patients underwent abdominal CT imaging as routine care. The muscle mass of each patient was determined using DEXA and by both psoas muscle and total skeletal muscle area on CT, normalised for patient height (PMI and CT-SMI, respectively). Low muscle mass was defined by published age- and sex-specific cut-offs. Grip strength data was combined with muscle mass to define sarcopenic patients. One- and 3-year mortality and time to readmission was recorded. Conclusion and Results: 10-22% of patients had low muscle mass and 4-10% of patients were sarcopenic, depending on the method employed. PMI did not correlate with DEXA or CT-SMI for low muscle mass, but CT-SMI correlated with DEXA (p = 0.0007). For sarcopenia, CT-SMI and DEXA scoring correlated (p = 0.002); PMI correlated with CT-SMI (p = 0.0006) but not DEXA. Low muscle mass by PMI predicted 1-year mortality (p = 0.02, X2 = 5.34, Effect size = 1.04) but the applicability of this finding is limited by the diverse pathologies explored. No other method predicted 1- or 3-year mortality or readmissions in this heterogenous cohort. The psoas area did not correlate with muscle mass defined by DEXA or total lumbar skeletal muscle area. Low psoas muscle index may be an independent marker of poor outcome, unrelated to generalised sarcopenia, and this warrants investigation in specific pathologies. A lower total number of patients were sarcopenic than had been expected, emphasising the need to use population-based pre-defined cut-offs.

Abstract Context Atherosclerosis is a systemic pro-inflammatory and pro-oxidative disease, accounting for approximately a third of deaths globally. It has been proposed that omega-3s, through their antioxidant and anti-inflammatory properties, mitigate atherosclerotic disease progression. However, due to the systemic pro-inflammatory and pro-oxidative state of atherosclerosis, it is proposed that patients with atherosclerotic disease may have higher omega-3 requirements than the average requirement, due to increased nutrient utilization in anti-inflammatory and anti-oxidant processes. Objective The aim of this review was to determine what dose and duration of omega-3 supplementation is required to reach a therapeutic blood level of omega-3s (eicosapentaenoic acid ≥150 µg/mL or omega-3 index ≥8%) in people with chronic atherosclerotic disease. Data Sources This systematic review comprehensively searched MEDLINE, Emcare, Scopus, and CINAHL using key search terms for atherosclerotic disease, omega-3, supplementation, and blood levels of omega-3s. Data Extraction Two reviewers independently screened 529 randomized controlled trials (RCTs) supplementing omega-3s in patients with chronic atherosclerotic disease. Data Analysis In total, 25 journal articles from 17 original RCTs were included and assessed quantitatively. Supplementation at 1.8 g to 3.4 g per day for a 3-month–6-month duration, and at 4.4 g and above for as little as 1 month–6 months were identified as the most effective dosage ranges for increasing blood levels of omega-3s to therapeutic levels in people with atherosclerotic disease. Conclusions Consideration should be given to routine omega-3 supplementation and to increasing the omega-3 dietary recommendations and upper limits of daily intake to improve clinical outcomes and reduce the risk of cardiac mortality in this population.

Context Atherosclerosis is a systemic pro-inflammatory and pro-oxidative disease, accounting for approximately a third of deaths globally. It has been proposed that omega-3s, through their antioxidant and anti-inflammatory properties, mitigate atherosclerotic disease progression. However, due to the systemic pro-inflammatory and pro-oxidative state of atherosclerosis, it is proposed that patients with atherosclerotic disease may have higher omega-3 requirements than the average requirement, due to increased nutrient utilization in anti-inflammatory and anti-oxidant processes. Objective The aim of this review was to determine what dose and duration of omega-3 supplementation is required to reach a therapeutic blood level of omega-3s (eicosapentaenoic acid >= 150 mu g/mL or omega-3 index >= 8%) in people with chronic atherosclerotic disease. Data Sources This systematic review comprehensively searched MEDLINE, Emcare, Scopus, and CINAHL using key search terms for atherosclerotic disease, omega-3, supplementation, and blood levels of omega-3s. Data Extraction Two reviewers independently screened 529 randomized controlled trials (RCTs) supplementing omega-3s in patients with chronic atherosclerotic disease. Data Analysis In total, 25 journal articles from 17 original RCTs were included and assessed quantitatively. Supplementation at 1.8 g to 3.4 g per day for a 3-month-6-month duration, and at 4.4 g and above for as little as 1 month-6 months were identified as the most effective dosage ranges for increasing blood levels of omega-3s to therapeutic levels in people with atherosclerotic disease. Conclusions Consideration should be given to routine omega-3 supplementation and to increasing the omega-3 dietary recommendations and upper limits of daily intake to improve clinical outcomes and reduce the risk of cardiac mortality in this population.

