Chapter 9 describes a study showing that whilst hypoxaemia does positively predict adverse outcome, it is not as predictive as existing severity scores. The presence of hypoxaemia may however identify a subset of patients who are classified as low severity by existing severity scoring, but are nevertheless at increased risk of adverse outcome.Severity scoring is the cornerstone of management in adult CAP, and is explored in chapter 10. Current severity scores adequately predict mortality in CAP, but often generate a group of “moderate severity” where appropriate management is often unclear.

This only gets better if we work toward a safe, respectful and equitable industry together. Companies, collectives and educational institutions need to create real pathways for women to safely report sexual misconduct without fear of retribution or inaction. Individuals who witness their friends and colleagues behaving badly need to call them out.

A review into Eltiona Skana’s care found that mental health services could not have ‘predicted or prevented’ her attack on Emily Jones. (Image: GMP)The father of Emily Jones has criticised mental health services after they claimed her death could not have been or prevented The seven year old was killed by Eltiona Skana, a paranoid schizophrenic who had previously been sectioned over outbursts of violence.Emily had been riding her scooter through Queens Park, Bolton, on Mothers Day, March 22, last year, when Skana leapt up from a nearby bench and fatally slashed the young girl across the throat with a craft knife.The 30 year old was well known to the local mental health services and had been under the care of a community nurse who would regularly check in on her.Read MoreSign up for daily news updates from Bolton with our free email newsletterBut, for a three month period before the attack, Skana nurse had been off sick and she had fallen out of regular contact with mental health teams.Later, when police searched her home they discovered a month worth of unused anti psychotic medication which should have been taken to treat the symptoms of her condition, including paranoid delusions of people trying to hurt her.She has since been found guilty of manslaughter by means of diminished responsibility and was handed a life sentence and a hospital order in December last year.The report acknowledged that Skana risk assessment document intended to give mental health nurses an idea of the dangers she might pose missed out key events, including an incident in 2017 where she visited the home of a friend and demanded to see the woman 13 year old daughter while she was thought to have been carrying a knife.It also detailed the conclusions of her community nurse, who noted that the 30 year old had regularly appeared paranoid through late 2019 and had begun to experience thoughts Skana was switched from injected anti psychotics to tablets in August 2019 and was expected to approach her doctor when she needed more pills. The review pointed out that the Bolton mental health team had established system to recognise when an individual would have been running out of medication Her last contact with her nurse came on March 11, just over a week before the attack on Emily, but the notes from that meeting were not entered into the service systems until much later, with the nurse explaining that she had other patients to prioritise and was about to go off on leave.Read MoreBolton in 2020 a historic year in picturesInvestigators noted that Skana sister had told doctors early on in her illness that she would not always take her medication as she was prescribed and repeated the claims in further interviews following Emily death.And, the review included references to a vicious attack by Skana on her own mother in February 2017.