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Rationale: With emerging evidence indicating vitamin C deficiency (VCD) is present in community settings of high-income countries, there is growing interest in understanding the prevalence of VCD during hospitalisation, in order to prevent deficiency progression to scurvy and other clinical outcomes associated with VCD. This study aimed to explore the prevalence of VCD in adult hospitalised patients, describe patient characteristics, and identify associated risk factors and clinical outcomes. Methods: A systematic scoping review was conducted following the PRISMA-ScR framework. Six databases were searched. Eligibility included hospital inpatients in high-income countries and VCD prevalence using World Health Organisation reference standards (plasma/serum concentration <11.4 μmol/L, whole blood <17 μmol/L). Cumulative prevalence of VCD in pooled studies was calculated using REVMAN 5.4. Results: Twenty-two studies from 8 countries were included, representing 23 articles. Cumulative prevalence of VCD was 26.6% (95% CI: 20.7-32.5; n=2494), prevalence was highest in patients with severe illness and poor nutrition status, and scurvy was present in 18-48% (n=581) of VCD patients. VCD status did not resolve during admission unless therapeutically replaced. Being retired (p=0.015), and taking excessive alcohol and tobacco (p=0.0003) were independent risk factors for VCD (n=184); clinical outcomes included increased risk of frailty (aOR 4.3, 95% CI 1.33-13.86, p=0.015) and cognitive impairment (aOR 2.93, 95% CI 1.05-8.19, p=0.031; n=160). Two studies examined nutrition associations with VCD (n=309); results were inconsistent. Conclusion: High prevalence of VCD exists in adult hospitalised patients in high-income countries. Research which focuses on early detection, and examination of VCD prevalence in a broader range of hospital settings and patient groups is warranted. Disclosure of Interest: None declared

Shift workers are known to have poorer metabolic health outcomes compared to day workers,(1) whilst those who work in rotating shift work roles have the highest risk.(2) To date, overall energy intake in shift workers has been found to be similar to day workers,(3) but it is unknown whether energy intake in workers on rotating shift schedules may be a contributing factor to the observed higher chronic disease risk. A systematic review and meta-analysis were conducted to explore how rotating shift work schedules impact total energy intake compared to fixed day/morning work schedules. Intra-person differences in energy intake amongst rotating shift workers on day/morning versus night shifts was also examined. Searches were conducted on CINAHL, Cochrane, Embase, MEDLINE PsycINFO and Scopus databases to identify articles reporting energy intake for rotating shift workers and fixed day workers. Articles were screened in duplicate against inclusion criteria using Covidence software. Data were extracted by one reviewer and checked independently by one of three reviewers. Quality assessment of included studies was assessed in duplicate using the American Dietetic Association (ADA) Quality Criteria Checklist for Primary Research. Meta-analyses were performed in RevMan using a random effects model, to compare mean difference in 24-hour energy intake with 95% confidence intervals. Heterogeneity was assessed with the I-squared test (I2). Thirty-one studies (n = 18196 participants) met the inclusion criteria and were included in the review with data for the two meta-analyses comprising 18 studies and seven studies, respectively. Overall, rotating shift workers had significantly higher average 24-hour energy intake compared to fixed day or morning work schedules (weighted mean difference [WMD] = 264 kJ;95% CI [70, 458], p < 0.008;I2 = 63%). Within rotating shift workers, the mean difference in 24-hour energy intake across morning/day shifts compared to night shifts was not statistically significant (WMD = 101 kJ;95% CI [-651, 852];p = 0.79;I2 = 77%). Results indicate workers on rotating shift schedules had a higher average 24-hour energy intake compared to their fixed day schedule counterparts. However, energy intake across shift schedules did not differ for individuals working this pattern. A higher 24-hour energy intake in rotating shift workers can contribute to gradual weight gain and higher metabolic risk in rotating shift work populations.

