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Summary Background & aims Patients receiving home enteral nutrition (HEN) via an enteral feeding tube often have complex healthcare requirements. There is limited information regarding how HEN care is provided within Australia and New Zealand. This study aimed to investigate the characteristics of HEN services and the provision of nutrition care to individuals receiving HEN within Australia and New Zealand. Methods A cross-sectional study, surveying lead HEN dietitians for HEN services was conducted from the period 09 July 2019 to 20 September 2019 inclusive. An online survey was used to obtain data relating to the demographics, funding and clinical resources of respondents’ HEN services. Services were benchmarked against a HEN service implementation checklist adapted from the Agency for Clinical Innovation (ACI). Results Responses were received from 107 HEN services, with an estimated combined population of 7122 HEN patients. Services were predominantly government-funded (n = 102, 95.3%) and operated from acute hospitals (n = 57, 53.3%). The reported combined cost of all HEN equipment to the patient ranged from $0-$77 per week or $0-$341 per month. Fifty-two services were reported to have a dedicated HEN dietitian/coordinator, which was positively associated with the undertaking of quality improvement activities (p = 0.019). Mean compliance to the ACI HEN implementation checklist was 70.4% (±15.7%) with a range of 13.0–98.2%. Mean compliance was significantly higher in services with a HEN dietitian/coordinator than services without one (75.5% (±12.0%) vs 64.3% (±16.6%); p Conclusions This study provides detailed information regarding the characteristics of HEN services and nutrition care provided to enterally-fed patients across Australia and New Zealand. The majority of HEN services are not adhering to the ACI HEN service guidelines and there is considerable variation in cost burden for consumers indicating inequitable delivery of care to patients.

Background Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs. Methods An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios. Results In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%). Conclusions This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.

IntroductionProviding effective nutritional rehabilitation to patients hospitalised with anorexia nervosa (AN) is challenging, partly due to conservative recommendations that advocate feeding patients at low energy intakes. An ‘underfeeding syndrome’ can develop when patients are not provided with adequate nutrition during treatment, whereby malnourished patients fail to restore weight in a timely matter, and even lose weight. Of particular concern, the reintroduction of carbohydrate in a starved patient can increase the risk of developing electrolyte, metabolic and organ dysfunction. The proposed trial assesses the efficacy and safety of a lower carbohydrate enteral formula (28% carbohydrate) against a standard enteral formula (54% carbohydrate), in adolescent and young adult patients (aged 15–25 years), hospitalised with AN.Methods and analysisThe study employs a double-blind randomised controlled trial design. At admission to hospital, malnourished adolescent and young adults with AN will be randomly allocated to commence feeding on a standard enteral feeding formula (1.5 kcal/mL, 54% carbohydrate) or a lower carbohydrate isocaloric enteral feeding formula (1.5 kcal/mL, 28% carbohydrate). Assessments of nutritional intake, weight and biochemistry (phosphate, magnesium, potassium) will be conducted at baseline and during the first 3 weeks of hospital admission. The primary outcome measure will be incidence of hypophosphatemia. Secondary outcomes include weight gain, oedema, other electrolyte distortion, length of hospital admission, admission to the Intensive Care Unit (ICU) and number of days to reach medical stability, using defined parameters.Ethics and disseminationThe protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee and institutional research governance approvals were granted. Written informed consent will be sought prior to study enrolment. Study findings will be widely disseminated through peer-reviewed publications and conference presentations.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12617000342314); Pre-results.

