The New Zealand medical journal
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To determine the most common challenges to improving acute patient flow and resolving emergency department (ED) overcrowding in New Zealand hospitals, and to share some of the promising initiatives that have been implemented in response to them. ⋯ To improve acute care, resolve ED overcrowding and achieve the Target we need a comprehensive, whole of system approach and some significant changes to the way we use our physical and human resources. To address common challenges we need to share our experiences and expertise.
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Recent studies have demonstrated a reduction in perioperative complications if a surgical safety checklist is utilised. In our institution an adaptation of the WHO Surgical Safety Checklist is administered in 3 "domains": on arrival of the patient in the operating room (Sign In); before surgical incision (Time Out) and before the patients leaves the operating room (Sign Out). Since incomplete administration or staff disengagement could diminish any safety benefit we evaluated administration of this checklist. ⋯ The Sign Out domain was almost always omitted, which may increase the risk of important omissions in postoperative care. Most other aspects of checklist administration could also be improved. This will require strong leadership from senior clinicians in all relevant teams.
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Letter Case Reports
Encapsulating peritoneal sclerosis--a complication of peritoneal dialysis.
Encapsulating peritoneal sclerosis (EPS) is a rare complication of peritoneal dialysis. It often presents with non-specific symptoms, leading to a delay in diagnosis and a poor prognosis. Here we report a case of EPS in a patient treated with peritoneal dialysis and discuss the risk factors, diagnostic challenges and treatment options available.
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The aim of this update is to critically evaluate the evidence for or against the effectiveness of spinal manipulation in patients with any type of clinical condition. ⋯ Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.