Improving the performance of nutrition screening through a series of quality improvement initiatives

Background Nutrition screening identifies patients at risk of malnutrition to facilitate early nutritional intervention. Studies have reported incompletion and error rates of 30-90% for a range of commonly used screening tools. This study aims to investigate the incompletion and error rates of 3-Minute Nutrition Screening (3-MinNS) and the effect of quality improvement initiatives in improving the overall performance of the screening tool and the referral process for at risk patients. Methods Annual audits were carried out from 2008-2013 on 4467 patients. Value Stream Mapping, Plan-Do-Check-Act cycle and Root Cause Analysis were used in this study to identify gaps and determine the best intervention. The intervention included 1) implementing a nutrition screening protocol, 2) nutrition screening training, 3) nurse empowerment for online dietetics referral of at-risk cases, 4) closed-loop feedback system and 5) removing a component of 3-MinNS that caused the most error without compromising its sensitivity and specificity. Results Nutrition screening error rates were 33% and 31%, with 5% and 8% blank or missing forms, in 2008 and 2009 respectively. For patients at risk of malnutrition, referral to dietetics took up to 7.5 days, with 10% not referred at all. After intervention, the latter decreased to 7% (2010), 4% (2011) and 3% (2012 and 2013), and the mean turnaround time from screening to referral was reduced significantly from 4.3 ± 1.8 days to 0.3 ± 0.4 days (p < 0.001). Error rates were reduced to 25% (2010), 15% (2011), 7% (2012) and 5% (2013) and percentage of blank or missing forms reduced to and remained at 1%. Conclusion Quality improvement initiatives are effective in reducing the incompletion and error rates of nutrition screening, and led to sustainable improvements in the referral process of patients at nutritional risk.

Indigenous names for Indigenous Support Centres as part of the Welcome to (University) Country

The significance of naming Indigenous Support Centres (ISCs) with Indigenous language terminology — given that such reconciliatory acts may serve as symbolic means to improve the cultural efficacy of an Australian university’s Welcome to Country on offer to Indigenous Australian students — is explored and discussed in this paper. A survey of all 39 Australian universities was conducted, and the results regarding the Indigenous naming of their ISCs were tabulated and compared.

An examination of how the military, the conservative press and ministerialist politicians generated support within Queensland for the war in South Africa in 1899 and 1900

This thesis examines the role of conservative newspaper proprietors and editors to generate support for war against the Boers in South Africa. The thesis utilises Rune Ottosen's theoretical model concerning newspapers creating a pro-war mentality, and S.E. Finer's theory on the influences of the military on civilian Government. The pivotal supportive roles of Governor Lamington and Premiers Dickson and Philp and the oppositional role of Premier Dawson are also examined.

Sports dietitians Australia position statement : sports nutrition for the adolescent athlete

It is the position of Sports Dietitians Australia (SDA) that adolescent athletes have unique nutritional requirements as a consequence of undertaking daily training and competition in addition to the demands of growth and development. As such, SDA established an expert multidisciplinary panel to undertake an independent review of the relevant scientific evidence and consulted with its professional members to develop sports nutrition recommendations for active and competitive adolescent athletes. The position of SDA is that dietary education and recommendations for these adolescent athletes should reinforce eating for long term health. More specifically, the adolescent athlete should be encouraged to moderate eating patterns to reflect daily exercise demands and provide a regular spread of high quality carbohydrate and protein sources over the day, especially in the period immediately after training. SDA recommends that consideration also be given to the dietary calcium, Vitamin D and iron intake of adolescent athletes due to the elevated risk of deficiency of these nutrients. In order to maintain optimal hydration, adolescent athletes should have access to fluids that are clean, cool and supplied in sufficient quantities before, during and after participation in sport. Finally, it is the position of SDA that use of nutrient needs should be met by core foods rather than supplements, as the recommendation of dietary supplements to developing athletes over-emphasises their ability to manipulate performance in comparison to other training and dietary strategies.

