Clin Med
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Systematic reviews of acupuncture have tended to support its use, but few applied rigorous inclusion criteria. We tested the credibility of conclusions of systematic reviews of acupuncture published since 1996 by applying rigorous inclusion criteria. Reinterpretation used randomised and double blind trials with valid outcomes or design, and with information available from at least four trials or from 200 patients. ⋯ Six reviews with more than 200 patients in randomised, double blind studies had good evidence of no benefit. Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased. They provide no robust evidence that acupuncture works for any indication.
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Lord Joffe's revised Assisted Dying for the Terminally III Bill was defeated in the House of Lords in May 2006, but it may return to Parliament in Autumn 2006. Assisted dying is being promoted as a logical extension to patient autonomy for those who are terminally ill and suffering intolerably, and proponents claim to have overwhelming public support. Those who have most experience of caring for the terminally ill, however, come out most strongly against any change in the current law. This paper suggests that estimates of public opinion are unreliable; that assisted dying is unnecessary if we are prepared to prioritise good end-of-life care; and that a change in the law would do little to protect patients but would put other vulnerable members of society at risk.
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General hospitals have commonly involved a wide range of medical specialists in the care of unselected medical emergency admissions. In 1999, the Royal Liverpool University Hospital, a 915-bed hospital with a busy emergency service, changed its system of care for medical emergencies to allow early placement of admitted patients under the care of the most appropriate specialist team, with interim care provided by specialist acute physicians on an acute medicine unit - a system we have termed 'specialty triage'. Here we describe a retrospective study in which all 133,509 emergency medical admissions from February 1995 to January 2003 were analysed by time-series analysis with correction for the underlying downward trend from 1995 to 2003. ⋯ No significant effect was seen for those over 65 or all age groups together when corrected for the underlying trend. Length of stay and readmission rates showed a consistent downward trend that was not significantly affected by specialty triage. The data suggest that appropriate specialist management improves outcomes for medical emergencies, particularly amongst younger patients.