Cognitive testing and the hazards of cut-offs.

The article reviews some basic statistical concepts used in medicine, including the mean, standard deviation, sensitivity and specificity. Using this background the authors describe how these can be applied to cognitive tests, taking the Montreal Cognitive Assessment (MoCA) as an example. Two different approaches to using the MoCA in diagnosing dementia are considered: one using a fixed cut-off score, the other taking account of normative data about the effects of age and educational level on MoCA scores.

Key stakeholder's attitudes towards the professional accountabilities and responsibilities of newly qualified Pharmacist Independent Prescribers (IPs) in England and enablers to implementation at scale?

Background: Independent prescribing is set to expand amongst community pharmacists in England in the next few years. This study aims to explore the different accountabilities and responsibilities associated with independent prescribing compared to more traditional pharmacist roles.

Objective: To inform commissioning frameworks that will allow independent prescribing by community pharmacists to be commissioned safely and appropriately at scale.

Guest Editorial - Shifting Dynamics: ICU Admissions in Denmark during the First Wave of the COVID-19 Pandemic.

The advent of the SARS-CoV-2 pandemic brought unprecedented challenges to healthcare systems worldwide. As the virus spread across continents, hospitals faced a surge in patient admissions, particularly to intensive care units (ICUs). Understanding the impact of the pandemic on the sickest patients admitted to hospital is crucial for enhancing preparedness for future outbreaks.

Analyzing diagnostic and treatment wait times for lung cancer Patients: Key insights from a provincial registry study.

Background: Lung cancer (LC) remains the leading cause of cancer-related mortality globally, necessitating timely diagnosis and treatment to improve patient outcomes. This study aimed to evaluate the timeliness of care for LC patients at a public hospital in Almería, Spain, assess adherence to guidelines, and explore associations between timeliness and survival.

Methods: A retrospective cohort study was conducted, reviewing medical records of LC patients diagnosed between 2019 and 2021.

Impact of the COVID-19 pandemic on the clinical management trends for acute appendicitis among the under-25s: a retrospective study.

Objective: To describe the COVID-19 pandemic's impact on acute appendicitis management on children and young people (CYP).

Design: Retrospective cohort study.

Setting: All English National Health Service hospitals.

Free-Cog revisited: the diagnostic contribution of cognitive and executive function.

To examine Free-Cog, a recently described, hybrid screening instrument, as separate tests of cognitive (Free-Cog-Cog) and executive function (Free-Cog-Exec) to see if this improved screening accuracy for cognitive impairment compared with standard Free-Cog. Free-Cog-Cog and Free-Cog-Exec were combined using Boolean logical 'AND' and 'OR' operators (serial and parallel combination), and also used to construct a stepwise decision tree. Serial combination improved specificity and positive predictive value whereas parallel combination improved sensitivity, typical findings with these operators.

A systems approach to the safety and efficiency of prescribing at the primary-secondary care interface.

The interface between primary and secondary care represents a highly complex and heterogeneous system that continues to pose risks to the safety and quality of care. Many issues relate to prescribing activities, and suboptimal information sharing between stakeholders can lead to avoidable harm events and system inefficiencies that increase workload. The framework of a systems approach is used to structure four key interface issues: medicines reconciliation, prescribing at secondary care outpatient appointments, shared records, and quality of communication.

Development of trauma systems in Europe-reports from England, Germany, the Netherlands, and Spain.

Major trauma systems have evolved in many European countries and have resulted in improved care in terms of mortality and morbidity. Many of the systems have similar history, with reports of either poor services, or a single disaster, driving change of policy and set up. We report on 4 European systems, looking at the background, set up and some of the results.

Value of improving patient safety: health economic considerations for rapid response systems-a rapid review of the literature and expert round table.

Objectives: Failure to rescue deteriorating patients in hospital is a well-researched topic. We aimed to explore the impact of safer care on health economic considerations for clinicians, providers and policymakers.

Design: We undertook a rapid review of the available literature and convened a round table of international specialists in the field including experts on health economics and value-based healthcare to better understand health economics of clinical deterioration and impact of systems to reduce failure to rescue.

NEWS2 and improving outcomes from sepsis.

The cause of deterioration is often unclear, so it is vitally important that we spot the sick and deteriorating patient from all causes. As a result, warning scores must cater for all conditions, and - where possible - be standardised across all healthcare settings. This article summarises the importance of an 'unblinkered' approach to acute illness assessment, comparing and examining the evidence for different historical scoring systems and looking at the early impact of national alignment to NEWS2 in patients admitted to hospital with suspected bacterial infections.

Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study.

Objectives: To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people.

Setting: All National Health Service (public) hospitals in England.

Participants: All people in England aged <25 years.

Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015-2020.

Background: The NHS response to COVID-19 altered provision and access to primary care.

Aim: To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England.

Design And Setting: A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database.

Transmission of SARS-CoV-2 arising from international flights arriving in Ireland in December 2020: a descriptive analysis using national surveillance data.

Objectives: There is limited evidence on the risk of in-flight transmission of SARS-CoV-2. This study estimated the extent of in-flight SARS-CoV-2 transmission on international flights arriving in Ireland during December 2020.

Study Design: This was a cross-sectional analysis.

Uncovering the treatable burden of severe aortic stenosis in the UK.

Objective: To estimate the population prevalence and treatable burden of severe aortic stenosis (AS) in the UK.

Methods: We adapted a contemporary model of the population profile of symptomatic and asymptomatic severe AS in Europe and North America to estimate the number of people aged ≥55 years in the UK who might benefit from surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI).

Results: With a point prevalence of 1.

The potential use of folate and its derivatives in treating psychiatric disorders: A systematic review.

Objectives: To examine the strengths and limitations of existing data to provide guidance for the use of folate supplements as treatment, with or without other psychotropic medications, in various psychiatric disorders. To identify area for further research in terms of the biosynthesis of mechanism of folate and genetic variants in metabolic pathway in human.

Methods: A systematic review of published literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to assess whether folate supplements are beneficial in certain psychiatric disorders (depression, bipolar disorder, schizophrenia, autism spectrum disorder, and attention deficit hyperactivity disorder).

Making Legs Matter: A Case for System Change and Transformation in Lower-Limb Management.

This consensus document is endorsed by The Queen's Nursing Institute (QNI) and The Queen's Nursing Institute Scotland (QNIS).

Introducing the new Chronic Oedema Wet Leg Pathway.

Reticence to apply compression therapy has been widely observed in clinical practice, compounded by an absence of evidenced-based pathways for application of prompt compression prior to measuring ankle brachial pressure index (ABPI). Importantly, delaying compression therapy for patients with chronic oedema and lymphorrhoea causes many avoidable complications. In 2017, Lymphoedema Network Wales (LNW) developed an evidenced-based pathway to improve the management of chronic oedema and wet legs (lymphorrhoea) for community nurses.

The life of Roger Williams.

In this brief obituary, we celebrate the life and achievements of Professor Roger Williams, who set up the UK's first liver transplant programme and championed excellence in hepatology for six decades.

Lifetime cardiovascular management of patients with previous Kawasaki disease.

Kawasaki disease (KD) is an inflammatory disorder of young children, associated with vasculitis of the coronary arteries with subsequent aneurysm formation in up to one-third of untreated patients. Those who develop aneurysms are at life-long risk of coronary thrombosis or the development of stenotic lesions, which may lead to myocardial ischaemia, infarction or death. The incidence of KD is increasing worldwide, and in more economically developed countries, KD is now the most common cause of acquired heart disease in children.