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This feature investigates the potential relevance to community care of a new food provision and nutritional management system for older hospital patients. A qualitative study identified the core factors contributing to inadequate food intake in older patients in hospital, including: poor mealtime ambience; lack of necessary mealtime assistance; inflexible meal provision; lack of monitoring of nutrient intake and absence of accountability in nutritional care. Many of these factors are also relevant to older people living in the community. To address these issues, we designed a new system for the nutritional care of the older patient: 'hospitalfoodie'. Hospitalfoodie facilitates: patient nutritional screening; patient-tailored food choice; and information exchange among the healthcare team. The system introduces a more flexible approach to provision of food, including the development of nutrient-dense 'mini meals' for older patients. The system facilitates monitoring of patient food intake against their nutrition targets and alerts staff of nutrition shortfalls. The relevance of components of hospitalfoodie to community nutritional care was explored through qualitative interviews and focus groups with a range of care providers.

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Over a period of 12 months 3 patients presented with severe tonsillitis and subsequently grew Fusobacterium necrophorum (literally-spindle-shaped rod which brings death!) from blood cultures. Two patients responded well to antibiotics and were discharged within 4 days of admission. The third case had a longer history of symptoms and following investigations of a minor but unusual neck swelling was found to have thrombosis of the external and internal jugular vein. This is the first stage in the potentially fatal dissemination of this virulent organism which manifests clinically as Lemierre's syndrome. We describe the clinical histories and discuss whether cases are unrecognised because of the prompt clinical response to penicillin and metronidazole. We stress the importance of taking blood cultures and careful examination of the neck in all patients presenting with a severe tonsillitis.