PurposeSelf-Reporting using traditional text-based Quality-of-Life (QoL) instruments can be difficult for people living with sensory impairments, communication challenges or changes to their cognitive capacity. Adapted communication techniques, such as Easy-Read techniques, or use of pictures could remove barriers to participation for a wide range of people. This review aimed to identify published studies reporting adapted communication approaches for measuring QoL, the methodology used in their development and validation among adult populations.MethodsA scoping review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist was undertaken.ResultsThe initial search strategy identified 13,275 articles for screening, with 264 articles identified for full text review. Of these 243 articles were excluded resulting in 21 studies for inclusion. The majority focused on the development of an instrument (12 studies) or a combination of development with some aspect of validation or psychometric testing (7 studies). Nineteen different instruments were identified by the review, thirteen were developed from previously developed generic or condition-specific quality of life instruments, predominantly aphasia (7 studies) and disability (4 studies). Most modified instruments included adaptations to both the original questions, as well as the response categories.ConclusionsStudies identified in this scoping review demonstrate that several methods have been successfully applied e.g. with people living with aphasia post-stroke and people living with a disability, which potentially could be adapted for application with more diverse populations. A cohesive and interdisciplinary approach to the development and validation of communication accessible versions of QOL instruments, is needed to support widespread application, thereby reducing reliance on proxy assessors and promoting self-assessment of QOL across multiple consumer groups and sectors.

Identifying nutritional deficits and implementing appropriate interventions in patients requiring vascular surgery is challenging due to the paucity of appropriate screening and assessment tools in this group. This retrospective study aimed to determine the validity of the Global Leadership Initiative on Malnutrition (GLIM) in identifying protein-energy malnutrition (PEM) in inpatients admitted to a vascular surgery unit, using the PG-SGA as the comparator. Diagnostic accuracy and consistency were determined between the GLIM and the Patient-Generated Subjective Global Assessment (PG-SGA) global rating. The GLIM determination was made retrospectively using the relevant parameters collected at baseline in the original study. Two hundred and twenty-four (70·1 % male) participants were included. The prevalence of PEM was 28·6 % on GLIM and 17 % via the PG-SGA. Compared with the PG-SGA, the GLIM achieved sensitivity of 73·7 % and specificity of 80·6 %; however positive predictive value was 43·7 % indicating that the GLIM over-diagnosed malnutrition compared with the PG-SGA. Kappa reached 0·427 indicating moderate diagnostic consistency. Due to the absence of an ideal instrument and the complexity of malnutrition often seen in this group which extends beyond PEM to significant micronutrient deficiencies, further work is required to determine the most appropriate instrument in this patient group, and how micronutrient status can also be included in the overall assessment given the critical role of micronutrients in this group.

Background Teleconsultation via videocall by a dietitian may allow remote diagnosis of malnutrition amongst patients undertaking home rehabilitation; however, whether or not a physical examination can be performed accurately remotely has not yet been determined. Objective This study aimed to compare agreement between an in-person and videocall by a dietitian for overall physical assessment in patients admitted to a home rehabili-tation service. Design This was a cross-sectional diagnostic accuracy study. Participants and setting This study involved 71 adults admitted to the home reha-bilitation program at Flinders Medical Centre in Adelaide, South Australia, Australia, between September 2019 to November 2019 and August 2020 to November 2020. Main outcome measures Validity of the videocall by a dietitian to undertake a physical assessment was determined using an in-person physical assessment completed by a trained dietitian in the participant's own home. A dietitian blinded to the in-person assessment completed the physical examination via a videocall to determine the presence and degree of deficit at each anatomical site and make an overall physical assessment. Statistical analyses performed Percentage agreement, weighted kappa, sensitivity, and specificity were determined to assess agreement between videocall and in-person assessments undertaken by a dietitian. Results The overall videocall physical examination by a dietitian rating achieved a percentage agreement of 69.0% against the in-person assessment by a dietitian, with a weighted kappa agreement of 0.658 (95% CI 0.530 to 0.786), sensitivity of 87.5%, and specificity of 81.1%. Conclusions The substantial weighted kappa, good sensitivity, and specificity supports the use of the physical assessment in contributing to diagnosing malnutrition via vid-eocall in home rehabilitation settings. Services that are without a local dietetic work-force should consider using dietitians to undertake videocalls for the physical examination component of nutrition assessment to facilitate timely nutrition assess-ment and optimal nutrition interventions, as well as support review of nutrition in-terventions. J Acad Nutr Diet. 2023;123(8):1207-1214.

