Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010

Background & aims The Australasian Nutrition Care Day Survey (ANCDS) ascertained if malnutrition and poor food intake are independent risk factors for health-related outcomes in Australian and New Zealand hospital patients. Methods Phase 1 recorded nutritional status (Subjective Global Assessment) and 24-h food intake (0, 25, 50, 75, 100% intake). Outcomes data (Phase 2) were collected 90-days post-Phase 1 and included length of hospital stay (LOS), readmissions and in-hospital mortality. Results Of 3122 participants (47% females, 65 ± 18 years) from 56 hospitals, 32% were malnourished and 23% consumed ≤ 25% of the offered food. Malnourished patients had greater median LOS (15 days vs. 10 days, p < 0.0001) and readmissions rates (36% vs. 30%, p = 0.001). Median LOS for patients consuming ≤ 25% of the food was higher than those consuming ≤ 50% (13 vs. 11 days, p < 0.0001). The odds of 90-day in-hospital mortality were twice greater for malnourished patients (CI: 1.09–3.34, p = 0.023) and those consuming ≤ 25% of the offered food (CI: 1.13–3.51, p = 0.017), respectively. Conclusion The ANCDS establishes that malnutrition and poor food intake are independently associated with in-hospital mortality in the Australian and New Zealand acute care setting.

The impact of malnutrition and decreased food intake on length of stay, readmission, and mortality in acute care patients

Rationale: The Australasian Nutrition Care Day Survey (ANCDS) evaluated if malnutrition and decreased food intake are independent risk factors for negative outcomes in hospitalised patients. Methods: A multicentre (56 hospitals) cross-sectional survey was conducted in two phases. Phase 1 evaluated nutritional status (defined by Subjective Global Assessment) and 24-hour food intake recorded as 0, 25, 50, 75, and 100% intake. Phase 2 data, which included length of stay (LOS), readmissions and mortality, were collected 90 days post-Phase 1. Logistic regression was used to control for confounders: age, gender, disease type and severity (using Patient Clinical Complexity Level scores). Results: Of 3122 participants (53% males, mean age: 65±18 years) 32% were malnourished and 23% consumed�25% of the offered food. Median LOS for malnourished (MN) patients was higher than well-nourished (WN) patients (15 vs. 10 days, p<0.0001). Median LOS for patients consuming �25% of the food was higher than those consuming �50% (13 vs. 11 days, p<0.0001). MN patients had higher readmission rates (36% vs. 30%, p = 0.001). The odds ratios of 90-day in-hospital mortality were 1.8 times greater for MN patients (CI: 1.03 3.22, p = 0.04) and 2.7 times greater for those consuming �25% of the offered food (CI: 1.54 4.68, p = 0.001). Conclusion: The ANCDS demonstrates that malnutrition and/or decreased food intake are associated with longer LOS and readmissions. The survey also establishes that malnutrition and decreased food intake are independent risk factors for in-hospital mortality in acute care patients; and highlights the need for appropriate nutritional screening and support during hospitalisation. Disclosure of Interest: None Declared.

Towards a structured understanding of caregivers’ safety behaviour in the domestic and driveway setting

Slow speed run-overs represent a major cause of injury and death among Australian children, with higher rates of incidents being reported in Queensland than in the remaining Australian states. Yet, little attention has been given to how caregivers develop their safety behaviour in and around the driveway setting. To address this gap, the current study aimed to develop a conceptual model of driveway child safety behaviours among caregivers of children aged five years or younger. Semi-structured interviews were conducted with 26 caregivers (25 females/1 male, mean age, 33.24 year) from rural and metropolitan Queensland. To enable a comparison and validation of findings from the driveway, the study analysed both driveway and domestic safety behaviours. Domestic safety behaviours were categorised and validated against driveway safety behaviours, uncovering a process of risk appraisal and safety behaviour that was applicable in both settings (the Safety System Model). However, noteworthy differences between the domestic and driveway setting were uncovered. Unlike in the domestic setting, driveway risks were perceived as shifting according the presence of moving vehicles, which resulted in inconsistent safety behaviours. While the findings require further validation, they have implications for the design and implementation of driveway run-over interventions.

