Emergency department malnutrition screening and support model improves outcomes in a pilot randomised controlled trial.

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 -1.1 kg (±4.6). The intervention group also had better quality of life, less depression and shorter hospital admissions. CONCLUSIONS: Malnutrition screening appears feasible in ED. This pilot suggests a model of care providing nutrition support to older adults identified at nutritional risk may lead to improved patient outcomes but further research in a larger sample is required to confirm these findings.

Effect of tiotropium on sputum and serum inflammatory markers and exacerbations in COPD.

Chronic obstructive pulmonary disease (COPD) patients experiencing frequent exacerbations demonstrate increased stable-state airway inflammation. Tiotropium has been shown to reduce exacerbation frequency, but its effect on airway inflammation is unknown. The aim of the present study was to investigate the effect of tiotropium on sputum inflammatory markers and exacerbation frequency. Patients (n = 142) were randomised to receive tiotropium or placebo in addition to their usual medication for 1 yr. Sputum and serum cytokines were assayed by ELISA and exacerbation frequency calculated using a symptom-based diary. There was no difference in the area under the curve for sputum interleukin (IL)-6 or myeloperoxidase between the groups, but sputum IL-8 level was increased in the tiotropium arm. There was no difference between start and end of study in serum IL-6 or C-reactive protein level. Tiotropium was associated with a 52% reduction in exacerbation frequency (1.17 versus 2.46 exacerbations.yr(-1)). Of patients on tiotropium, 43% experienced at least one exacerbation, compared with 64% on placebo. The total number of exacerbation days was reduced compared with placebo (17.3 versus 34.5 days). Tiotropium reduces exacerbation frequency in chronic obstructive pulmonary disease, but this effect does not appear to be due to a reduction in airway or systemic inflammation.