BACKGROUND:There is increasing provision of telehealth services, including nutrition services. However, remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status.OBJECTIVE:The aim of this study was to evaluate whether remote completion of the Patient-Generated Subjective Global Assessment physical examination using still images captured by allied health assistants (AHAs) is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service.DESIGN:This study was cross-sectional in design.PARTICIPANTS/SETTING:This study involved 104 adults admitted to the home rehabilitation service at Southern Adelaide Local Health Network, Adelaide, Australia, over 2 sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities.MAIN OUTCOME MEASURES:Validity of the still image-based physical assessment was determined using still images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-Generated Subjective Global Assessment.STATISTICAL ANALYSES PERFORMED:Percentage agreement, weighted κ, sensitivity, and specificity between the still image based and in-person physical examinations were determined to assess agreement between the 2 methods of assessment.RESULTS:The still image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted κ of 0.662 (95% confidence interval 0.516-0.808) and a sensitivity-specificity pair of 76.6% and 89.1%.CONCLUSIONS:Physical examination using still images collected by AHAs achieved percentage agreement, κ, and sensitivity and specificity compared with an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians; however, further work is needed to ensure dietitians are able to assess still images reliably.

Abstract Background As the need for health care services rise, alternative service delivery models such as student-led health interventions become attractive alternatives to alleviate the burden on healthcare. Predominantly, student-led health interventions were free clinics servicing socially disadvantaged communities in the USA. A 2015 systematic review identified that students value these student-run clinics and reported skill and knowledge attainment from participating. Previous research has reported on patient satisfaction outcomes, but less frequently about the clinical outcomes patients accrue from these student-delivered services. As cardiovascular disease is the leading cause of death worldwide, this review aimed to explore the effectiveness of student-led health interventions through examining their impact on objective clinical outcomes, using the case of patients at risk of, or with, cardiovascular disease. Methods A systematic literature search was conducted in eight electronic databases to identify student-led health interventions conducted on adults with a cardiovascular disease risk factor or established cardiovascular disease, and a clinical outcome of interest. Through double-blinded screening and data extraction, sixteen studies were identified for synthesis. Results The majority of student-led health interventions for patients at risk of cardiovascular disease demonstrated a positive impact on patient health. Statistically significant changes amongst patients at risk of cardiovascular disease appeared to be associated with student-led individualised intervention or group-based interventions amongst patients with diabetes or those who are overweight or obese. The evidence was of moderate quality, as included studies lacked a control group for comparison and detail to enable the intervention to be replicated. Conclusions Future research applying a student-led health intervention through a randomised control trial, with rigorous reporting of both student and patient interventions and outcomes, are required to further understand the effectiveness of this alternative service delivery model.

BACKGROUND AND OBJECTIVES Undernutrition in vascular surgery patients has a significant impact on clinical outcomes. This observational study aimed to investigate the nutritional status of a heterogeneous sample of vascular surgery inpatients and to determine the prevalence of nutritional risk, malnutrition (including nutrient deficiencies) and sarcopenia. METHODS AND STUDY DESIGN All participants were screened for risk of malnutrition using the Malnutrition Universal Screening Tool (MUST) and assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Micronutrient status was examined via plasma/serum samples. The presence of sarcopenia was explored using an accepted algorithm incorporating gait speed, muscle mass (DEXA) and grip strength. RESULTS 322 participants (69% male, mean age 67.6±14.1y) consented to the study. 12.5% were identified as at risk of malnutrition by the MUST while 15.8% were deemed malnourished by the PG-SGA. Only 5% were diagnosed as sarcopenic. Prevalence of malnutrition was much higher when micronutrients were examined with 79% showing low vitamin C, 56% low vitamin D and over 40% having low zinc, vitamin B-12 and folate. A smaller proportion were also low in selenium (19%). CONCLUSIONS Patients with vascular disease are a nutritionally vulnerable group. The MUST and PG-SGA did not identify the full extent of nutritional deficiencies. Further investigation is warranted to assess tool validity in this group. A number of micronutrients are crucial in these patients and hence a more comprehensive assessment that encompasses a wider range of parameters, including micronutrient status appears warranted.

