Dietetic confidence working with clients with depression/anxiety is associated with client-focused practic and advocacy skills

Confidence in a professional role is a key element in the successful transition to competent practice. New graduate dietitians report that whilst they are confident about their general dietetic ability, they are not as confident when working with clients experiencing depression and anxiety. This study aimed to develop and validate a scale which measured confidence about working with clients with depression/anxiety. The 21-item Dietetics Collaborative Practice Scale was developed using research about dietetic practice in mental health, coping self-efficacy literature and collaboration with industry experts. A convenience sample of 189 Australian dietitians completed the questionnaire. Exploratory factor analysis suggests that dietetic confidence is best represented by a two dimensional solution consisting of (a) Client –focused practice (CFP, 50.8% variance) and (b) Advocacy for self and client care (ASC, 9.7% variance). The alpha coefficient of both dimensions (CFP ɑ=0.95, ASC ɑ=0.84) demonstrated the internal consistency of components. Combined, these two components account for 60.5% of variance. The scale components were not related to years of practice or working with mental health clients but were significantly related to overall dietetic confidence (ODC). Correlation coefficients between ODC and CFP were 0.501 (p<0.01), ODC and ASC were correlated at 0.465 (p<0.01) and CFP and number of years as a dietitian were weakly correlated at 0.24 (p<0.05). Results have implications for dietetic training and professional development. Client focus and advocacy for self and client appear to be important factors in overall confidence as a dietitian.

Comparison of two methods to assess malnutrition in community-dwelling people with Parkinson's disease

Nutritional status in people with Parkinson’s disease (PD) has previously been assessed in a number of ways including BMI, % weight loss and the Mini-Nutritional Assessment(MNA). The symptoms of the disease and the side effects of medication used to manage them result in a number of nutrition impact symptoms that can negatively influence intake. These include chewing and swallowing difficulties, lack of appetite, nausea, and taste and smell changes, among others. Community-dwelling people with PD, aged >18 years, were recruited (n=97, 61 M, 36 F). The Patient-Generated Subjective Global Assessment(PG-SGA) and (MNA) were used to assess nutritional status. Weight, height, mid-arm circumference(MAC) and calf circumference were measured. Based on SGA, 16(16.5%) were moderately malnourished (SGA B) while none were severely malnourished (SGA C). The MNA identified 2(2.0%) as malnourished and 22(22.7%) as at risk of malnutrition. Mean MNA scores were different between the three groups,F(2,37)=7.30,p<.05 but not different between SGA B (21.0(2.9)) and MNA at risk (21.8(1.4)) participants. MAC and calf circumference were also different between the three groups,F(2,37)=5.51,p<.05 and F(2,37)=15.33,p<.05 but not between the SGA B (26.2(4.2), 33.3(2.8)) and MNA at risk (28.4(5.6), 36.4(4.7)) participants. The MNA results are similar to other PD studies using MNA where prevalence of malnutrition was between 0-2% with 20-33% at risk of malnutrition. In this population, the PG-SGA may be more sensitive to assessing malnutrition where nutrition impact symptoms influence intake. With society’s increasing body size, it might also be more appropriate as it does not rely on MAC and calf circumference measures.

Digital dietetics : practices and attitudes to technology use among Australian dietitians

Recent advancements in the capabilities of information and communication technologies (ICT) offer unique avenues to support the delivery of nutrition care. Despite ICTs being widely available, evidence on the practices and attitudes with regard to ICT use among dietitians is limited. A cross-sectional survey of Dietitians Association of Australia members was administered online in August 2011. All dietitians who responded (n=87) had access to a computer at work. Half reported providing non face-to-face consultations, with the telephone and email the most common modes of delivery. The use of smart phones was prevalent for 49% of practitioners, with 30% recommending nutrition-related applications and/or programs to clients. Benefits to technology use in practice most commonly reported included improvements in access to information/resources, time management, and workflow efficiency. Barriers identified related to cost and access to technology, and lack of suitable programs/applications. Technology was viewed as an important tool in practice among 93% of dietitians surveyed, however only 38% were satisfied with their current level of use. The majority (81%) believed more technology should be integrated within dietetics, while 85% indicated that the development of suitable and practical applications andprograms is necessary for future practice. Technology is regarded as an important tool by Australian dietitians, with an expressed need for theirinclusion to further facilitate nutrition care. Regular and ongoing evaluation of technology use among dietitians is vital to ensure thatapplications and use are evidence based and relevant to consumers in the digital world.

