Objective To trial malnutrition screening in older adults presenting to an emergency department (ED) and compare two service delivery models of nutritional support on nutritional status, quality of life, falls and unplanned hospital admissions. Design Participants (>60 years) presenting to ED screened at malnutrition risk were randomly allocated to either the control group (receiving regular treatment from community hospital interface programme nursing staff ) or intervention group (receiving dietetic assessment, nutrition intervention and follow-up in addition to regular community hospital interface programme support). Outcome measures including body weight, quality of life, depression, falls history and days of hospital admissions were collected at baseline and 12 weeks. Results Of 703 patients screened, 84 (12%) were identified at malnutrition risk. 24 consented to the intervention study, with 88% (21/24) confirmed to be malnourished. Clinically important but not statistically significant differences were found over the 12-week trial; the intervention group (n=9) gained 0.8 kg (±3.7) while the control group (n=10) lost −1

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Objective: To determine the prevalence of chro- nic obstructive pulmonary disease (COPD) in adults with Human Immunodeficiency virus infection (HIV). Design: Systematic review of Medline, Embase, CINAHL, PsycINFO and references from identified papers. Study selection: Studies determining the prevalence of COPD in adults with HIV infection. Independent duplicate data extraction. Study quality was assessed in terms of whether consecutive patients were en- rolled, recruitment and follow-up periods were defined, <10% of subjects were lost to follow-up, subjects with missing data, method of COPD diagnosis and antiretroviral treatment were described. Data synthesis and results: Of the 911 citations identified, 8 North American studies conducted from 2005 to 2010 were reviewed. The demographics were: mean age 43 - 50.3yrs, >60% males, <50% African Americans, 37.1% - 83.3% active smokers, >60% on antiretroviral therapy. COPD was diagnosed by post-bronchodilator FEV1/FVC < 0.7 in three studies, by International Classification of Diseases (ICD-9) codes in three studies, by FEV1/FVC < 5% of lower adjusted normal in one and by pre- bronchodilator FEV1/FVC < 0.7 in another study. The prevalence was 10% - 35%, except for one study that recorded prevalence of 4% by postbronchodilator FEV1/FVC < 0.7, but <38% of patients with prebronchodilator FEV1/FVC < 0.7 had post-bronchodilator spirometry in that study. Conclusion: COPD is becoming increasingly common in HIV infected as they smoke and live longer due to efficient antiretrovirals. However, definite conclusions cannot be drawn and more longitudinal studies are needed. In the meantime health care providers should be vigilant to screen for undiagnosed COPD and hesitant to attribute respiratory symptoms solely to HIV infection

There is currently no standardised procedure checklist for bronchoscopies in the United Kingdom. Furthermore, very few hospitals appear to routinely use any form of checklist for these procedures. Conversely, the World Health Organisation surgical checklist has become standard practice in most hospitals, our own included, for all surgical procedures. Based on our own needs, we decided to create a bronchoscopy checklist which could be used at our hospital with the primary emphasis on ensuring patient safety and improving clinical outcomes. We surveyed local surgical checklists as well as endoscopic checklists used in hospitals around the world. We then created an initial draft which was sent out to consultation to all Respiratory Physicians in our hospital. Comments were also taken from the endoscopy nursing staff. After a series of consultations, a checklist was trialled over the course of two weeks. Feedback from use in the endoscopy suite resulted in further modifications and a final version of the checklist came into use in May 2013. It is now used for all bronchoscopic procedures carried out by Respiratory Physicians in the hospital. An audit is planned for later this year to monitor uptake of the checklist and to determine if it has changed outcomes.