QJM : monthly journal of the Association of Physicians
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The 20-min whole blood clotting test (WBCT20) is widely used for the identification of coagulopathy in snake envenoming, but its performance in practice has not been evaluated. ⋯ In clinical practice, the WBCT20 has low sensitivity for detecting coagulopathy in snake envenoming and should not over-ride clinical assessment-based decisions about antivenom administration. There is an urgent need to develop a simple bedside test for coagulopathy in snake envenoming.
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Studies have shown higher in-hospital mortality rates in patients with not-for-resuscitation (NFR) decisions. Long-term survival of these patients after their discharge from acute care is largely unknown as is communication of such decisions to primary care givers through letters or discharge summaries. ⋯ Many general medical patients with a documented NFR decision survive beyond 1 year after their index admission. The rate of communication of resuscitation decisions in hospital discharge summaries is low.
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Increasing hospital or specialist volumes has been shown to improve outcomes; there are little data on volumes and outcomes in emergency medical admissions. We have examined the hospital length of stay (LOS) and 30-day mortality for patients admitted under a consultant 'of the day' having high- or low-admission volumes. ⋯ In an era of increasing specialization, these data provide support for the concept that the frequency of being 'on-call' contributes to maintaining competence with an associated improvement in patient outcomes.