QJM : monthly journal of the Association of Physicians
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Due to aging and resources limitation, septic patients are often admitted to medical wards (MWs). Early warning deterioration is a relevant issue in this setting. Unfortunately, a suitable prognostic score has not been identified, yet. ⋯ Our findings do not seem to support the use of MEWS to predict the in-hospital mortality risk of sepsis in MWs.
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Multicenter Study
A cross-sectional study of doctors', managers' and public representatives' views regarding acceptable level of risk in discharges from the emergency department.
Discharging a patient from the emergency department (ED) always involves some risk of a poor outcome. ⋯ There are significant differences in risk tolerance when considering discharge from the ED between different groups with doctors being most risk tolerant and politicians most risk averse.
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Multicenter Study
Do Not Attempt Cardiopulmonary Resuscitation orders in acute medical settings: a qualitative study.
Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders have been shown to be independently associated with patients receiving fewer treatments, reduced admission to intensive care and worse outcomes even after accounting for known confounders. The mechanisms by which they influence practice have not previously been studied. ⋯ DNACPR orders can act as unofficial 'stop' signs and can often signify the inappropriate end to clinical decision making and proactive care. Many clinicians were uncomfortable discussing DNACPR orders with patients and families. These findings help understand why patients with DNACPR orders have worse outcomes, as such they may inform improvements in resuscitation policies.
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Randomized Controlled Trial Multicenter Study
Fluid management in diabetic-acidosis--Ringer's lactate versus normal saline: a randomized controlled trial.
To determine if Ringer's lactate is superior to 0.9% sodium chloride solution for resolution of acidosis in the management of diabetic ketoacidosis (DKA). ⋯ This study failed to indicate benefit from using Ringer's lactate solution compared to 0.9% sodium chloride solution regarding time to normalization of pH in patients with DKA. The time to reach a blood glucose level of 14 mmol/l took significantly longer with the Ringer's lactate solution.
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Documentation of resuscitation status in hospitalized patients has relevance in the management of cardiopulmonary arrest. Its association with mortality, Length Of hospital Stay (LOS) and the patients' primary diagnosis has not been established in general medical inpatients in hospitals in Australia and New Zealand. ⋯ The documentation of NFR in a patient's admission notes is associated with increased in-hospital mortality and LOS. This is only partly explicable in terms of these patients' greater age and co-morbidity.