-Studies have shown that end-of-life care within the UK hospital setting is variable, and care pathways are now being advocated in the UK. This report presents results from an audit revealing that it is possible to anticipate a large proportion of deaths within an acute setting, but this is generally achieved very close to the end of life. Fortynine per cent of patients were recognised as dying 24 hours or less before death, 17% between 24 and 36 hours before death, 21% between 36 and 72 hours before death, and 13% greater than 72 hours before death. It discusses the challenges around making the 'diagnosis of dying' and highlights that if clinicians do not feel confident in performing such a diagnosis, then patients cannot benefit from end-of-life care pathways. Instead of asking healthcare professionals to make accurate prognoses or diagnose dying, an environment needs to be created where teams feel comfortable in actively managing patients (appropriately) alongside considering their symptom control and planning for possible end-of-life care.KEY WORDS: care of the dying, diagnosis of dying, end-of-life care pathways, prognostication

Mild hypothermia for 48 hours in preterm neonates with severe NEC seems both feasible and safe. Additional investigation of the efficacy of this therapeutic intervention in this population is warranted.

Near-hanging is an increasing presentation to hospitals in Australasia. We reviewed the clinical management and outcome of these patients as they presented to public hospitals in Queensland. A retrospective clinical record audit was made at five public hospitals between 1991 and 2000. Of 161 patients enrolled, 82% were male, 8% were indigenous and 10% had made a previous hanging attempt. Chronic medical illnesses were documented in 11% and previous psychiatric disorders in 42%. Of the 38 patients with a Glasgow Coma Scale score (GCS) of 3 on arrival at hospital, 32% returned to independent living and 63% died. Fifty-two patients received CPR, of whom 46% had an independent functional outcome. Independent predictors of mortality were a GCS on hospital arrival of 3 (AOR 150, CI 95% 12.4–1818, P<0.001), taking plain X-rays of the cervical spine (AOR 0.06, CI 95% 0.004–0.97, P=0.047) and contact with the ground (AOR 0.03, CI 95% 0.002–0.62, P=0.02). Only 66% had imaging of the cervical spine performed with other imaging performed infrequently. There were three laryngeal, two hyoid bone and three cervical spine injuries and one carotid dissection. The number of cervical spine X-rays required to find a significant cervical spine fracture was 54. Near-hanging presenting to hospital with a poor conscious state or even cardiac arrest can have a favourable clinical outcome. Radiological investigations are infrequently performed despite a low GCS precluding early accurate assessment. Given the general favourable outcome, an aggressive approach to searching for correctable injuries is recommended.