Assessment of health-related quality of life in patients with respiratory failure on home ventilation requires appropriate and highly specific measurement tools. We attempt to validate the English version of the Severe Respiratory Insufficiency Questionnaire (SRI).Psychometric properties of the SRI in 152 patients established on home ventilation were assessed.Cronbach's alpha ranged between 0.77 and 0.89 for the seven subscales and and was 0.93 for the summary scale. Principal components analysis revealed a one-factor solution for four and two factors for three subscales. Confirmatory factor analysis revealed a two-factor solution for six subscales, but these factors were dependent on each other. One factor was extracted out of the subscales confirming one summary scale accounting for 70% of the total variance. Correlation analysis between scales of the SRI and the Medical Outcome Study 36-item short-form health survey demonstrated highest correlations between comparable subscales. Chronic obstructive pulmonary disease patients had lower summary scale scores than patients with restrictive chest wall diseases, neuromuscular disorders and obesity hypoventilation syndrome.The English SRI has high internal consistency reliability, clearly established construct and concurrent validity, and is capable of differentiating between different diseases. It is now validated for use in research involving patients receiving home ventilation.

The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries.

Our study showed that diagnoses were not accurately recorded in discharge summaries, highlighting the need to measure and improve discharge summary quality.

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This simple equation has now been validated to be highly sensitive in identifying long term compliers and it also identifies those with worse compliance. This group could be targeted for a more intensive follow up regime with the aim of improving their compliance.

We evaluated clinicians' current practice for giving advice to patients with Obstructive Sleep Apnoea Syndrome (OSAS). Clinicians were invited to complete a web based survey and indicate the advice they would give to patients in a number of scenarios about driving; theywere also asked what they considered to be residual drowsiness and adequate compliance following CPAP treatment. In the least contentious scenario, 94% of clinicians would allow driving; in the most contentious a patient had a 50% chance of being allowed to drive.Following treatment with CPAP, clinicians' interpretation of what constituted residual drowsiness was inconsistent. In each vignette the same clinician was more likely to say "yes" to "excessive" than to "irresistible" (71+/12% v/s 42+/ 10%, P= 0.0045). There was also a lack of consensus regarding "adequate CPAP compliance"; "yes" responses ranged from 13% to 64%. There is a need for clearer guidance; a recent update to the DVLA guidance, and a statement from the BTS, making it clear that sleepiness while driving is the key issue, may help.2

Obstructive sleep apnoea (OSA) is a prevalent condition, affecting up to 20% of the population in first world countries [1]. The obstructive sleep apnoea hypopnea syndrome (OSAHS) is diagnosed when symptoms of excessive daytime somnolence or cognitive impairment are present in the context of an elevated apnoea-hypopnoea index (AHI) per hour of sleep. The definitions vary according to the lower cut-off for the AHI, which can range from >5 to >15 events per hour [2]. However, as with any sleep disorder, it is important to establish whether the sleep disordered breathing (SDB) per se is the true cause of symptoms of daytime somnolence. As is apparent to everyone who practises in the area, a large number of other factors can intervene, such as shift work, sleep insufficiency, psychiatric disorders, metabolic disorders and nutritional deficiencies, which may be the true cause of the somnolence rather than the AHI as measured on polysomnography. Additionally, a true AHI cannot be reported on the basis of any respiratory measurements conducted during sleep, if no electroencephalogram is simultaneously recorded [2].

Non-invasive ventilation (NIV) given to the right patient, in the right setting, in the right way and at the right time improves outcomes. However, national audits reveal poor practice in patient selection, clinical judgement, treatment initiation and availability of trained staff. NIV is indicated for persistent acute hypercapnic respiratory failure (AHRF) with acidosis after usual medical management in chronic obstructive pulmonary disease (COPD) exacerbation and even without acidosis in neuromuscular disorders or other restrictive conditions eg obesity hypoventilation or kyphoscoliosis. Having trained staff in a suitable environment with adequate equipment are keys to its success, along with close monitoring. A plan should be put in place at the time of initiating NIV about the ceiling of care, eg escalation to intubation or palliation, if the patient is not improving with NIV. Early NIV failure is most likely due to technical issues, such as inadequate pressures or mask leak, while late failure is usually the consequence of advanced disease. Any presentation with AHRF is a poor prognostic indicator and outpatient respiratory follow-up is indicated following discharge. For selected patients with COPD who remain hypercapnic 2 weeks after an exacerbation, domiciliary NIV can reduce admissions and improve survival. For patients with neuromuscular disorders or kyphoscoliosis a presentation with AHRF almost always indicates the need for domiciliary NIV.