An algebraic approach for determination of DG parameters to support voltage profiles in radial distribution networks

Rapidly increasing electricity demands and capacity shortage of transmission and distribution facilities are the main driving forces for the growth of Distributed Generation (DG) integration in power grids. One of the reasons for choosing a DG is its ability to support voltage in a distribution system. Selection of effective DG characteristics and DG parameters is a significant concern of distribution system planners to obtain maximum potential benefits from the DG unit. This paper addresses the issue of improving the network voltage profile in distribution systems by installing a DG of the most suitable size, at a suitable location. An analytical approach is developed based on algebraic equations for uniformly distributed loads to determine the optimal operation, size and location of the DG in order to achieve required levels of network voltage. The developed method is simple to use for conceptual design and analysis of distribution system expansion with a DG and suitable for a quick estimation of DG parameters (such as optimal operating angle, size and location of a DG system) in a radial network. A practical network is used to verify the proposed technique and test results are presented.

The importance of social support for students with intellectual disability : an intervention to promote mental health and well-being

Children and adolescents with intellectual disability have higher rates of mental health problems compared with there typically developing peers. Social support has been identified as an important protective factor for psychological well - being. In this paper we discuss the benefits of social support networks, and consider approaches for promoting children’s perceptions of the availability of social support. We describe an evidence-based intervention that has been specially adapted and implemented for students with intellectual disability in school settings. In a randomised controlled trial, the Aussie Optimism Resilience Skills Program was associated with improved perceptions of social support following a 10-week intervention. Educators need to be aware of the increased vulnerability of students with intellectual disability to the development mental health problems and the proactive ways in which they can promote psychological well - being within their classrooms.

Effect of real support conditions on the shear strength of hollow flange channel beams

This paper presents the details of experimental studies on the effect of real support conditions on the shear strength of LiteSteel beams (LSB). The LSB has a unique shape of a channel beam with two rectangular hollow flanges, made using a unique manufacturing process. In some applications in the building industry LSBs are used with only one web side plate (WSP) at their supports and are not used with full height web side plates (WSP) at their supports. Past research studies showed that theses real support connections did not provide simply supported conditions. Many studies have been carried out to evaluate the behaviour and design of LSBs with simply supported conditions subject to pure bending and predominant shear actions. To date, however, no investigation has been conducted into the effect of real support conditions on the shear strength of LSBs. Hence detailed experimental studies were undertaken to investigate the shear behaviour and strength of LSBs with real support conditions. A total of 28 experimental tests were conducted as part of the studies. Simply supported test specimens of LSBs with aspect ratios of 1.0 and 1.5 were loaded at mid-span until failure. It was found that the effect of using one WSP on the shear behaviour of LSB is significant and there is about 25% shear capacity reduction due to the lateral movement of the bottom flange at the supports. Shear capacity of LSB was also found to decrease when full height WSPs were not used. Suitable support connections were developed to improve the shear capacity of LSBs based on test results.

Innovations in dietetic training in foodservice management : can early exposure to practice enhance final year competency development?

Student engagement in the delivery of theoretical course materials is a current challenge in the tertiary sector including for dietetic training. In 2011 with the creation of a new nutritionist position for Queensland Meals on Wheels (QMOW), a service learning approach to support this organisation was used with third year dietetic students undertaking two days of structured activities at various QMOW sites in South East Queensland, aligned with coursework in Foodservice Management (FSM). This cohort of students was then followed in their final year post successful completion of five weeks professional practice in FSM to see if this experience supported readiness for placement and competency development. Evaluation was undertaken of eligible students (n = 50) via paper based survey (response rate 94%) with all participating in targeted focus groups. Findings showed that students acknowledged the QMOW experience (on reflection 14 months later) providing opportunity for participation and/or observation in 5 of 12 FSM areas taught in third year, including food safety, meal production, assembly, delivery and dishwashing. Over half the students identified good exposure to FSM competency areas during the QMOW experience, with 83% satisfied with their competency exposure and subsequent practice during final year placements. A consistent theme emerged from focus groups supporting inclusion of practical opportunities with the theoretical component of the FSM subject to highlight relevance to learning. These findings highlight the importance of such teaching initiatives to met student learning preferences, linking theory with practice and supporting competency development in the final year of training programs.

