Acute geriatrics at the front door.

Older people with frailty and urgent care needs are major uses of health and social care services. Comprehensive geriatric assessment (CGA) is an evidence-based approach to improving their outcomes, as well as improving service outcomes. Geriatricians form a small proportion of the overall workforce and cannot address the population need alone, so all clinicians (doctors, nurses, therapists and so on) need to engage in delivering CGA as a process of care, underpinned by specific competencies - which can be developed. Delivery of this care pathway needs to be measured and improved as rigorously as campaigns like those for improving sepsis or eradicating methicillin-resistantStaphylococcus aureus

Promoting healthy gender relationships in secondary schools through a mixed netball competition

Context: Gender-based violence is a widespread problem with significant impacts. Young people are identified as a priority group: as targets for change, and agents of change in violence prevention strategies. By increasing knowledge; providing opportunities to discuss issues in a supportive environment; challenging attitudes about roles and expectations; and providing skills to challenge sexism, harassment, and gender-based discrimination; we hope to prevent gender-based violence. Objectives: • Increase adolescent awareness to recognise the early warning signs of relationship and gender-based violence and the multiple factors that enable it; • Provide students the opportunity to practice and implement skills to take bystander action to prevent or intercede in situations of relationship and gender-based violence Process: Students participated in workshops exploring consent, gender equity, the role of the bystander and the impact of attitudes and behaviours on enabling or preventing the incidence of gender-based violence. These workshops were followed by a mixed round robin netball competition. Analysis: Interviews and surveys were conducted to measure baseline of students’ knowledge and confidence to intervene and impact of the workshops and netball competition. Outcomes: 75 surveys were completed. 66.2% reported learning about early signs of unhealthy relationships. 55.6% would only act if it was safe to. Some participants were unable to transfer class-based learning to the netball competition. Evidence showed students were surprised and strongly impacted by the data provided. Presumptions cannot be made that information is available and known to most. Efforts to raise awareness of the statistics on violence against women needs to continue

The challenges of using the Hospital Frailty Risk Score - Author's reply

We thank John Soong and colleagues, Sandra M Shi and Dae H Kim, and Rónán O'Caoimh and colleagues for their careful consideration of our Article. We note some concerns about the clinical utility of our scoring method; our approach is to position the Hospital Frailty Risk Score (HFRS) as a tool that can be implemented without the need for additional assessment or data collection, and direct high-risk individuals towards frailty-attuned interventions, such as the Comprehensive Geriatric Assessment (CGA).1 We acknowledge that the HFRS can only be generated after an initial admission, so risk stratification information would not be possible at first presentation. Two-thirds of people aged 75 years or older access acute-care hospitals more than once over a 2-year period, and those patients who have not previously accessed hospital care are typically at low risk of hospital-related adverse outcomes; thus, we view the HFRS as being especially useful to identify individuals at the highest risk of hospital-related harm and resource use. We accept that manual scales, such as the Clinical Frailty Scale,2 could be used, but the HFRS has the advantage of being automated and capturing all patients, not just a selected sample

Activist dispositions for social justice in advantaged and disadvantaged contexts of schooling

This article advances current conceptions of teacher activism through an exploration of the social justice dispositions of teachers in advantaged and disadvantaged contexts of schooling. We interrogate the practices of teachers in a government school, with a high proportion of refugee students and students from low socio-economic backgrounds, in a high-fees, multi-campus independent school, and in a disadvantaged Systemic Catholic school to illustrate how Bourdieu’s notion of dispositions (which are constitutive of the habitus) and Fraser’s distinction between affirmative and transformative justice are together productive of four types of teacher activism. Specifically, we show that activist dispositions can be characterised as either affirmative or transformative in stance and as either internally or externally focused in relation to the education field. We argue that the social, cultural and material conditions of schools are linked to teachers’ activist dispositions and conclude with the challenge for redressing educational inequalities by fostering a transformative activism in teachers’ practices

Mepolizumab does not alter the blood basophil count in severe asthma.

[First paragraph] To the Editor: Mepolizumab (anti‐IL‐5) depletes blood and airway eosinophils, and, clinically, allows down‐titration of oral corticosteroid and a reduction in the frequency of eosinophil‐dependent exacerbations.1 Basophils also express IL‐5Rα, participate in T2‐mediated inflammatory pathways2 and have been associated with exacerbation frequency.3 Whilst basophil progenitors are unlikely to depend on IL‐5 for development,4 blood basophil counts measured in routine clinical laboratories suggest they decrease following mepolizumab treatment.5-

Cognitive and psychiatric symptom trajectories 2–3 years after hospital admission for COVID-19: a longitudinal, prospective cohort study in the UK

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning. Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2–3 years, and whether symptoms at 2–3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2–3 years were associated with occupation change. People with lived experience were involved in the study. Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2–3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16–1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2–3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2–3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0–48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0–17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2–3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6–31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04–2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21–1·98] for every point increase in CCI-20). Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2–3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19. Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.</p