Recent Submissions

  • The links between the amount of antipsychotic medication prescribed at GP practice level, local demographic factors and medication selection.

    Khine, C (BMC Psychiatry, 2021-06)
    Background: Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. Methods: The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Results: We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. Conclusions: The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.

    Toru, Hamza Khan (Journal of Population Therapeutics & Clinical Pharmacology, 2024-04)
    Background: Acute cholecystitis is considered the most common complication of cholelithiasis. Annually, around 64,000 people require surgical intervention for this frequent surgical disease. The normal medical practice for individuals with acute cholecystitis is to do an early laparoscopic cholecystectomy (LC). The objective of this research is to present compelling data regarding the impact of laparoscopic cholecystectomy on reducing hospitalization duration, postoperative complications, morbidity, and mortality rate, as well as to assess its overall practicality. This objective was accomplished through carrying out a methodical examination of the existing evidence in the study undertaken in this particular area. Objective: To compare the current evidences of open cholecystectomy Laparoscopic Cholecystectomy (LC) in the management of acute cholecystitis. Methods: Systematic review was carried out in accordance with the PRISMA standards. Relevant searches were conducted using PubMed, EMBASE, and CINAHL. Eligible quasi-experimental & randomized controlled experiments were conducted utilizing various Mesh terms associated with laparoscopic cholecystectomy as well as open cholecystectomy interventions. Four main outcome parameters (hospital stay, post op complications, morbidity and mortality rate) were assess on short, medium, and long-term effect. Result: The initial search yielded a total of 65 items. Following the screening process, a total of 10 publications were collected for the study. Multiple studies have consistently shown that laparoscopic cholecystectomy, when compared to open cholecystectomy, results in shorter hospital stays, reduced morbidity, and decreased postoperative problems. The outcome implies that. Laparoscopic cholecystectomy is a safe procedure for treating acute cholecystitis, with lower mortality rates, shorter hospital stays, and less postoperative problems compared to open cholecystectomy. Conclusion: The evidence of moderate quality indicates that laparoscopic cholecystectomy provides a safe and effective alternative to open cholecystectomy for patients with acute cholecystitis. It has been shown to reduce hospital stay, morbidity, mortality, and post-operative problems.
  • Methodological development of molecular endotype discovery from synovial fluid of individuals with knee osteoarthritis: the STEpUP OA Consortium

    Walsh, David A (Osteoarthritis and Cartilage, 2024-04)
    Objectives To develop and validate a pipeline for quality controlled (QC) protein data for largescale analysis of synovial fluid (SF), using SomaLogic technology. Design Knee SF and associated clinical data were from partner cohorts. SF samples were centrifuged, supernatants stored at −80 °C, then analysed by SomaScan Discovery Plex V4.1 (>7000 SOMAmers/proteins). Setting An international consortium of 9 academic and 8 commercial partners (STEpUP OA). Participants 1746 SF samples from 1650 individuals comprising OA, joint injury, healthy controls and inflammatory arthritis controls, divided into discovery (n=1045) and replication (n=701) datasets. Primary and secondary outcome measures An optimised approach to standardisation was developed iteratively, monitoring reliability and precision (comparing coefficient of variation [%CV] of ‘pooled’ SF samples between plates and correlation with prior immunoassay for 9 analytes). Pre-defined technical confounders were adjusted for (by Limma) and batch correction was by ComBat. Poorly performing SOMAmers and samples were filtered. Variance in the data was determined by principal component (PC) analysis. Data were visualised by Uniform Manifold Approximation and Projection (UMAP). Results Optimal SF standardisation aligned with that used for plasma, but without median normalisation. There was good reliability (<20 %CV for >80% of SOMAmers in pooled samples) and overall good correlation with immunoassay. PC1 accounted for 48% of variance and strongly correlated with individual SOMAmer signal intensities (median correlation coefficient 0.70). These could be adjusted using an ‘intracellular protein score’. PC2 (7% variance) was attributable to processing batch and was batch-corrected by ComBat. Lesser effects were attributed to other technical confounders. Data visualisation by UMAP revealed clustering of injury and OA cases in overlapping but distinguishable areas of high-dimensional proteomic space. Conclusions We define a standardised approach for SF analysis using the SOMAscan platform and identify likely ‘intracellular’ protein as being a major driver of variance in the data.
  • Advance care planning in end-stage cirrhosis in a UK district general hospital.