In 2022, two clinical practice guidelines were published, one for allied health and nursing assessment and management of individuals with Duchenne muscular dystrophy (DMD) and the other, for the management of paediatric Charcot-Marie-Tooth disease (CMT). Over the last 10 years, there has been a proliferation of practice guidelines and standards of care for neuromuscular disorders. However, very little is known about adherence to and implementation of these guidelines by health professionals delivering neuromuscular care. To develop strategies for guideline implementation, we must first understand what evidence-to-practice gaps exist as well as the enablers and barriers to the uptake of guideline recommendations. This project will explore health professionals' awareness of and adherence to the recently published DMD and CMT guidelines via an online survey administered on the REDCap platform (hosted by Murdoch Children's Research Institute). Health professionals (medical, nursing and allied health) who manage the clinical care and treatment of individuals with DMD and/or children and young people with CMT across Australia and New Zealand will be invited to participate in this once-only survey. The survey will be distributed to all Australian and New Zealand neuromuscular clinics and centres and through community health networks and professional associations. The overall aim is to determine current practice and implementation of clinical practice guidelines for neuromuscular disorders, specifically DMD and CMT and in particular relating to assessment and outcome measures (DMD) and exercise, physical activity and nutritional status (CMT). The findings from this project will provide preliminary evidence around awareness of guidelines, as well as enablers and barriers to compliance with guidelines. This information will be used to design tailored guideline implementation strategies and inform further research in the uptake of clinical practice guidelines. In 2022, two clinical practice guidelines were published, one for allied health and nursing assessment and management of individuals with Duchenne muscular dystrophy (DMD) and the other, for the management of paediatric Charcot-Marie-Tooth disease (CMT). Over the last 10 years, there has been a proliferation of practice guidelines and standards of care for neuromuscular disorders. However, very little is known about adherence to and implementation of these guidelines by health professionals delivering neuromuscular care. To develop strategies for guideline implementation, we must first understand what evidence-to-practice gaps exist as well as the enablers and barriers to the uptake of guideline recommendations. This project will explore health professionals' awareness of and adherence to the recently published DMD and CMT guidelines via an online survey administered on the REDCap platform (hosted by Murdoch Children's Research Institute). Health professionals (medical, nursing and allied health) who manage the clinical care and treatment of individuals with DMD and/or children and young people with CMT across Australia and New Zealand will be invited to participate in this once-only survey. The survey will be distributed to all Australian and New Zealand neuromuscular clinics and centres and through community health networks and professional associations. The overall aim is to determine current practice and implementation of clinical practice guidelines for neuromuscular disorders, specifically DMD and CMT and in particular relating to assessment and outcome measures (DMD) and exercise, physical activity and nutritional status (CMT). The findings from this project will provide preliminary evidence around awareness of guidelines, as well as enablers and barriers to compliance with guidelines. This information will be used to design tailored guideline implementation strategies and inform further research in the uptake of clinical practice guidelines.

Rationale: Despite changes in metabolism associated with ageing, resting metabolic rate (RMR) still contributes 50-70% of total energy needs. A simple and accurate method is needed to estimate energy requirements in older adults. The aim was to generate and validate new RMR equations specifically for older adults and to report their performance and accuracy. Methods: Our international dataset, including data from the Women's Health Initiative, comprised of measured RMR and anthropometric measures in n=1686 individual participants (age 65-98 years 38.5% male). Multiple regression was used to predict RMR from age, sex, weight, and height. Validation was performed using double-cross-validation in a randomized, sex-stratified, age-matched 50:50 split and leave-one-out techniques. Equations developed in each group were cross-validated in the opposite group. Comparisons were made to existing predictive equations. Results: The new prediction equation for males and females ≥65 years is: RMR (kJ/d) = 31.524*Weight (kg) + 25.851*Height (cm) - 24.432*Age (y) + 486.268*Sex (M=1, F=0) + 530.557. This equation estimates RMR within a population mean prediction bias of approximately 50 kJ/day (∼1%). Accuracy was reduced in adults aged ≥80 years (∼100 kJ/day, ∼2%) but was still within clinically acceptable range. Compared to other prediction equations the new equation had the smallest relative standard deviation (430kJ/d) and smallest median percentage error (6.7%). Limits of agreement indicated a poorer performance at an individual level with 1.96SD limits of approximately ±25%. Conclusion: This equation improves accuracy in prediction of RMR in older adults at a population level but less well at an individual level. Disclosure of Interest: None declared

Rationale: Blended tube feeding (BTF) is common in the adult home enteral nutrition population. Existing reviews have compared outcomes in a mixed population of adults and children. The aim of this study is to determine if BTF has an effect on nutritional status, adverse events, and quality of life (QOL) compared to conventional (CONV) formula in adults. Methods: Databases (MEDLINE, EMBASE, CENTRAL, CINAHL and SCOPUS) were searched from any date to 6 Nov 2022. Studies were included if they were observational/interventional comparing BTF to CONV, completed on enterally fed adults, and reported nutritional status, adverse events, or QOL. Certainty assessment was done using the Cochrane Risk of Bias Tools and the GRADE approach. Results: From 4227 studies screened, 10 were included (2 RCTs, n=854 (9-215)). Five studies were hospital-based and five home-based with duration from 4hrs-8mths. Energy (6 studies) and protein (5 studies) content were 0.4-1.7kcal/ml and 21-68.5g/L for BTF, and 1.0-1.57kcal/ml and 38-100g/L for CONV formulas. One study reported on QOL, two on tube blockages, seven on anthropometry, five gastrointestinal symptoms, and four biochemistry. Five studies found no difference in their outcomes. Of the two that favoured CONV, one study had inferior protein content in the BTF (54g/L vs. 100g/L, respectively), and the other study differed in energy and delivery (0.7kcal/ml bolus BTF vs. 1.0kcal/ml pump CONV). Of the three that favoured BTF, delivery differed for one (bolus BTF vs. pump CONV), and two had low study completion (9/20 and 16/30 participants). No studies used validated tools when assessing nutritional status and QOL. The GRADE certainty of evidence was very low. Conclusion: The evidence is very uncertain about the effect of BTF compared to CONV formulas on nutritional status, adverse events, and QOL in adults on enteral nutrition. Disclosure of Interest: None declared

