Do specific delirium aetiologies have different associations with death? A longitudinal cohort of hospitalised patients.

PURPOSE: To describe aetiology-specific associations with mortality among older hospital patients with delirium. METHODS: Over 21 months, a cohort of 1702 patients with 2471 acute hospital admissions (median age 85, IQR 80-90, 56% women) were assessed for delirium, categorised with inflammatory and metabolic aetiologies based on available laboratory results, and followed up for all-cause mortality. Interactions between aetiology and delirium were tested. RESULTS: The total mortality for the cohort was 35.2%. While inflammation, metabolic disturbance, and delirium at time of admission all demonstrated independent associations with mortality, there was no evidence for any interactions between delirium and these laboratory-measured aetiologies. CONCLUSIONS: Delirium remains an important predictor of death in older hospital patients, irrespective of underlying aetiology.

IMPLSE course: a near-peer simulation course.

Background: Near-peer teaching is recognised for its benefit to both students and facilitators when used as an adjunct to traditional teaching. Simulation is an effective tool for teaching acute management. There are currently no published long-term objective data of the efficacy of near-peer simulation teaching. Methods: We designed the 'Immediate Management: Peer Led Simulated Emergencies' course, a near-peer simulation course for medical students run by junior doctors covering common medical and surgical emergencies. Participants and teachers were objectively tested before and after sessions, and participant confidence in various areas was self-assessed. Participants were followed up at 18 months with both repeat testing and analysis of finals examination results. Results: Participants' mean test scores improved significantly postcourse and remained significantly higher than baseline at 18-month follow-up. There was no difference between participants' and non-participants' final examination performance. Participant confidence increased in all areas immediately and at 18-month follow-up. Junior doctor facilitator test scores significantly improved after teaching on the course. Conclusions: Near-peer simulation courses can be effectively designed and run by junior doctors and our results suggest that they result in long-term improvement in test scores. Larger studies with randomised control groups are required to confirm the efficacy of such teaching.