Sharpening our tools – translating research into practice

Providing culturally appropriate health communication tools at a community level, whilst meeting funding objectives set by Government led initiatives, can be challenging. Literature states that a translational research framework fostering community communication can encourage the development of appropriate communication tools to facilitate transfer of health information between community and researchers. Reflections from initial Need for Feed cooking and nutrition education program trials in remote Indigenous communities across Cape York indicated program resources were neither meeting community nor researchers needs. In response, a translational research framework was modelled with collaborative partnerships formed between researchers and community with the aim of modifying current resources. Local working groups were established to facilitate communication and guide continual remodelling and retrial of resources for successive programs. Feedback from working groups indicated community members wanted resources with more pictures and less words. Partnership with Chronic Disease Resources Online (CDRO) led to the development of pictorial resources including 3 evaluation tools, 27 recipe sets and 10 education support materials. Between June to December 2012 resources were trialled across 4 Cape York communities with 69 school aged children and 4 community elders. Qualitative data has indicated high satisfaction with modified pictorial resources, proving pictorial resources to be an effective and culturally appropriate method to both communicate health messages to community and facilitate flow of evaluation data to researchers. A translational research framework fostering communication between community and researchers can potentially enhance the quality of health communication tools.

Socioeconomic differences in food choices : deficiencies in nutrition knowledge or simply too much on your plate?

Nutrition knowledge is associated with dietary choices in the general population and has been proposed to contribute to socioeconomic differences in food choices and corresponding socioeconomic gradients in mortality and morbidity for a number of diet-related illnesses. This paper explores current evidence regarding socioeconomic differences in nutrition knowledge, reviewing the components of nutrition knowledge that have been assessed, the dietary intake or food choice outcomes considered, and the socioeconomic indicators used. In addition, this paper considers how socioeconomic differences in nutrition knowledge may arise, and potential determinants of inequalities in the application of nutrition knowledge. It highlights issues to consider when developing strategies to improve nutrition knowledge and facilitate knowledge application among those of lower socioeconomic position.

A new national women's health policy : legal, ethical and policy initiatives to support women's health

In 1989 the first National Women's Health Policy was launched in Australia. Now, 20 years later, the Federal Government has announced plans for the development of a new National Women's Health Policy to address the health needs of Australian women. The Policy will be based on five principles: gender equity; health equity between women; a focus on prevention; an evidence base for interventions; and a life course approach. This editorial examines the role for law in the development of a new National Women's Health Policy. It considers the relevance of regulatory frameworks for health research in supporting an evidence base for health interventions and analyses the requirement in the National Health and Medical Research Council's National Statement on Ethical Conduct in Human Research for "fair inclusion" of research participants. The editorial argues for a holistic approach to women's health that includes regulatory frameworks for research, identification of funding priorities for research, and the need for a dedicated government department or agency to promote women's health.

Reasoning paradigms in legal decision support systems

In this paper we discuss the strengths and weaknesses of a range of artificial intelligence approaches used in legal domains. Symbolic reasoning systems which rely on deductive, inductive and analogical reasoning are described and reviewed. The role of statistical reasoning in law is examined, and the use of neural networks analysed. There is discussion of architectures for, and examples of, systems which combine a number of these reasoning strategies. We conclude that to build intelligent legal decision support systems requires a range of reasoning strategies.

Deductive, inductive and analogical reasoning in legal decision support systems

In this paper we provide an overview of a number of fundamental reasoning formalisms in artificial intelligence which can and have been used in modelling legal reasoning. We describe deduction, induction and analogical reasoning formalisms, and show how they can be used separately to model legal reasoning. We argue that these formalisms can be used together to model legal reasoning more accurately, and describe a number of attempts to integrate the approaches.

Designing intelligent litigation support tools : The IKBALS perspective

In the legal domain, it is rare to find solutions to problems by simply applying algorithms or invoking deductive rules in some knowledge‐based program. Instead, expert practitioners often supplement domain‐specific knowledge with field experience. This type of expertise is often applied in the form of an analogy. This research proposes to combine both reasoning with precedents and reasoning with statutes and regulations in a way that will enhance the statutory interpretation task. This is being attempted through the integration of database and expert system technologies. Case‐based reasoning is being used to model legal precedents while rule‐based reasoning modules are being used to model the legislation and other types of causal knowledge. It is hoped to generalise these findings and to develop a formal methodology for integrating case‐based databases with rule‐based expert systems in the legal domain.