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  1. The Triumvirate
  1. Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK

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‘There is a great deal to be seen in the tilt of a man’s hat’

So said John Steinbeck in his novella The Pearl, a parable about society, greed and evil. In essence the value of the pearl was associated with poor outcomes, including envy, fire, destruction and death. While not quite so apocalyptic the study by Echevarria et al showed that increasing values of the simple clinical score, incorporating: (1) previous admissions; (2) the extended Medical Research Council dyspnoea score; (3) age; (4) right- and (5) left-sided heart failure, lead to a shorter time to readmission ( see page 686 ). So while we might be tempted to predict a successful discharge by appearance perhaps the more objective PEARL score will help to guide discharge planning.

‘Give me a child until he is seven and I will show you the man’

This statement has been attributed to the Greek scientist and philosopher Aristotle and later to the Jesuit priest St Francis Xavier and the hypothesis was famously tested by the Granada Television series. It is clear now that all these great minds were wrong on so many levels. Two studies from Australia published in this month’s Thorax …

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