    Poon, Dennis; Dunn, Lauren (Future Healthcare Journal, 2023-11)
    Advance care planning (ACP) has been shown to improve health-related quality of life (QoL) for patients with advanced liver disease and their caretakers.1,2 It is increasingly recognised that ACP alongside palliative input should be initiated in these patients early to help to address their needs as their disease progresses and facilitate completion of advance directives via discussion between healthcare professionals, patients and their carers.2 This study assessed the local practice of implementing ACP in patients with end-stage cirrhosis against international recommendations. We also explored quality of life (QoL), depression score, religious belief and spiritual needs in these patients using questionnaires. The findings of the study provide a better insight of our local patient cohort with advanced cirrhosis and allow us to improve our approach in delivering ACP to these patients.
  • Modelling the economic constraints and consequences of Anaesthesia Associate expansion in the UK National Health Service. Response by the Association of Anaesthetists SAS Committee to Br J Anaesth 2024.

    Fleming, Robert J; Wain, Emma C
    We welcome publication of the article on the economic constraints and consequences of anaesthesia associate expansion in the UK by Hanmer and colleagues. 1 This article provides valuable economic context to the current discussion surrounding where anaesthesia associates (AAs) might fit into the current and future delivery of anaesthetic services in the UK.
  • Can an educational video improve the adequacy of bowel preparation for patients undergoing their first colonoscopy? Results of the EBOPS RCT.

    Foley, Stephen (Endoscopy International Open, 2024-03)
    Background and study aims The aim of this study was to assess the effect of an educational video on the quality of bowel preparation of patients from a UK population attending for their first colonoscopy. Patients and methods A prospective, endoscopist-blinded trial with 1:1 allocation was performed. Patients referred for their first colonoscopy were recruited between February 2019 and December 2019. All participants were prescribed Moviprep and received the trial site’s standard written bowel preparation instructions, with the intervention group also receiving a bespoke educational video. Adequacy of bowel preparation (defined as a Boston Bowel Preparation Scale of ≥2 in each segment of the bowel) and polyp detection rates (PDRs) were compared. Fisher’s chi squared test was utilized with P <0.05 as the threshold for significance. Results A total of 509 participants completed the trial from six centers; 251 were randomized to the intervention group. The mean age was 57 years and 52.3% were female. The primary endpoint was met with an adequacy rate of 216 of 251 (86.1%) in the intervention group, compared with 205 of 259 (79.1%) in the control group ( P <0.05, odds ratio [OR] 1.626, 95% CI 1.017–2.614). The PDR was significantly higher in the intervention group (39% vs 30%, OR 1.51, 95% CI 1.04–2.19, P <0.05). Conclusions An educational video leads to improved bowel preparation for patients attending for their first colonoscopy, and is also associated with greater detection of polyps. Widespread adoption of an educational video incurs minimal investment, but would reduce the number of inadequate procedures, missed pathology, and the cost that both these incur.
  • Budget Impact of RefluxStopTM as a Treatment for Patients with Refractory Gastro-oesophageal Reflux Disease in the United Kingdom

    Gemmill, Elizabeth (Journal of Health Economics and Outcomes Research, 2024-01)
    Background: Gastro-oesophageal reflux disease (GORD) is a common condition associated with heartburn and regurgitation. Standard of care for GORD patients in the UK involves initial treatment with proton pump inhibitors (PPIs) and laparoscopic antireflux surgery in patients unwilling to continue or intolerant of long-term PPI treatment. Recently, RefluxStop™, a novel, implantable medical device, has proven to be an efficacious and cost-effective treatment for patients with GORD. The current analysis aimed to describe the budget impact of introducing RefluxStop™ within National Health Service (NHS) England and Wales. Objectives: To estimate the more immediate, short-term clinical and economic effects of introducing RefluxStop™ as a therapeutic option for patients with GORD treated within NHS England and Wales. Methods: A model adherent to international best practice guidelines was developed to estimate the budget impact of introducing RefluxStop™ over a 5-year time horizon, from an NHS perspective. Two hypothetical scenarios were considered, one without RefluxStop™ (comprising PPI treatment, laparoscopic Nissen fundoplication, and magnetic sphincter augmentation using the LINX® system) and one with RefluxStop™ (adding RefluxStop™ to the aforementioned treatment options). Clinical benefits and costs associated with each intervention were included in the analysis. Results: Over 5 years, introducing RefluxStop™ allowed the avoidance of 347 surgical failures, 39 reoperations, and 239 endoscopic esophageal dilations. The financial impact of introducing RefluxStop™ was £3 029 702 in year 5, corresponding to a 1.68% increase in annual NHS spending on GORD treatment in England and Wales. Discussion: While the time horizon was too short to capture some of the adverse events of PPIs and complications of GORD, such as the development of Barrett’s esophagus or esophageal cancer, the use of RefluxStop™ was associated with a substantial reduction in surgical complications, including surgical failures, reoperations, and endoscopic esophageal dilations. This favorable clinical profile resulted in cost offsets for the NHS and contributed to the marginal budget impact of RefluxStop™ estimated in the current analysis. Conclusions: Introducing RefluxStop™ as a treatment option for patients with GORD in England and Wales may be associated with clinical benefits at the expense of a marginal budget impact on the NHS.
  • Assessing postural hypotension in a UK District General Hospital.