Vascular surgery patients are nutritionally vulnerable. Various malnutrition screening and assessment tools are available; however, none has been developed or validated in vascular patients. The present study aimed to: (1) investigate the validity of four commonly administered malnutrition screening tools (Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Nutrition Risk Screen-2002 (NRS-2002) and the Mini-Nutritional Assessment - Short Form (MNA-SF) and an assessment tool (the Patient-Generated Subjective Global Assessment (PG-SGA)) compared against a comprehensive dietitian's assessment and (2) evaluate the ability of the instruments to predict outcomes. Vascular inpatients were screened using the four malnutrition screening tools and assessed using the PG-SGA. Each was assessed by a dietitian incorporating nutritional biochemistry, anthropometry and changes in dietary intake. Diagnostic accuracy, consistency and predictive ability were determined. A total of 322 (69·3 % male) patients participated, with 75 % having at least one parameter indicating nutritional deficits. No instrument achieved the a priori levels for sensitivity (14·9-52·5 %). Neither tool predicted EuroQoL 5-dimension 5-level score. All tools except the MNA-SF were associated with length of stay (LOS); however, the direction varied with increased risk of malnutrition on the MUST and NRS-2002 being associated with shorter LOS (P=0·029 and 0·045) and the reverse with the MST and PG-SGA (P=0·005 and <0·001). The NRS-2002 was associated with increased risk of complications (P=0·039). The MST, NRS-2002 and PG-SGA were predictive of discharge to an institution (P=0·004, 0·005 and 0·003). The tools studied were unable to identify the high prevalence of undernutrition; hence, vascular disease-specific screening and/or assessment tools are warranted.

OBJECTIVE:This study aimed to compare clinical outcomes of chemotherapy patients who received either a neutropenic diet (ND) or liberalised diet (LD) and to investigate associations between ND and infectious outcomes.METHODS:A retrospective case note audit of patients admitted to Flinders Medical Centre from 2013 to 2017 was conducted. Patients were eligible if they were aged 18 years and above, received chemotherapy and were neutropenic during admission. Demographic and clinical data were collected from medical records. Primary outcomes were occurrence of infections and fever. Secondary outcomes include hospital length of stay and infection-related mortality.RESULTS:Seventy-nine patients received ND while 75 patients received LD. The ND group had more patients with acute myeloid leukaemia (p < .001) and receiving high-toxicity chemotherapy (p = .005). Incidence of febrile neutropenia (p = .016), bacteraemia (p = .044) and number of febrile days (p = .033) was higher in the ND group. ND was not independently associated with occurrence of febrile neutropenia or infections. Subsample analysis of 20 pairs of patients matched on age, sex and cancer diagnosis found no significant differences in clinical outcomes between groups.CONCLUSION:ND was not associated with the prevention of adverse outcomes in chemotherapy patients.

Objectives: There are no agreed comprehensive tests for age-related changes to physical, emotional, mental and social functioning. Research into declining function focuses on those 75 years and older and little is known about age-related changes in younger people. The aims of this project were (1) to ascertain a comprehensive test battery that could underpin community-based health screening programmes for people aged 40–75 years and pilot both (2) community-based recruitment and (3) the utility, acceptability, response burden and logistics. Methods: A total of 11 databases were searched using a broad range of relevant terms. An identified comprehensive, recent, high-quality systematic review of screening instruments for detection of early functional decline for community-dwelling older people identified many relevant tools; however, not all body systems were addressed. Therefore, lower hierarchy papers identified in the rapid review were included and expert panel consultation was conducted before the final test battery was agreed. Broad networks were developed in one Australian city to aid pilot recruitment of community-dwellers 40–75 years. Recruitment and testing processes were validated using feasibility testing with 12 volunteers. Results: The test battery captured (1) online self-reports of demographics, health status, sleep quality, distress, diet, physical activity, oral health, frailty and continence; and (2) objective tests of anthropometry; mobility; lung function; dexterity; flexibility, strength and stability; hearing; balance; cognition and memory; foot sensation; and reaction time. Recruitment and testing processes were found to be feasible. Conclusion: This screening approach may provide new knowledge on healthy ageing in younger people.

