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Background: This study aimed to assess the validity of a qualitative score derived from a nutritional screening tool when used by a dietitian or nurse against physical markers of nutritional status. Methods: A screening tool designed for elderly patients in use at St John's Hospital was evaluated. Using this, scores derived by dietitian and nurse were compared with physical measurements used in nutritional assessment. The agreement between scores in each of the five categories of the tool (clinical condition, body weight, dietary intake, ability to eat and mental condition) was determined. Results: Sixty-six subjects (19 male, 47 female, mean age 78.5 years) were recruited. Undernutrition was found in 23% (n=15) of the patient population (Ζ80% of reference values for one or more physical measurements of nutritional status). A significant correlation between the qualitative score derived by the dietitian using the screening tool and physical markers of nutritional status was evident (body weight expressed as ideal body weight r=0.36, P< 0.005 and arm muscle circumference r=0.53, P< 0.001). Using the screening tool 85% of the under-nourished patients were correctly classified as nutritionally 'at risk' by the dietitian; however, only 58% were correctly identified by the nurse. There was no agreement between scores from the dietitian and nurse in any of the five scoring categories. Conclusion: These results show that the nurse failed to identify over 40% of atrisk patients when using the screening tool. The lack of agreement between dietitian and nurse within each scoring category may suggest fundamental differences in assessing factors contributing to nutritional risk by these two professions.

Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described.Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced.Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission.

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