    Poon, Dennis; Muthukumar, Babyshalini; Pang, YL
  • The Difficulties of Managing Pain in People Living with Frailty: The Potential for Digital Phenotyping.

    Walsh, David A
    Pain and frailty are closely linked. Chronic pain is a risk factor for frailty, and frailty is a risk factor for pain. People living with frailty also commonly have cognitive impairment, which can make assessment of pain and monitoring of pain management even more difficult. Pain may be sub-optimally treated in people living with frailty, people living with cognitive impairment and those with both these factors. Reasons for sub-optimal treatment in these groups are pharmacological (increased drug side effects, drug–drug interactions, polypharmacy), non-pharmacological (erroneous beliefs about pain, ageism, bidirectional communication challenges), logistical (difficulty in accessing primary care practitioners and unaffordable cost of drugs), and, particularly in cognitive impairment, related to communication difficulties. Thorough assessment and characterisation of pain, related sensations, and their functional, emotional, and behavioural consequences (“phenotyping”) may help to enhance the assessment of pain, particularly in people with frailty and cognitive impairment, as this may help to identify who is most likely to respond to certain types of treatment. This paper discusses the potential role of “digital phenotyping” in the assessment and management of pain in people with frailty. Digital phenotyping is concerned with observable characteristics in digital form, such as those obtained from sensing-capable devices, and may provide novel and more informative data than existing clinical approaches regarding how pain manifests and how treatment strategies affect it. The processing of extensive digital and usual data may require powerful algorithms, but processing these data could lead to a better understanding of who is most likely to benefit from specific and targeted treatments.
  • Short-term COVID-19 vaccine adverse effects among adults in Ekiti State, Nigeria

    Adesokan, Adedapo
    Background: The safety of the COVID-19 vaccines has been a topic of concern globally. This issue of safety is associated with vaccine hesitancy due to concerns about the adverse effects of the vaccines. Consequently, this study determined the short-term safety profile of the Oxford/AstraZeneca COVID-19 vaccine in Ekiti State, Nigeria. Methods: Descriptive cross-sectional study conducted between May and July 2021 among individuals who had received the first dose of the first batch of the Oxford/AstraZeneca COVID-19 vaccine at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Nigeria. A Google form was used to collect data on the adverse effects of the vaccine. Results: Out of over 1,000 individuals who were approached, 758 respondents completed the study. A large percentage (57.4%) of those who received the vaccines were healthcare workers. Adverse effects were reported in 70.8% of the participants with most manifesting on the first day of the vaccination. The predominant adverse effects were injection site soreness (28.5%), followed by fatigue (18.7%) and muscle pain (8.6%). There was no report of severe adverse effects such as anaphylactic reactions, thrombosis, myocarditis, transient myelitis, or Guillen-Barre syndrome. Conclusion: This study found that self-reported adverse effects of the Oxford/AstraZeneca COVID-19 vaccine were mild and short in duration. This outcome has promising implications for improving COVID-19 vaccine uptake in the immediate environment and Nigeria.
  • Sedation from analgesics: patient preference survey

    Burdon, Joseph
    Background The propensity for certain analgesics to cause sedation is well documented, yet physician–patient dialogue does not routinely include pre-emptive exploration of preferences regarding this side effect. Objectives To investigate the extent to which palliative patients would accept sedation as a side effect of analgesia and to identify factors affecting decision-making. Methods Patients (n=76) known to a specialist palliative care services were given hypothetical scenarios regarding pain and asked about the acceptability of varying levels of sedation occurring as an analgesic side effect. Demographic data, including diagnosis, performance status and experience of pain and sedation, were collated for evaluation of the influence of these factors on patient opinion. Results Most patients (89.47%) would be quite or very likely to accept mild sedation. A significant minority (40.79%) would accept high levels of sedation. There is no significant association with the acceptability of sedation according to demographics. Almost half (40.79%) reported that their responses may change if the prognosis were extended, typically for less sedation with a longer prognosis. Conclusions Increasing levels of sedation are less acceptable, although there is significant variation in views. Palliative care patients are likely to indicate preferences regarding their acceptability of sedation. Palliative physicians must explore preferences on an individualised basis.
  • Battling a rarity: A case of kindler syndrome from a developing country