A safe system-based approach to selection of clear zones, safety barriers and other roadside treatments

On average, 560 fatal run-off-road crashes occur annually in Australia and 135 in New Zealand. In addition, there are more than 14,000 run-off-road crashes causing injuries each year across both countries. In rural areas, run-off-road casualty crashes constitute 50-60% of all casualty crashes. Their severity is particularly high with more than half of those involved sustaining fatal or serious injuries. This paper reviews the existing approach to roadside hazard risk assessment, selection of clear zones and hazard treatments. It proposes a modified approach to roadside safety evaluation and management. It is a methodology based on statistical modelling of run-off-road casualty crashes, and application of locally developed crash modification factors and severity indices. Clear zones, safety barriers and other roadside design/treatment options are evaluated with a view to minimise fatal and serious injuries – the key Safe System objective. The paper concludes with a practical demonstration of the proposed approach. The paper is based on findings from a four-year Austroads research project into improving roadside safety in the Safe System context.

Effect of depithing on the safety and environmental aspects of bagasse stockpiling

Large scale sugarcane bagasse storage in uncovered stockpiles has the potential to result in adverse impacts on the environment and surrounding communities through hazards associated with nuisance dust, groundwater seepage, spontaneous combustion and generation of contaminated leachates. Managing these hazards will assist in improved health and safety outcomes for factory staff and reduced potential environmental impacts on surrounding communities. Removal of the smaller fibres (pith) from bagasse prior to stockpiling reduced the dust number of bagasse by 50% and modelling suggests peak ground level PM10 dust emissions would reduce by 70%. Depithed bagasse has much lower water holding capacity (~43%) than whole bagasse. This experimental and modelling study investigated the physical properties of depithed and whole bagasse. Dust dispersion modelling was undertaken to determine the likely effects associated with storage of whole and depithed sugarcane bagasse.

Team communications in surgery - creating a culture of safety

As a key department within a healthcare organisation, the operating room is a hazardous environment, where the consequences of errors are high, despite the relatively low rates of occurrence. Team performance in surgery is increasingly being considered crucial for a culture of safety. The aim of this study was to describe team communication and the ways it fostered or threatened safety culture in surgery. Ethnography was used, and involved a 6-month fieldwork period of observation and 19 interviews with 24 informants from nursing, anaesthesia and surgery. Data were collected during 2009 in the operating rooms of a tertiary care facility in Queensland, Australia. Through analysis of the textual data, three themes that exemplified teamwork culture in surgery were generated: ‘‘building shared understandings through open communication’’; ‘‘managing contextual stressors in a hierarchical environment’’ and ‘‘intermittent membership influences team performance’’. In creating a safety culture in a healthcare organisation, a team’s optimal performance relies on the open discussion of teamwork and team expectation, and significantly depends on how the organisational culture promotes such discussions.

How safe is safe enough? : a socio-technical view of low-cost level crossing safety

Low-cost level crossings are often criticized as being unsafe. Does a SIL (safety integrity level) rating make the railway crossing any safer? This paper discusses how a supporting argument might be made for low-cost level crossing warning devices with lower levels of safety integrity and issues such as risk tolerability and derivation of tolerable hazard rates for system-level hazards. As part of the design of such systems according to fail-safe principles, the paper considers the assumptions around the pre-defined safe states of existing warning devices and how human factors issues around such states can give rise to additional hazards.

An innovative information gathering and data analysis platform for railway level crossing safety data

This paper describes an innovative platform that facilitates the collection of objective safety data around occurrences at railway level crossings using data sources including forward-facing video, telemetry from trains and geo-referenced asset and survey data. This platform is being developed with support by the Australian rail industry and the Cooperative Research Centre for Rail Innovation. The paper provides a description of the underlying accident causation model, the development methodology and refinement process as well as a description of the data collection platform. The paper concludes with a brief discussion of benefits this project is expected to provide the Australian rail industry.

The political economy of food in schools : the case of Queensland State education

Food in schools is typically understood from a biomedical perspective. At practical, ideational and material levels, whether addressed pedagogically or bureaucratically, food in schools is generally considered from a natural sciences perspective. This perspective manifests as the bioenergetic principle of energy in versus energy out and appears in policy focused on issues such as obesity and physical activity. Despite the considerable literature on the sociology of food and eating, little is understood about food in schools from a sociological perspective. This oversight of one of the most fundamental requirements of the human condition--namely, food--should be of concern for educators. Investigating food through a political economy lens means understanding food in schools as part of broader economic, political, social and cultural conditions. Hence, a political economy of food and schooling is concerned with the formation of ideas about food relative to political, economic, and cultural ideologies in social practice. From a critical sociology study of food messages students receive in the primary school curriculum, this paper reports on some of the official food messages of an Australian state's education policy, as a case to highlight the current political economy of food in Australia. It examines the role of the corporate food industry in the formation of Australian food policy and how that policy created artefacts infused with competing messages. The paper highlights how food and nutrition policy moved from solely a health concern to incorporate an economic dimension and links that shift with the quality of food available in Queensland schools.

