Clin Med
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Bed availability remains the main operational focus for managers and clinicians on a day-to-day basis within the NHS. There is now published research that establishes a lack of bed stock is too simplistic an explanation of the situation. ⋯ So far most of what little work has been done has focused on the front end of the process, to 'buffer' unplanned admissions through the use of short-stay facilities, such as medical assessment units, as a short-term solution. This paper reviews the evidence for the hypothesis that bed availability problems can be solved by actions other than the addition of more beds to the system.
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Clinical ethics committees (CECs) are increasing in number in the UK and have mostly developed in response to local interest, as opposed to being mandated as in the USA. However, there is no regulatory framework for UK CECs with no defined educational requirements or specification of core competencies for their members. ⋯ Recommendations for educational and membership requirements for CECs have also been made. Given the appropriate resources the standards proposed can be appropriately evaluated and are consistent with principles of ethical governance.
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Case Reports
Delayed pericardial effusions: life-threatening complication presenting up to 100 days after chest trauma.
Stab wounds are often managed conservatively with simple wound assessment and closure. However, even apparently minor thoracic wounds can cause delayed pericardial effusions presenting as life-threatening tamponade sometimes days, weeks or months later. Patients suffering stab wounds to the chest should receive echocardiographic follow-up to exclude delayed pericardial effusions.