    Zehra, Tasheen (SAGE Open Medical Case Reports, 2024-02)
    Kindler syndrome, a rare branching of inherited epidermolysis bullosa, is an autosomal recessive condition characterized by the eruption of painful blisters and hemorrhagic vesicles in infancy. With age, the eruption of blisters are seen to decline leaving behind fibrosed, scarred, and paper-like skin, and poikilodermic features. To this date, about 400 cases have been reported worldwide for this disease only. This report aims to discuss the presence and diagnosis of Kindler Syndrome using limited resources in developing countries. It describes the presence of clinically diagnosed Kindler Syndrome in a young male of Pakistani descent that started in infancy and presented with a variety of clinical features over the years. Even though genetic analysis remains the gold standard diagnostic for Kindler syndrome, for third world countries, relying on Diagnostic clinical criteria remains helpful in establishing a diagnosis of Kindler syndrome for further management, as seen in our patient.
  • Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries

    Jan, A; Riaz, A; Gill, M; Sewell, T A (Atherosclerosis, 2019-06)
    Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.
  • The association of painful and non-painful morbidities with frailty: a cross sectional analysis of a cohort of community dwelling older people in England.

    Walsh, David A (BMC Geriatrics, 2024-02)
    Introduction: The association between chronic pain and frailty might indicate that pain is an independent driver of frailty but might alternatively be explained by inclusion within frailty identification tools of morbidities that commonly lead to chronic pain. This research examines the extent to which the association of pain with frailty might be attributed to morbidities. Methods: A cross-sectional analysis of older people in a UK cohort with or at risk of musculoskeletal problems or frailty (Investigating Musculoskeletal Health and Wellbeing study), used multivariable logistic regression and Z-tests to assess the degrees of associations of pain (McGill Pain Rating Index), and painful and non-painful morbidity counts with frailty (modified FRAIL questionnaire). Results: Data were from 2,185 participants, 56% female, median age 73 (range 60 to 96) years. 430 (20%) participants were classified as frail. In a fully adjusted standardised model, pain (aOR 2.07 (95%CI 1.83 to 2.33) and 'any' morbidity aOR (1.74 (95%CI 1.54 to 1.97) were both significantly associated with frailty. When morbidity was subclassified as painful or non-painful, painful (aOR 1.48 (95%CI 1.30 to 1.68) and non-painful (aOR1.39 (95%CI 1.24 to 1.56)) morbidities each were associated with frailty, as also was pain (aOR 2.07 (95%CI 1.83 to 2.34, p < 0.001). Conclusions: Pain is associated with frailty, over and above any effect of painful and non-painful morbidities. This forms the justification for future research which focuses on pain management in the identification, prevention, and treatment of frailty.
  • Multidisciplinary team approach in breast cancer care: Benefits and challenges

    Blackwood, Owain (Indian Journal of Pathology & Microbiology, 2020-02)
    The multidisciplinary team approach has been employed internationally for decades, as an attempt to bring collaborative decision-making and concentrate clinical experience from multiple specialties on single patient cases in a systematic fashion. Adoption is not yet worldwide, but is increasing. The role of the histopathologist is central, providing vital information and context to clinical diagnosis and management. Our review summarizes some of the most relevant research on the topic of MDT usage and efficacy in relation to breast cancer, attempting to draw together its advantages and challenges. It is hoped that this review will make a contribution to the current international literature regarding multidisciplinary approaches in breast cancer care. Competing Interests: None
  • Advancements in Gene Therapy approaches for Atrial Fibrillation: Targeted delivery, Mechanistic Insights and Future Prospects

