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Objectives: We aimed to derive and validate a triage tool, based on clinical assessment alone, for predicting adverse outcome in acutely ill adults with suspected COVID-19 infection. Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. The primary outcome was death or organ support (respiratory, cardiovascular, or renal) by record review at 30 days. We split the cohort into derivation and validation sets, developed a clinical score based on the coefficients from multivariable analysis using the derivation set, and the estimated discriminant performance using the validation set. Results: We analysed 11773 derivation and 9118 validation cases. Multivariable analysis identified that age, sex, respiratory rate, systolic blood pressure, oxygen saturation/inspired oxygen ratio, performance status, consciousness, history of renal impairment, and respiratory distress were retained in analyses restricted to the ten or fewer predictors. We used findings from multivariable analysis and clinical judgement to develop a score based on the NEWS2 score, age, sex, and performance status. This had a c-statistic of 0.80 (95% confidence interval 0.79–0.81) in the validation cohort and predicted adverse outcome with sensitivity 0.98 (0.97–0.98) and specificity 0.34 (0.34–0.35) for scores above four points. Conclusion: A clinical score based on NEWS2, age, sex, and performance status predicts adverse outcome with good discrimination in adults with suspected COVID-19 and can be used to support decision-making in emergency care. Registration: ISRCTN registry, ISRCTN28342533, http://www.isrctn.com/ISRCTN28342533 [ABSTRACT FROM AUTHOR]

Background: Hospital emergency departments play a crucial role in the initial assessment and management of suspected COVID-19 infection. This needs to be guided by studies of people presenting with suspected COVID-19, including those admitted and discharged, and those who do not ultimately have COVID-19 confirmed. We aimed to characterise patients attending emergency departments with suspected COVID-19, including subgroups based on sex, ethnicity and COVID-19 test results. Methods and findings: We undertook a mixed prospective and retrospective observational cohort study in 70 emergency departments across the United Kingdom (UK). We collected presenting data from 22445 people attending with suspected COVID-19 between 26 March 2020 and 28 May 2020. Outcomes were admission to hospital, COVID-19 result, organ support (respiratory, cardiovascular or renal), and death, by record review at 30 days. Mean age was 58.4 years, 11200 (50.4%) were female and 11034 (49.6%) male. Adults (age >16 years) were acutely unwell (median NEWS2 score of 4), frequently had limited performance status (46.9%) and had high rates of admission (67.1%), COVID-19 positivity (31.2%), organ support (9.8%) and death (15.5%). Children had much lower rates of admission (27.4%), COVID-19 positivity (1.2%), organ support (1.4%) and death (0.3%). Similar numbers of men and women presented to the ED, but men were more likely to be admitted (72.9% v 61.4%), require organ support (12.2% v 7.7%) and die (18.2% v 13.0%). Black or Asian adults tended to be younger than White adults (median age 54, 50 and 67 years), were less likely to have impaired performance status (43.1%, 26.8% and 51.6%), be admitted to hospital (60.8%, 57.3%, 69.6%) or die (11.6%, 11.2%, 16.4%), but were more likely to require organ support (15.9%, 14.3%, 8.9%) or have a positive COVID-19 test (40.8%, 42.1%, 30.0%). Adults admitted with suspected and confirmed COVID-19 had similar age, performance status and comorbidities (except chronic lung disease) to those who did not have COVID-19 confirmed, but were much more likely to need organ support (22.2% v 8.9%) or die (32.1% v 15.5%). Conclusions: Important differences exist between patient groups presenting to the emergency department with suspected COVID-19. Adults and children differ markedly and require different approaches to emergency triage. Admission and adverse outcome rates among adults suggest that policies to avoid unnecessary ED attendance achieved their aim. Subsequent COVID-19 confirmation confers a worse prognosis and greater need for organ support. Registration: ISRCTN registry, ISRCTN56149622, http://www.isrctn.com/ISRCTN28342533. [ABSTRACT FROM AUTHOR]

In 1894, two-fifths of the men who served in the Royal Naval Reserves (RNR) were drawn from the Highlands and Islands of Scotland, despite the region containing only 0.5% of the total UK population. This was not an atypical spike in recruitment, however, but represents merely one moment in a relationship that lasted for nearly a century. Highlanders and Islanders had served in the RNR since its inception in 1859, and continued to do so in large numbers right up to the outbreak of war in 1939. This article explores the association between region and military institution that developed as a result, and the economic and social reasons that lay behind this. In doing so, it challenges the tendency for Scottish historians to focus overwhelmingly on questions of national identity when examining the British military. It also suggests that the historiography of the Highlands and Islands has focused too much on questions of land and land ownership, and not enough on the wider economic and social circumstances impacting on individual and community life across the region. [ABSTRACT FROM AUTHOR]