Is mental health education really needed?

Dietitians play a key role in supporting and advocating for the physical health care of mental health (MH) consumers, with 68-80% seeing clients with associated depression issues in Australia. The DAA Mental Health Curricula Project found dietetic training in MH was inadequate and recommended increased MH education. A MH resource package was developed and sent to universities in 2010 for incorporation into teaching. The aim of this study was to assess dietetic students’ baseline MH knowledge, attitudes and exposure prior to dietetics coursework and package implementation. An online survey measured dietetic students’ mental health knowledge (MHK), attitudes towards mental illness (MHA) and previous exposure to mental illness. MHK was assessed by sixteen dietetics-specific questions. MHA were measured by Day’s Mental Illness Stigma Scale. Exposure was assessed using an adapted version of Eack’s Social Work Students’ Experiences with Schizophrenia questions. Fifty-nine dietetic students (30% response rate) from two universities were surveyed at the beginning of dietetic coursework. Survey responses revealed students had low MHK (mean 5.48, scale 0-16) with no significant difference between cohorts (p=0.67). Half of respondents (n=31) recorded never or rarely being in contact with people with mental illness. 82% of respondents (n=48) reported having no or little experience with mental illness. Data suggests low levels of sitgmatising attitudes about people with mental illness. Given the high prevalence of clients with MH issues in everyday dietetic practice, this study is a first step in addressing integration of MH education into dietetics training.

Is there a place for pixels in our practice? Dietitians' attitudes towards the use of photographic dietary records within the nutrition care process

Photographic records of dietary intake (PhDRs) are an innovative method for the dietary assessment and may alleviate the burden of recording intake compared to traditional methods of recording intake. While the performance of PhDRs has been evaluated, no investigation into the application of this method had occurre within dietetic practice. This study examined the attitudes of dietitians towards the use of PhDRs in the provision of nutrition care. A web-based survey on the practices and beliefs with regards to technology use among Dietitians Association of Australia members was conducted in August 2011. Of the 87 dietitians who responded, 86% assessed the intakes of clients as part of individualised medical nutrition therapy, with the diet history the most common method used. The majority (91%) of dietitians surveyed believed that a PhDR would be of use in their current practice to estimate intake. Information contained in the PhDR would primarily be used to obtain a qualitative evaluation of diet (84%) or to supplement an existing assessment method (69%), as opposed to deriving an absolute measure of nutrient intake (31%). Most (87%) indicated that a PhDR would also be beneficial in both the delivery of the intervention and to evaluate and monitor goals and outcomes, while only 46% felt that a PhDR would assist in determining the nutrition diagnosis. This survey highlights the potential for the use of PhDRs within practice. Future endeavours lie in establishing resources which support the inclusion of PhDRs within the nutrition care process.

Comparative eye tracking of experts and novices in web single sign-on

Security indicators in web browsers alert users to the presence of a secure connection between their computer and a web server; many studies have shown that such indicators are largely ignored by users in general. In other areas of computer security, research has shown that technical expertise can decrease user susceptibility to attacks. In this work, we examine whether computer or security expertise affects use of web browser security indicators. Our study takes place in the context of web-based single sign-on, in which a user can use credentials from a single identity provider to login to many relying websites; single sign-on is a more complex, and hence more difficult, security task for users. In our study, we used eye trackers and surveyed participants to examine the cues individuals use and those they report using, respectively. Our results show that users with security expertise are more likely to self-report looking at security indicators, and eye-tracking data shows they have longer gaze duration at security indicators than those without security expertise. However, computer expertise alone is not correlated with recorded use of security indicators. In survey questions, neither experts nor novices demonstrate a good understanding of the security consequences of web-based single sign-on.

Chinese fashion designers in Shanghai : identifying a fresh perspective about their role in the world order of fashion