    Toru, Hamza Khan (Current Problems in Cardiology, 2024-04)
    Atrial fibrillation (AF) remains a complex and challenging arrhythmia to treat, necessitating innovative therapeutic strategies. This review explores the evolving landscape of gene therapy for AF, focusing on targeted delivery methods, mechanistic insights, and future prospects. Direct myocardial injection, reversible electroporation, and gene painting techniques are discussed as effective means of delivering therapeutic genes, emphasizing their potential to modulate both structural and electrical aspects of the AF substrate. The importance of identifying precise targets for gene therapy, particularly in the context of AF-associated genetic, structural, and electrical abnormalities, is highlighted. Current studies employing animal models, such as mice and large animals, provide valuable insights into the efficacy and limitations of gene therapy approaches. The significance of imaging methods for detecting atrial fibrosis and guiding targeted gene delivery is underscored. Activation mapping techniques offer a nuanced understanding of AF-specific mechanisms, enabling tailored gene therapy interventions. Future prospects include the integration of advanced imaging, activation mapping, and percutaneous catheter-based techniques to refine transendocardial gene delivery, with potential applications in both ventricular and atrial contexts. As gene therapy for AF progresses, bridging the translational gap between preclinical models and clinical applications is imperative for the successful implementation of these promising approaches.
  • Monitoring thyroid function during amiodarone use.

    Sharma, Priya; Sheikh, Riyad; Siribaddana, Nipuna; Sathyanarayanan, Abilash; Fernando, Devaka; Muralheedharan, Vakkat (British Journal of Hospital Medicine, 2024-01)
    Amiodarone is an antiarrhythmic drug used to treat cardiac tachyarrhythmias. It has many adverse effects, with thyroid dysfunction one of the most notable. Through various mechanisms, both thyrotoxicosis and hypothyroidism can occur secondary to amiodarone therapy. There are two types of amiodarone-induced thyrotoxicosis: type 1 occurs in those with pre-existing thyroid disease and is treated with thionamide, whereas type 2 occurs in those without and is treated with glucocorticoids. Patients with amiodarone-induced hypothyroidism may be given levothyroxine to replace thyroid hormone, but in some cases, the appropriate management may be cessation of amiodarone.
  • Reducing epilepsy diagnostic and treatment gaps: Standardized paediatric epilepsy training courses for health care professionals.

    Dunkley, Colin
    Aim: To evaluate improvement in knowledge and clinical behaviour among healthcare professionals after attendance at paediatric epilepsy training (PET) courses. Method: Since 2005, 1-day PET courses have taught evidence-based paediatric epilepsy management to doctors and nurses in low-, middle-, and high-income countries. A cohort study was performed of 7528 participants attending 252 1-day PET courses between 2005 and 2020 in 17 low-, middle-, and high-income countries, and which gathered data from participants immediately after the course and then 6 months later. Training outcomes were measured prospectively in three domains (reaction, learning, and behaviour) using a mixed-methods approach involving a feedback questionnaire, a knowledge quiz before and after the course, and a 6-month survey. Results: Ninety-eight per cent (7217 of 7395) of participants rated the course as excellent or good. Participants demonstrated knowledge gain, answering a significantly higher proportion of questions correctly after the course compared to before the course (88% [47 883 of 54 196], correct answers/all quiz answers, vs 75% [40 424 of 54 196]; p < 0.001). Most survey responders reported that the course had improved their epilepsy diagnosis and management (73% [311 of 425]), clinical service (68% [290 of 427]), and local epilepsy training (68% [290 of 427]). Interpretation: This was the largest evaluation of a global epilepsy training course. Participants reported high course satisfaction, showed knowledge gain, and described improvements in clinical behaviour 6 months later. PET supports the global reduction in the epilepsy 'treatment gap' as promoted by the World Health Organization.
  • Recognition, prevention and management of 'digital harm'.

    Quinn, Lauren; Joustra, Arthur; Walker, Vicki
    The digital world continues to evolve and is apparent in all aspects of daily life. For children and young people, their online life is as real to them as their in-person life. Health professionals urgently need to update their knowledge and awareness of the positive and negative impacts of the myriad of online content and how this is viewed and used by children and young people. Digital harm can contribute to multiple clinical presentations and paediatricians must ask about online life in consultations and be able to provide holistic digital safety advice, while recognising serious digital harm requiring safeguarding input.This article will introduce the main areas of harm and how to include assessment in routine clinical practice. It will equip paediatricians to offer advice and safeguard children and young people and offer resources and links to further learning.
  • Hypothermic episodes during hospital admission and the correlation with clinical condition and mortality in different age groups.

    Pugh, Laura; Dattani, Kishan (Clinical Medicine, 2023-11)
    Studies demonstrate that older patients are more likely to have a lower body temperature,1 yet we currently use the same National Early Warning Score (NEWS) parameters for all adults.2 Recent studies indicate that low temperature is associated with increased mortality in younger patients;3 however, no such correlation was found in older patients. We wondered whether episodes of hypothermia are normal in older patients, even when medically safe for discharge (MSFD), or do they correlate with clinical deterioration and poor mortality outcomes?

View more