Compendium of best practices on motorcycle and scooter safety

Throughout the Asia Pacific Economic Cooperation (APEC) and across the world, riders and passengers of motorcycles and scooters are among the most vulnerable road users. Such vulnerability is especially pertinent for nations that more often use motorcycles and scooters as a method of transportation. In developing effective countermeasures to reduce motorcycle and scooter death and injury across multiple regions, consideration is required of various situational and socio-cultural factors that vary across APEC economies. This compendium aims to facilitate implementation of best practice countermeasures to improve motorcycle safety in APEC member economies.

Survey of motorcycle and scooter safety for Project : Compendium of Best Practices on Motorcycle and Scooter Safety

Throughout the Asia Pacific Economic Cooperation (APEC) and across the world, riders and passengers of motorcycles and scooters are among the most vulnerable road users. There is considerably greater likelihood of death or injury from use of these vehicles compared with other motor vehicles. Such vulnerability is especially pertinent for economies that more often use motorcycles and scooters as a method of transportation. In developing effective countermeasures to reduce motorcycle and scooter death and injury across multiple regions consideration is required of various situational and socio-cultural factors that vary across APEC economies. The study presented here sought to understand important motorcycle and scooter safety issues across APEC economies and any current barriers that might exist in implementing potentially effective countermeasures. This is the first stage of a wider project which also includes a literature review and ultimately the production of a compendium to facilitate implementation of best practice countermeasures.

A Review of potential countermeasures for motorcycle and scooter safety practices across APEC for project : Compendium of Best Practices on Motorcycle and Scooter Safety

Motorcyclists and scooter riders are among the most vulnerable road users, across APEC. This report assesses the potential road safety measures that can be used to address these issues and selects measures that could feasibly and effectively be implemented across the Asia Pacific Economic Communities (APEC). The scope of the report is confined to on-road motorcycle riding. While the numbers of injuries resulting from off-road riding (including as part of farm work) are likely to be substantial based on data from other states, many of the issues and measures to reduce trauma in off-road riding would be quite different. A previous report described important motorcycle and scooter safety issues across APEC economies and any current barriers that might exist in implementing potentially effective countermeasures.

The role of, and key considerations for, advertising campaigns and educational awareness workshops within the work-related road safety context

Australian and international evidence suggests that, in the work-related driving context, road crashes account for a substantial number of occupational incidents. In the attempt to reduce injury and improve safety, organisations may implement an array of strategies and interventions ranging from policy development and implementation, vehicle selection and incident monitoring through to education and awareness-raising. This conceptual paper discusses aspects relating to the latter collection of interventions and, in particular, the role, and some key considerations with respect to the content and dissemination, of advertising campaigns and educational awareness workshops. In relation to advertising campaigns, this paper discusses how some of the overarching principles associated with advertising in the broader general community road safety strategy also apply within the work-related road safety context. Specifically, advertising campaigns/materials should be viewed as a key component within a dedicated organisational approach to road (driver) safety. This dedicated approach would need to comprise of a number, and varied array, of strategies. In addition, the content of, and medium/s (e.g., posters) by which to deliver such advertising campaigns, cannot be addressed by a one-size-fits all approach but, rather, requires careful consideration of the needs as well as characteristics of specific organisations and their driver fleet. The paper provides a summary of some key considerations when devising an advertising campaign, including the nature of campaign/message content as well as the processes by which to devise and refine such content. In relation to driver education awareness workshops, this paper outlines the key considerations for delivering a series of workshops specifically aimed at occupational driving within the organisational context. A case study approach will be utilised to demonstrate the manner in which educational awareness workshops can compliment successful advertising campaigns promoting safer work related driving through better risk management practice. Research underpinning the development of driver behaviour modification tools incorporated within the workshops will also be discussed along with the mechanisms utilised to encourage improvements in driver monitoring and behaviour. In an effort to assist organisations with their continual search for cost-effective approaches which may, ultimately, contribute to improvements in driver behaviour and safety, the current paper offers some clear and practical suggestions in relation to the development and dissemination of two types of interventions, advertising campaigns and education awareness workshops.