AIM: There is currently limited information regarding the home enteral nutrition population and its service practice at the state and national levels. The aim of this study is to report on patient numbers and demographics of the home enteral nutrition population in New South Wales, and to evaluate the implementation of home enteral nutrition services in public hospitals in the state. METHODS: A cross‐sectional study was conducted using two online questionnaires, which were completed by the dietitian overseeing home enteral nutrition at each participating hospital. RESULTS: The home enteral nutrition population of participating hospitals was approximately 7600, with 81% oral nutrition support patients and 19% tube‐fed patients. Mean compliance score to the home enteral nutrition implementation checklist was 54.1% (±20.7%), with a range of 14.3% to 98.2%. Hospitals with a home enteral nutrition dietitian/coordinator scored a higher rate of compliance with the implementation checklist compared with hospitals without one (79.6% (±15.6%) vs 47.6% (±2.4%); P < 0.001). The key service improvements suggested by dietitians included increased funding towards a home enteral nutrition dietitian/coordinator (67.8%); improved resources to provide outpatient reviews, home visits and multidisciplinary service model (54.2%); improved database management and a more efficient registration process (52.5%). CONCLUSIONS: Home enteral nutrition services continue to be inconsistent across New South Wales. Funding and resource limitations were identified as the major barriers to addressing gaps in service provision.

Aim There are limited data on home enteral nutrition patients in NSW because of the lack of a state-wide or national registry in Australia. The present study aimed to report on the trends in home enteral nutrition at a tertiary teaching hospital in NSW Australia, from 2005 to 2013. Methods A 9-year retrospective study (2005–2013) on the trends of home enteral nutrition was performed by retrieving data from a database set up specifically for home enteral nutrition patients at the study hospital. Results The number of home enteral nutrition patients at the study hospital is increasing; however, the rate of expansion has slowed down. Mean age ranged from 52.3 to 55.7 years during the study period and the most common primary diagnosis of patients remained cancer, non-malignant respiratory disease and neurological disorders. Over time there has been a notable increase in patients requiring oral nutrition support, and a corresponding decrease in patients requiring enteral tube feeding. Gastrostomy tubes remained the most common type of enteral access device for tube fed patients; however, an increase in jejunostomy tubes was observed. Death was the principal reason for discharge from the service followed by completion of home enteral nutrition. Conclusions The use of home enteral nutrition has increased in the last 9 years at the study hospital. Most patients were registered for oral nutrition support and had an underlying cancer diagnosis, which may have contributed to the high rate of death observed in this patient population.

Objective: This article aims to draw mental health clinicians’ attention to the connections between nutrition and mental health, and the roles that Accredited Practising Dietitians play in improving mental and physical health through dietary change. Methods: Selective narrative review. Results: Unhealthy dietary practices are common in high prevalence and severe mental illness. Epidemiological evidence demonstrates that nutrients and dietary patterns impact on mental health. In addition, poor physical health is well documented in people with mental illness and the greatest contributor to the mortality gap. Dietary intervention studies demonstrate improved mental and physical health outcomes. Accredited Practising Dietitians translate nutrition science into practical advice to improve the nutritional status of patients with mental illness, and prevent and manage comorbidities in a variety of care settings. Conclusions: Medical Nutrition Therapy offers opportunities to improve the physical and mental health of people living with mental illness.

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

Results The mean (SD) age of the 184 adolescents was 16.7 years (0.9). Mean (SD) admission BMI was 16.9kg/m2 (2.3) and discharge BMI was 19.5kg/m2 (1.5). The mean (SD) starting caloric intake was 2523.6kcal/day (383.5) equating to 56kcal/kg (12). Most patients (87.5%) were treated with nasogastric tube feeding. Mean (SD) length of stay was 3.5 weeks (1.9) with a weekly weight gain of 2.1kg (0.9). No patients developed cardiac signs of refeeding syndrome or delirium; complications included peripheral oedema (3.8%), hypophosphatemia (1.1%), hypomagnesaemia (6%), and hypokalaemia (1.6%). Caloric prescription on admission was not associated with developing hypophosphatemia (p=0.15), hypokalaemia (p=0.40) and hypomagnesaemia (p=0.96). Conclusion Results demonstrated the efficacy of treating adolescent inpatients with restrictive EDs safely with higher initial caloric intakes, resulting in rapid weight restoration without major refeeding complications; which challenges current conservative calorie prescriptions advocated in clinical guidelines.

