Decision support aids in acute stroke and other stories . . .

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h920 (Published 25 February 2015) Cite this as: BMJ 2015;350:h920

“I don’t want to be the one saying: ‘let him die.’” The dilemmas faced by relatives when a loved one has had a stroke are explored in 15 interviews conducted by Dutch researchers six months after the event (Palliative Medicine 2015, doi:10.1177/0269216314563427). Few people have any preparation for making life and death decisions on someone else’s behalf in a situation of sudden distress. Better decision support aids are urgently needed for relatives and clinicians in acute stroke, particularly when there is time pressure to decide on interventions such as thrombolysis and thrombectomy.

Deciding which patients need their appendix out used to be the classic middle of the night clinical challenge for house surgeons: get it wrong and the patient ends up with peritonitis. Nowadays, doctors can turn to computed tomography (CT) for help, but a study from Taiwan (QJM 2015, doi:10.1093/qjmed/hcv010) raises questions about this decision. Using the national health insurance database, investigators …

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