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Objectives. The aims of the present study were to: (1) describe the documentation process of limitation of medical therapy (LMT) orders at the time of a rapid response team (RRT) call; and (2) compare documented LMT orders not associated with an RRT call (control, Group 1) with LMT orders documented at the time of an RRT call (Group 2). Methods. A descriptive study, over a 6-month period (February-August 2011), involving the review of the medical records of patients prospectively identified as either Group 1 or Group 2. Results. There were 994 RRT calls; of these, 50 patients (5%) had an LMT order documented by the RRT. A cardiac arrest was the trigger for the RRT for six patients (12%). Patients in Group 1 (n = 50) and Group 2 were of similar median age (80.5 vs 78.5 years; P = 0.30), LMTs were recorded at a similar time of day (15 : 30 vs 15 : 55 hours; P = 0.52) and day of the week (weekend: 32% vs 35%; P = 0.72). Comparing group 2 with Group 1, the RRT was less likely to document a not-for-resuscitation (NFR; 31 (62%) vs 49 (98%); P < 0.01) or a not-for-ICU (NFICU; 18 (36%) vs 41 (82%); P < 0.01) order, but more likely to document a not-for-RRT call (NFRRT; 31 (62%) vs 22 (44%); P = 0.04) and modified RRT calling criteria (MRRT; 4 (8%) vs 0 (0%); P = 0.04) orders. For Group 2 compared with Group 1 orders, involvement of the patient in the decision making process (9 (18%) vs 25 (50%); P < 0.01) or the next of kin (29 (58%) vs 45 (90%); P < 0.01) was documented less often. Conclusions. Documentation of LMT orders at the time of an RRT call is less likely to include documented involvement of patients or their next of kin, and is more likely to be an NFRRT or MRRT order. These findings have implications for overall clinical governance. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the clinical features, predisposing factors, complications and mortality of patients with submandibular space infections (SMSI). Particular focus is given to pathogenic microorganisms responsible for SMSI. Topics discussed include the risk of intensive care unit (ICU) readmission in patients with non-odontogenic SMSI, importance of dental care in preventing SMSI, and inadequacy of primary dental care in South Australia.

The scale of the COVID-19 pandemic represents unprecedented challenges to healthcare systems. We describe a cohort of 18 critically ill COVID-19 patients - to our knowledge the highest number, in a single intensive care unit in Australia. We discuss the complex challenges and dynamic solutions that concern an intensive care unit pandemic response. Acting as the State's COVID-19 referral hospital, we provide local insights to consider alongside national guidelines., (© 2020 Royal Australasian College of Physicians.)