Objectives: Dehydration in older adults contributes to increased morbidity and mortality during hospitalization. As such, early diagnosis of dehydration may improve patient outcome and reduce the burden on healthcare. This prospective study investigated the diagnostic accuracy of routinely used physical signs, and non-invasive markers of hydration in urine and saliva. Design: Prospective diagnostic accuracy study. Setting: Hospital acute medical care unit and emergency department. Participants: One hundred and thirty older adults (59 males, 71 females, mean (SD) age = 78 (9) y). Measurements: Participants with any primary diagnosis underwent a hydration assessment within 30min of admittance to hospital. Hydration assessment comprised seven physical signs of dehydration (tachycardia (>100bpm), low systolic blood pressure (<100mmHg), dry mucous membrane, dry axilla, poor skin turgor, sunken eyes, and long capillary refill time (>2s)), urine color, urine specific gravity (USG), saliva flow rate (SFR) and saliva osmolality. Plasma osmolality (Posm) and the blood urea nitrogen to creatinine ratio (BUN:Cr) were assessed as reference standards of hydration, with 21% of participants classified with water-loss dehydration (Posm >295mOsm/kg), 19% classified with water-and-solute-loss dehydration (BUN:Cr >20) and 60% classified as euhydrated. Results: All physical signs showed poor sensitivity (0-44%) for detecting either form of dehydration, with only low systolic blood pressure demonstrating potential utility for aiding the diagnosis of water-and-solute-loss dehydration (diagnostic OR = 14.7). Neither urine color, USG, nor SFR could discriminate hydration status (area under the receiver operating characteristic curve, AUCROC = 0.49-0.57, P>0.05). In contrast, saliva osmolality demonstrated moderate diagnostic accuracy (AUCROC = 0.76, P<0.001) to distinguish both dehydration types (70% sensitivity, 68% specificity, OR =5.0 (95%CI 1.7-15.1) for water-loss dehydration, and 78% sensitivity, 72% specificity, OR =8.9 (95%CI 2.5-30.7) for water-and-solute-loss dehydration). Conclusions: With the exception of low systolic blood pressure, which could aid in the specific diagnosis of water-and-solute-loss dehydration, physical signs and urine markers show little utility to determine if an elderly patient is dehydrated. Saliva osmolality demonstrated superior diagnostic accuracy compared with physical signs and urine markers, and may have utility for the assessment of both water-loss and water-andsolute-loss dehydration in older individuals. It is particularly noteworthy that saliva osmolality was able to detect water-and-solute-loss dehydration, for which a measurement of plasma osmolality would have no diagnostic utility. Thankyou for allowing us to resubmit the above manuscript to your journal. We have responded to the reviewers comments (see below), with changes in the manuscript highlighted in red text. We hope you feel that these changes have improved the manuscript.Please don't hesitate to contact me if you require...

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the case of a 59-year-old man who presented with headache, hypertension and a single episode of fever with no other symptoms. He subsequently developed unilateral weakness. Computer tomography identified a cerebral venous sinus thrombosis (CVST). A subsequent test for COVID-19 was positive. This is the first report of CVST as a presenting symptom of COVID-19 infection.

Digital technologies such as telemedicine have the potential to transform healthcare, but uptake has only recently gained momentum secondary to national policy drivers. This paper reviews the potential benefi ts of telemedicine in secondary care and explores the use of video conferencing to support the hospital follow-up of older people with chronic disease, identifying a wide variety of issues that need to be addressed for successful implementation. We believe these issues will interest secondary care colleagues considering the use of telemedicine to support or substitute for some outpatient activities.

Purpose: Rebuilding one's life after stroke is a key priority persistently identified by patients yet professionally led interventions have little impact. This co-design study constructs and tests a novel peer-led coaching intervention to improve post-stroke leisure and general social participation. Methods: This study followed the principles of co-design by actively engaging and harnessing the knowledge of stroke survivors in order to develop and test a peer-lead coaching intervention. Phase 1 assessed function, mood, and involvement in leisure and social activities 6 months following stroke (n ¼ 79). Phase 2 involved semi-structured, in-depth interviews with 18 stroke survivors, and 10 family carers to explore experiences related to social and leisure participation. Phase 3 tested the co-designed peer-led coaching intervention. Data collected also included co-design feedback sessions and a training workshop with selected peer coaches and in addition, interviews with stroke survivors and their peer coaches at two time-points: following the training program (n ¼ 5) and delivery of the intervention (n ¼ 2). Results: A peer-coaching intervention was successfully co-designed and tested combining the use of lay knowledge sociocognitive and self-regulatory theories with principles of transformational leadership theory. Both peers and stroke survivors reported having benefited at a personal level. Conclusions: This study reports on an innovative community-based and peer-led intervention and its results have generated new evidence on how stroke survivors engage with and respond to peer coaching support. It further provides a theoretical platform for designing and implementing peer interventions. Hence, these results have the potential to inform the development of future peer coaching intervention not only for stroke rehabilitation but also for a wide range of chronic conditions. ä IMPLICATIONS FOR REHABILITATIONThe results of this co-design study, if replicated and extended, provide a theoretical framework to guide rehabilitation professionals about the optimal timing of peer-coaching interventions and contextual factors that need to be taken into account. Applying transformational leadership theory principles to the training of peers may prove useful at the time of the implementation of a coaching intervention. Peer-led coaching interventions, which are community-based and tailored to stroke survivors at the time of discharge, may help support re-engagement in social and leisure activities.

These are the first published data to show that individuals classified as DE have higher Posm, indicating suboptimal hydration, compared with non-DE. These findings indicate that whole-body hydration is an important consideration in DE.