The former head of the Royal Marines died by suicide after experiencing “substantial stress”, an inquest has concluded. Major General Matthew Holmes, 54, was found in a bedroom at his home in Winchester, Hampshire, on October 2, 2021, the inquest heard.

Age-adjusted D-dimer thresholds in patients aged ≥50 years are now recommended, to reflect the fact that minor D-dimer elevations are common in older populations and rarely significant. Laboratory D-dimer testing remains the gold standard, but, if this is unavailable or unable to deliver a result within 4 hours, point-of-care (POC) D-dimer testing may be helpful. The sensitivity and specificity of POC D-dimer for VTE is 0.88 (95% CI = 0.83 to 0.92) and 0.70 (95% CI = 0.62 to 0.77), respectively. 6 POC testing is likely to incur additional costs for practices, particularly up front, for example, when purchasing analyser equipment and test kit consumables. However, a NICE cost consequence analysis found that quantitative POC testing was still associated with cost savings compared with laboratory testing because of reductions in hospital referrals and interim treatment, particularly where a delay in receiving a laboratory result might be expected. It is important to consider whether a confirmed VTE was ‘provoked’ by a secondary cause via close history and examination. One important change is that NICE no longer suggests patients with unprovoked VTE should be investigated for cancer, as this is felt to have a low yield and risks causing high levels of patient worry. Cancers associated with a higher risk of DVT include brain, ovary, pancreas, colon, stomach, lung, and kidney. She added that her brother was “awash with stress” in the final months of his life. Jonathan Ball, chief executive of the Royal Marines Association, spoke to him in the weeks before his death. He told the inquest that Maj Gen Holmes feared for the lives of “close personal friends” in the Afghan army who had been left behind.

He made some very close personal friends with senior Afghan officers,” he said. “He knew that they were unlikely to be able to get out. She said she asked him if he felt like killing himself, and he told her: “Why shouldn’t I?” She said she mentioned his children to him.

He feared for their lives and the lives of their families. He felt that somehow he had personally failed them by failing to help get them out.” She said that Fleet Commander Vice Admiral Jerry Kydd had told Maj Gen Holmes to agree to the restructuring, in which he would lose his role, or resign. “He was told he had to sign or agree to resign,” she said, adding that her husband found the experience “hugely humiliating”. I said, ‘what do you think you are doing?’,” she told the hearing. “I was concerned that he was in this way and I was also concerned that our daughter was in the next room. He said something along the lines of, ‘my life is not worth living without my family’.”He said he did not think it was necessary that the gun was removed as he wasn’t a threat to anyone else,” she said. He deeply loved his children,” she said. “He said the main thing that was on the front burner of his mind was the way in which his career had been brought to conclusion.”