Shanghai possesses an apt legacy, once referred to as “Paris of the East”. Municipal aspirations for Shanghai to assume a position among the great fashion cities of the world have been integrated in the recent re-shaping of this modern city into a role model for Chinese creative enterprise yet China is still known primarily as centre of clothing production. Increasingly however, “Made in China” is being replaced by “Created in China” drawing attention to two distinct consumer markets for Chinese designers. Fashion designers who have entered the global fashion system for education or by showing their collections have generally adopted a design aesthetic that aligns with Western markets, allowing little competitive advantage. In contrast, Chinese designers who rest their attention on the domestic Chinese market find a disparate, highly competitive marketplace. The pillars of authenticity that for foreign fashion brands extend far into their cultural and creative histories, often for many decades in the case of Louis Vuitton, Hermes and Christian Dior do not yet exist in China in this era of rapid globalisation. Here, the cultural bedrock allows these same pillars to extend only thirty years or so into the past reaching the moments when Deng Xiaoping granted China’s creative entrepreneurs passage. To this end, interviews with fashion designers in Shanghai have been undertaken during the last twelve months for a PhD dissertation. Production of culture theory has been used to identify working methods, practices of production and the social and cultural milieu necessary for designers to achieve viability. Preliminary findings indicate that some fashion designers have adopted an as-yet unexplored strategy of business and brand development with a distinct Chinese aesthetic at its core, in contrast to the clichéd cultural iconography often viewed by Western viewers as representative of Chinese creativity.

Chinese fashion designers in Shanghai : a new perspective about their role in the construction of a fashion city

Shanghai possesses an apt legacy, once referred to as ‘Paris of the East’. Municipal aspirations for Shanghai to assume a position among the great fashion cities of the world have been integrated in the recent re-shaping of this modern city into a role model for Chinese creative enterprise yet China is still known primarily as centre of clothing production. Increasingly however, ‘Made in China’ is being replaced by ‘Created in China’ drawing attention to two distinct consumer markets for Chinese designers. Fashion designers who have entered the global fashion system for education or by showing their collections have generally adopted a design aesthetic that aligns with Western markets, allowing little competitive advantage. In contrast, Chinese designers who rest their attention on the domestic Chinese market find a disparate, highly competitive marketplace. The pillars of authenticity that for foreign fashion brands extend far into their cultural and creative histories, often for many decades in the case of Louis Vuitton, Hermes and Christian Dior do not yet exist in China in this era of rapid globalisation. Here, the cultural bedrock allows these same pillars to extend only thirty years or so into the past reaching the moments when Deng Xiaoping granted China’s creative entrepreneurs passage. To this end, interviews with fashion designers in Shanghai have been undertaken during the last twelve months for a PhD dissertation. Production of culture theory has been used to identify working methods, practices of production and the social and cultural milieu necessary for designers to achieve viability. Preliminary findings indicate that some fashion designers have adopted an as-yet unexplored strategy of business and brand development with a distinct Chinese aesthetic at its core, in contrast to the clichéd cultural iconography often viewed by Western viewers as representative of Chinese creativity. The development of this aesthetic is similar to the development of the Scandinavian design ethos that emerged during the 1950s.

Innovative Products Focus Group Report 2012. Brisbane: QUT

This report presents the results of Phase 3 of the Innovative Road Products Project: National Focus Groups. The groups developed solutions to address the most important obstacles constraining the adoption of innovative products in Australian road construction projects. The Innovative Products Survey, the major Project deliverable in 2011, and the largest innovation survey ever undertaken in the Australian road consutrction industry, results in the identification of key obstacles constraining the adoption of innovative products on road projects.

Innovative Products Survey Report

This report presents the results of the 2011 Australian road and bridge product innovation survey, the largest survey of its kind ever undertaken. The survey sample was defined as key organisations involved in the Australian road and bridge construction industry. The survey focused on four sectors across the road and bridge product supply chain: suppliers (comprising manufacturers and distributors), consultants (primarily engineering consultant firms), contractors (comprising head and trade contractors and subcontractors) and clients (state government road agencies). The sample comprised the four sectors in Queensland, New South Wales and Victoria.

Innovative Products Project: Background Study

The Australian Research Council (ARC) Innovative Products Project aims to facilitate project innovation by exploring means to improve the diffusion of innovative products to road and bridge projects. It adopts a highly novel approach to achieve this end, developing three different ways of viewing the problem: (1) as a relational governance issue, (2) as an absorptive capacity issue and (3) as a knowlege intermediation issue. This report presents teh results of teh first phase of a three phase fieldwork program.