Service users' involvement in mental health service research is increasingly acknowledged as important, yet, whilst involving users of mental health services as research participants is commonplace, seeking out their experience and indeed their 'expertise' to facilitate the development of tools to be used within mental health services is in its infancy. This article describes the involvement and views of service users in the development of a nursing metric-the Therapeutic Engagement Questionnaire. It presents their role in the three stages of development: generation, statement reduction and authentication. [ABSTRACT FROM AUTHOR]

The article discusses developments in the health care sector in Great Britain as of December 2013. It cites the move by the four health departments and organisations in the independent and voluntary sector to establish a formal network called the national collaborative. It claims that the life expectancy of people with learning disabilities are increasing, while the number of learning disability nurses has declined by over 50% in the past 10 years.

The author reflects on the importance of following guidelines to improve the care and safety of service users and staff in the mental healthcare industry in Great Britain. The author inferred that guidelines are put in place to help nurses do their job well, provide some uniformity, and provide consistency and standardisation of care. However, he averred that reluctance to follow guidelines may result in harm, suffering, and death.

The article comments on the benefits of writing care plans to service users and in stimulating the intellectual curiosity of nurses in Great Britain. It argues that nurses should pay more attention to assessment, diagnosis, and care planning. With this regard, the fundamental problem in mental health nursing is the gap in their knowledge of what works best for people.

Comments on issues concerning mental health practice in Great Britain. Proposal of the World Health Organization of mainstreaming mental health services to improve funding and help reduce the risk of mental health care being marginalized; Improvement in the quality of life of mental health service users; Effect of lack of coordination among healthcare professionals and different services.

Abstract: Background: Inpatient suicide is a tragedy, and removal of the means is only a partially effective strategy. Objectives: To identify the mechanisms by which attempted inpatient suicides are prevented, so that their use can become more widespread. Method: Analysis of one year of nationally reported suicide attempts on inpatient psychiatric wards from the National Patient Safety Agency. Results: Patients are discovered in the act by staff checks (medication rounds, meals, routine activities, and intermittent observation) and by staff being caringly vigilant and inquisitive (noticing the absence of patients, their psychological distress, physical state, responding to unusual noises, etc.). Conclusions: The use of intermittent observation and other patient checks should be increased, and particularly directed to private areas of the ward. All staff should act on any sense of unease or feeling that something about a patient, their behaviour, or noises on the ward, are not right. [Copyright &y& Elsevier]

Competing Interests: Competing interests: We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: grant support from the National Institute of Health Research to our employing institutions. The authors are co-investigators on the PHEWS study.

Background: The WHO and National Institute for Health and Care Excellence recommend various triage tools to assist decision-making for patients with suspected COVID-19. We aimed to compare the accuracy of triage tools for predicting severe illness in adults presenting to the ED with suspected COVID-19., Methods: We undertook a mixed prospective and retrospective observational cohort study in 70 EDs across the UK. We collected data from people attending with suspected COVID-19 and used presenting data to determine the results of assessment with the WHO algorithm, National Early Warning Score version 2 (NEWS2), CURB-65, CRB-65, Pandemic Modified Early Warning Score (PMEWS) and the swine flu adult hospital pathway (SFAHP). We used 30-day outcome data (death or receipt of respiratory, cardiovascular or renal support) to determine prognostic accuracy for adverse outcome., Results: We analysed data from 20 891 adults, of whom 4611 (22.1%) died or received organ support (primary outcome), with 2058 (9.9%) receiving organ support and 2553 (12.2%) dying without organ support (secondary outcomes). C-statistics for the primary outcome were: CURB-65 0.75; CRB-65 0.70; PMEWS 0.77; NEWS2 (score) 0.77; NEWS2 (rule) 0.69; SFAHP (6-point rule) 0.70; SFAHP (7-point rule) 0.68; WHO algorithm 0.61. All triage tools showed worse prediction for receipt of organ support and better prediction for death without organ support. At the recommended threshold, PMEWS and the WHO criteria showed good sensitivity (0.97 and 0.95, respectively) at the expense of specificity (0.30 and 0.27, respectively). The NEWS2 score showed similar sensitivity (0.96) and specificity (0.28) when a lower threshold than recommended was used., Conclusion: CURB-65, PMEWS and the NEWS2 score provide good but not excellent prediction for adverse outcome in suspected COVID-19, and predicted death without organ support better than receipt of organ support. PMEWS, the WHO criteria and NEWS2 (using a lower threshold than usually recommended) provide good sensitivity at the expense of specificity., Trial Registration Number: ISRCTN56149622., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)