Objective The aims of the present study, in home enteral nutrition (HEN) patients, were to assess patient satisfaction with the service and quality of life (QOL) scores, and to compare QOL scores in HEN patients with general Australian population values. Methods Self-administered voluntary questionnaires for the present cross-sectional study were mailed out to 322 eligible participants registered with HEN for >5 months. The questionnaires used included a patient satisfaction survey and a validated QOL questionnaire. Data analysis consisted of cross-tabulation, Chi-squared tests and t-tests. Results There were 112 participants. Patients reported satisfaction with information received before discharge (86%), support received after discharge (74%), expertise of the health professional (87%), access to health professionals experienced with HEN (74%), communication between health professionals (74%), costs of HEN supplies (52%) and delivery of HEN supplies (88%). QOL scores related to physical, psychological, social and environment domains were significantly lower in HEN patients than in the Australian reference population (P

Objective This cross-sectional study investigates the home enteral nutrition (HEN) services of public principal referral hospitals in NSW, Australia, comparing their services to best practice guidelines for HEN. Methods HEN service processes were investigated using an online questionnaire and telephone interview with the dietitian primarily working with HEN at each hospital. Results Participating hospitals reported a total of approximately 3200 HEN patients, 76% required oral nutrition support. Only 69% of hospitals had a dietitian allocated to their HEN service and no hospitals had established multidisciplinary teams to manage HEN patients. Post-discharge follow-up, as recommended for tube fed and oral patients, was achieved by 8% and 15% of hospitals respectively. Forty-six per cent of dietitians were satisfied and 46% of dietitians were dissatisfied with current HEN services provided, and reported the following improvements were required: increased clinical resources allocated to HEN dietitian/coordinator; increased outpatient services (home visits, outpatient clinic, multidisciplinary clinic); and an efficient registration process and database. Conclusions HEN services among participating hospitals are inconsistent, demonstrating gaps in service provision. Baseline assessment scores varied, with an average of 61% of recommendations currently in use. Best practice guidelines are not firmly adhered to due to limited funding and allocated resources for HEN. What is known about the topic? HEN is recognised as a cost-effective and reliable way of treating patients requiring nutrition support post hospital discharge. There are best practice guidelines available to ensure quality care is provided to HEN patients in the community or home setting. As there is no national framework in place for HEN in Australia, currently total patient numbers are unknown and each state and territory provides different levels of service delivery and funding for HEN. It is unknown how guidelines in Australia have been implemented and practiced, as no studies were found that have audited HEN services in Australia. What does this paper add? From the participating hospitals we were able to obtain updated data on HEN patient numbers (~3200). This paper reports on baseline scores in meeting best practice HEN guidelines for tertiary referral hospitals in NSW, Australia and identifies gaps in service provision. It is essential to identify reasons that limit adherence to HEN guidelines, as consequences may include unnecessary re-admissions to emergency departments or hospitals, increasing healthcare costs. Our study found notable differences in service provision ranging from 29% to 86% of recommendations of HEN guidelines achieved, and identified a lack of multidisciplinary teams to manage HEN patients. What are the implications for practitioners? We found HEN services among principal referral hospitals are inconsistent and best practice guidelines are currently not adhered to. National guidelines together with local health policies assist in defining the required standard of care, enhance service delivery and promote clinical excellence. We found the NSW Health Agency for Clinical Innovation HEN Implementation Checklist to be a practical tool for obtaining baseline scores for adherence to best practice guidelines. Regulation of HEN will be positive for HEN users by ensuring a more equitable service is available by introducing consistent funding for HEN nationally. However, it is the responsibility of states and local health districts to implement guidelines, contributing to better health and quality of care provided to patients.

Results Median age 16.6 years (range: 14.7 19.9), median BMI 16.2 kg/m2 (12.4 18.5) on admission. Median weight gain in first week 4.0 kg (1.2 – 6.9), median total weight gain 7.8 kg (3.3 18.3). Median BMI on discharge 19.1 kg/m2 (16.4 21.0). Median length of stay 24.4 days (6.0 – 82.3 days). No admissions resulted in refeeding syndrome. Peripheral oedema and/or mild electrolyte abnormality occurred in 20.4% of admissions.