Screening and managing cannabis use: comparing GP's and nurses' knowledge, beliefs, and behavior

Background: General practitioners (GPs) and nurses are ideally placed to address the significant unmet demand for the treatment of cannabis-related problems given the numbers of people who regularly seek their care. The aim of this study was to evaluate differences between GPs and nurses’ perceived knowledge, beliefs, and behaviors toward cannabis use and its screening and management. Methods: This study involved 161 nurses and 503 GPs who completed a survey distributed via conference satchels to delegates of Healthed seminars focused on topics relevant to women and children’s health. Differences between GPs and nurses were analyzed using χ2- tests and two-sample t-tests, while logistic regression examined predictors of service provision. Results: GPs were more likely than nurses to have engaged in cannabis-related service provision, but also more frequently reported barriers related to time, interest, and having more important issues to address. Nurses reported less knowledge, skills, and role legitimacy. Perceived screening skills predicted screening and referral to alcohol and other drug (AOD) services, while knowing a regular user increased the likelihood of referrals only. Conclusions: Approaches to increase cannabis-related screening and intervention may be improved by involving nurses, and by leveraging the relationship between nurses and doctors, in primary care.

Stability and convergence of a finite volume method for the space fractional advection-dispersion equation

We consider the space fractional advection–dispersion equation, which is obtained from the classical advection–diffusion equation by replacing the spatial derivatives with a generalised derivative of fractional order. We derive a finite volume method that utilises fractionally-shifted Grünwald formulae for the discretisation of the fractional derivative, to numerically solve the equation on a finite domain with homogeneous Dirichlet boundary conditions. We prove that the method is stable and convergent when coupled with an implicit timestepping strategy. Results of numerical experiments are presented that support the theoretical analysis.

How do Australasian hospitals identify and manage malnutrition in their acute care wards?

One aim of the Australasian Nutrition Care Day Survey was to explore nutrition care practices in acute care hospital wards across Australia and New Zealand. Managers of Dietetic departments completed a questionnaire regarding ward nutrition care practices. Overall, 370 wards from 56 hospitals participated. The median ward size was 28 beds (range: 8–60 beds). Although there was a wide variation in full-time equivalent availability of dietitians (median: 0.3; range: 0–1.4), their involvement in providing nutrition care across ward specialities was signifi cantly higher than other staff members (χ2, p < 0.01). Feeding assistance, available in 89% of the wards, was provided mainly by nursing staff and family members (χ2, p < 0.01). Protected meal times were implemented in 5% (n = 18) of the wards. Fifty-three percent of the wards (n = 192) weighed patients on request and 40% (n = 148) on admission. Routine malnutrition screening was conducted in 63% (n = 232) of the wards and 79% (n = 184) of these wards used the Malnutrition Screening Tool, 16% (n = 37) the Malnutrition Universal Screening Tool, and 5% (n = 11) other tools. Nutrition rescreening was routinely conducted in 20% of the wards. Among wards that implemented nutrition screening, 41% (n = 100) routinely referred patients “at risk” of malnutrition to dietitians as part of their standard protocol for malnutrition management. Results of this study provide new knowledge regarding current nutrition care practice, highlight gaps in existing practice, and can be used to inform improved nutrition care in acute care wards across Australia and New Zealand.

Do the skeletons in the hospital closet still exist? What do they eat?

One aim of the Australasian Nutrition Care Day Survey (ANCDS) was to explore dietary intake and nutritional status of acute care hospital patients. Dietitians from 56 hospitals in Australia and New Zealand completed a 24-hour nutritional status and dietary intake audit of 3000 adult patients. Participants were evaluated for nutritional risk using the Malnutrition Screening Tool (MST). Those ‘at risk’ underwent nutritional assessment using Subjective Global Assessment (SGA). Dietitians observed participants’ dietary intake at each main meal and recorded mid-meal intake via participant interviews. Intakes were recorded as 0%, 25%, 50%, 75%, or 100% of that offered for each meal during the 24-hour audit. Preliminary results for 1550 participants (males = 853; females = 697), age = 64 ± 17 years and BMI = 27 ± 7 kg/m2. Fifty-five percent (n = 853) of the participants had BMI > 25 kg/m2. The MST identified 41% (n = 636) ‘at risk’ for malnutrition. Of those ‘at risk’, 70% were assessed as malnourished resulting in an overall malnutrition prevalence of 30% (25% moderately malnourished, 5% severely malnourished). One-quarter of malnourished participants (n = 118) were on standard hospital diets without additional nutritional support. Fifty percent of malnourished patients (n = 235) and 40% of all patients (n = 620) had an overall 24-hour food consumption of ≤50% during the 24-hour audit. The ANCDS found that skeletons in the hospital closet continue to exist and that acute care patients continue to have suboptimal dietary intake. The ANCDS provides valuable insight into gaps in existing nutrition care practices.