Malnutrition affects over three million people in the UK with associated health costs exceeding £13 billion annually. [1] In hospital, malnutrition has been shown to increase complication rates, morbidity, mortality, hospital readmissions, and length of hospital stay.[2] To screen for malnutrition, a reliable and validated screening tool such as the malnutrition universal screening tool (MUST) should be used. [3] We believe that improved patient outcomes and significant savings to the trust can be achieved, not only by ensuring that every patient has a MUST score documented, but that it is calculated correctly and the appropriate interventions are implemented.We have carried out the audit three times (May, July, and November 2013). The study included the patients on the elderly care ward of Watford General Hospital (n=64, 62, and 63 respectively). MUST scores documented in nursing notes for each patient were noted. We recalculated each MUST score ourselves for comparison. We went through patient notes and nursing information and noted which recommended nutritional interventions were being implemented.Our results highlighted several issues: 1) Patients did not consistently have a MUST score documented 2) MUST scores were calculated incorrectly. This was generally due to BMIs calculated incorrectly, and patients' weights from six months ago not being known 3) High MUST scores not being acted on appropriately.Our interventions have involved liaising with various teams within the hospital to maximise the efficacy of the MUST score. This has included encouraging the trust to provide regular training to nurses because of high nursing staff turnover. Following our audit, the dietitian department agreed to undertake weekly ward rounds to screen for patients at risk of malnutrition. Our interventions so far have resulted in increased proportion of MUST scores being calculated (73 to 97%), and increased rates of patients being referred to dietitians (62 to 86% in the second audit cycle). ProblemThe MUST is a screening tool used to detect patients who are at risk from malnutrition. The MUST score is calculated using three steps: body mass index (BMI), percentage weight loss in past six months, and disease effect. Each resulting score has its own set of recommended interventions. Higher scores represent a greater risk of malnutrition. In order for the MUST score to be used effectively, all of these steps need to be carried out accurately. This audit was carried out on the care of the elderly wards at Watford General Hospital. We found that the following errors commonly occur:1. Patients do not have a MUST score calculated at all 2. BMI is calculated incorrectly, or is not calculated at all and a score is selected at random 3. Weight loss in the past six months is frequently not known, and this is often guessed 4. Once a MUST score has been calculated, the recommended interventions are not always carried out. All of these factors contribute to malnourished patients not being recognised, which is likely to negatively...

An 86-year-old woman presented to hospital with melaena. This was her third presentation with the same symptom. There was no obvious source of bleeding on her oesophagogastroduodenoscopy; however, it did show a previously clipped Dieulafoy lesion. CT angiography showed an aneurysm arising from the hepatic artery. Selective coeliac artery angiogram showed aneurysmal dilatation of the distal part of the coeliac trunk and confirmed the presence of the common hepatic artery aneurysm. The aneurysm was coiled by the interventional radiologist. Final angiogram showed good flow through the hepatic artery with obliteration of the inferior patch. The procedure was uncomplicated and the patient was discharged shortly afterwards.

We present a case of a 49-year-old woman diagnosed with aquaporin-4 antibody-positive transverse myelitis, who developed a significant transaminitis 2 months after commencing mycophenolate mofetil (MMF) as a steroid-sparing agent. No other risk factors were identified, a blood liver panel was negative and liver biopsy showed features compatible with drug-induced liver injury (DILI). MMF was stopped with a corresponding normalisation of serum alanine aminotransferase over the next 2 months. This case highlights MMF as a rare cause of DILI and provides justification for monitoring of liver biochemistry on therapy.

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and after colonoscopy. Of these, 28% (n = 58) had a history of CKD. Overall, there was no statistically significant difference in the change in eGFR before and after colonoscopy for patients without CKD compared to those with CKD (p = 0.18). There were only five patients with eGFR of <30 mL/ min and in this subgroup there was no significant renal impairment after colonoscopy. There were no acute kidney injuries in both groups. Conclusions The data show that 2L PEG solution is safe in patients with impaired renal function. Routine screening for CKD in patients undergoing bowel preparation for colonoscopy may not be justified.