Clin Med
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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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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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This aim of this study was to assess the impact of the introduction of a standardised early warning scoring system (SEWS) on physiological observations and patient outcomes in unselected acute admissions at point of entry to care. A sequential clinical audit was performed on 848 patients admitted to a combined medical and surgical assessment unit during two separate 11-day periods. Physiological parameters (respiratory rate, oxygen saturation, temperature, blood pressure, heart rate, and conscious level), in-hospital mortality, length of stay, transfer to critical care and staff satisfaction were documented. ⋯ Following the introduction of the scoring system, inpatient mortality decreased (P=0.046). Staff responding to a questionnaire indicated that the scoring system increased awareness of illness severity (80%) and prompted earlier interventions (60%). A standardised early warning scoring system improves documentation of physiological parameters, correlates with in-hospital mortality, and helps predict length of stay.