Abstract Background Duchenne Muscular Dystrophy (DMD) causes progressive muscle weakness as a result of a mutation in the X-linked gene dystrophin. Recently glucocorticoid treatment has delayed deterioration in muscle strength prolonging survival. When respiratory failure develops, Non-invasive ventilation (NIV) is used to improve symptoms and prolong life. Recent research suggests the use of glucocorticoids with concomitant NIV may be associated with accelerated lung function decline. Methods To evaluate this we conducted a retrospective analysis of serial lung function data in patients with DMD across two healthcare campuses in Melbourne, Australia. A database of all patients with a coded diagnosis of DMD was collated from 1980-2010. Patient records were examined to collect data on age, lung function (FEV1/FVC/FER), glucocorticoid use (y/n), daily glucocorticoid dose, date of NIV initiation, FVC at NIV commencement, date of death (where applicable) and concomitant diagnosis of scoliosis or cardiomyopathy. This data was analysed to see if a trend for accelerated lung function decline with the use of NIV was observed. Progress to date A total of 356 patients were identified of which 36 had transitioned to the Austin Hospital adult Ventilation Service with available serial lung function data. There was no statistical difference in mean rate of decline in lung function post NIV initation (n=26, p=0.527) with glucocorticoid treatment. Intended outcome and impact Our inital results are in line with the previously observed rates of decline in lung function from other studies and do not indicate a negative synergistic effect on NIV with glucorticoid therapy.

Increasingly, patients with Duchenne Muscular Dystrophy (DMD) are surviving to adulthood, requiring monitoring for DMD-related cardiomyopathy. Transthoracic echo (TTE) parameters, including LV ejection fraction, fractional shortening and LV end-diastolic diameter have been recommended to detect DMD-related cardiomyopathy. We examined the viability of obtaining these parameters, and the proportion of adult DMD patients on medications for cardiomyopathy. From 2000–2021 at a tertiary Australian hospital, 53 patients with DMD were identified. The number of patients who had a TTE, technical difficulty, echocardiographic parameters and medication data were obtained. Of the 53 patients, only 29 patients had TTE studies (54.7%). In 84% of these, the TTE was described as technically difficult due to the patient being wheelchair-bound, having severe scoliosis or respiratory failure. Other than LVEDD, no parameter was successfully obtained at a high frequency. The mean fractional shortening was 27.4+/-10.1% and the mean LVEDD was 4.4+/-1.9 cm. None of the 53 patients had a cardiac MRI scan performed as an alternate imaging modality. ACE inhibitors & ARBs (87%) were the most commonly prescribed medications at time of TTE, followed by beta blockers (31%). Although TTE is recommended for DMD patients, images are often difficult to reliably obtain. Failure to identify heart failure may reduce prescription of essential medications in this high-risk population.Tabled 1TTE parameterRecordedDifficult study61 (84%)Fractional shortening35 (48%)Ejection fraction (Simpson's bi-plane)18 (25%)LV end-diastolic diameter60 (82%)LA diameter44 (60%)E/A ratio42 (58%)Global longitudinal strain0 (0%) Open table in a new tab

The Neuromuscular Clinic at the Royal Children’s Hospital, Melbourne, Australia manages the care of children and adolescents with a variety of neuromuscular conditions, including approximately 125 subjects with Duchenne or Becker Muscular Dystrophy (DMD/BMD). Increasingly families are reporting their use of complementary therapies. These include massage, osteopathy, chiropractic manipulation and nutritional supplements. In consultation with our physiotherapists and dietician, an online questionnaire has been developed to survey families on their use of additional mainstream allied health therapies, complementary therapies, structured physical activities and nutritional supplements. From this information we hope to understand families’ use of mainstream and alternative therapies and better inform our clinical practice. From the information we obtain we expect that we may be able to develop future studies to investigate the relevance of these therapies for subjects with DMD/BMD.