Background Undernourished patients discharged from the hospital require follow-up; however, attendance at return visits is low. Teleconsultations may allow remote follow up of undernourished patients; however, no valid method to remotely perform physical examination, a critical component of assessing nutritional status, exists. Objective This study aims to compare agreement between photographs taken by trained dietitians and in-person physical examinations conducted by trained dietitians to rate the overall physical examination section of the scored Patient Generated Subjective Global Assessment (PG-SGA). Design Nested cross-sectional study. Participants/setting Adults aged >60 years, admitted to the general medicine unit at Flinders Medical Centre between March 2015 and March 2016, were eligible. All components of the PG-SGA and photographs of muscle and fat sites were collected from 192 participants either in the hospital or at their place of residence after discharge. Main outcome measures Validity of photograph-based physical examination was determined by collecting photographic and PG-SGA data from each participant at one encounter by trained dietitians. A dietitian blinded to data collection later assessed de identified photographs on a computer. Statistical analyses performed Percentage agreement, weighted kappa agreement, sensitivity, and specificity between the photographs and in-person physical examinations were calculated. All data collected were included in the analysis. Results Overall, the photograph-based physical examination rating achieved a percentage agreement of 75.8% against the in-person assessment, with a weighted kappa agreement of 0.526 (95% Cl: 0.416, 0.637; P<0.05) and a sensitivity-specificity pair of 66.9% (95% Cl: 57.8%, 75.0%) and 92.4% (95% Cl: 82.5%, 97.2%). Conclusions Photograph-based physical examination by trained dietitians achieved a nearly acceptable percentage agreement, moderate weighted kappa, and fair sensitivity specificity pair. Methodological refinement before field testing with other personnel may improve the agreement and accuracy of photograph -based physical examination.

BACKGROUND:Assessment presents one of the greatest challenges to evaluating health professional trainee performance, as a result of the subjectivity of judgements and variability in assessor standards. The present study aimed to test a moderation procedure for assessment across four independent universities and explore approaches to assessment and the factors that influence assessment decisions.METHODS:Assessment tasks designed independently by each of the four universities to assess student readiness for placement were chosen for the present study. Each university provided four student performance recordings for moderation. Eight different academic assessors viewed the student performances and assessed them using the corresponding university assessment instrument. Assessment results were collated and presented back to the assessors, together with the original university assessment results. Results were discussed with assessors to explore variations. The discussion was recorded, transcribed, thematically analysed and presented back to all assessors to achieve consensus on the emerging major learnings.RESULTS:Although there were differences in absolute scores, there was consistency (12 out of 16 performances) in overall judgement decisions regarding placement readiness. Proficient communication skills were considered a key factor when determining placement readiness. The discussion revealed: (i) assessment instruments; (ii) assessor factors; and (iii) the subjectivity of judgement as the major factors influencing assessment.CONCLUSIONS:Assessment moderation is a useful method for improving the quality of assessment decisions by sharing understanding and aligning standards of performance.

Objective: To examine dietary Na and K intake at eating occasions in Australian adults and identify the contribution of major food sources to Na and K at different earing occasions. Design: Secondary analysis of 24 h recall diet data from the Australian Health Survey (2011-2013). Setting: Nationally representative survey in Australia. Subjects: Male and female Australians aged 18-84 years (n 7818). Results: Dinner contributed the greatest proportion to total daily Na intake (33%) and K intake (35%). Na density was highest at lunch (380 mg/MJ) and K density highest at between-meal rime eating occasions (401 mg/MJ). Between-mea1 time earing occasions provided 20% of daily Na intake and 26% of daily K intake. The major food group sources of Na were different at meal times (breads and mixed dishes) compared with between-meal times (cakes, muffins, scones, cake-type desserts). The top food group sources of K at meal times were potatoes and unprocessed meat products and dishes. Conclusions: Foods which contributed to Na and K intake differed according to earing occasion. Major food sources of Na were bread and processed foods. Major food sources of K were potatoes and meat products and dishes. Public health messages that emphasise meal-based advice and diet patterns high in vegetables, fruits and unprocessed foods may also aid reduction in dietary Na intake and increase in dietary K intake.