Epilepsy in the pediatric and adolescent populations is a devastating condition where individuals are prone to recurrent epileptic seizures or changes in behavior or movement that is the direct result of a primary change in the electrical activity in the brain. Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The term Ketogenic Diet or Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a ketogenic state of human metabolism. Currently, there are 4 major Ketogenic diet therapies—the classic ketogenic diet (cKD), the modified Atkins diet (MAD), the medium chain triglyceride ketogenic diet (MCTKD) and the low glycemic index treatment (LGIT). The compositions of the 4 main KDTs differ and limited evidence to distinguish the efficacy among different diets currently exists. Although it is apparent that more randomized controlled trials (RCTs) and long-term studies are needed to evaluate efficacy, side effects and individual response to the diet, it is imperative to study and understand the metabolic profiles of patients with epilepsy in order to isolate which dietary restrictions are necessary to maximize clinical benefit.

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284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.

Learning Outcome: Describe the dietary and alcohol use behaviors of college students during the early-and mid-stages of the COVID-19 pandemic. Background:The COVID-19 pandemic has disrupted college students' lives, subsequently impacting health. This study's purpose was to compare college students' dietary and alcohol use behaviors during the early-and mid-stages of the pandemic.Methods: This observational study was conducted at a large Midwestern university in March/April 2020 (early-stage; n¼797, 72.4% female, 22.5AE5.7 years, BMI 26.5AE6.5 kg/m2) and October/November 2020 (mid-stage; n¼409, 72.9% female, 22.4AE5.8 years, BMI 26.5AE6.6 kg/m2). Participants completed the Starting the Conversation (STC) food frequency questionnaire and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening instrument. For both surveys, higher scores reflect less desirable behaviors. Quantitative data were analyzed using independent samples t-tests. Qualitative feedback regarding dietary changes compared to pre-pandemic was collected mid-stage only; themes were generated through inductive coding and peer consensus.Results: Dietary behaviors worsened from the early-to mid-stages of the pandemic. STC total score increased, fruit and vegetable consumption decreased, and fast-food intake increased (p<0.05 for all). Sugar-sweetened beverage, high-quality protein, savory snack, sweet, and solid fat consumption were unchanged (p>0.05 for all). Nearly half of participants aged 21+ years were at risk of alcohol misuse (48.8% early-stage, 48.2% mid-stage) although alcohol use was unchanged. Qualitative themes included preparing more homecooked meals, experimenting with popular diets, and increasing awareness of intake as well as less healthful choices related to emotional and environmental changes.