Do not attempt resuscitation decisions in a cancer centre: addressing difficult ethical and communication issues

Talking to patients about ‘Do Not Attempt Resuscitation’ decisions is difficult for many doctors. Communication about ‘Do Not Attempt Resuscitation’ decisions should occur as part of a wider discussion of treatment goals at an earlier stage in the patient's illness. A doctor should not initiate any treatment, including cardio-pulmonary resuscitation if he/she does not believe it will benefit the patient. An ethical framework is offered which may be of practical help in clarifying decision-making

Peer expectations about outstanding competencies of men and women medical students

Men and women enrolled in a combined premedical-medical school programme were asked as they began their clinical training to rate their anticipated competence on sixteen criteria relevant to medical practice. Competence dimensions tapped scientific/technical skills, dedication/commitment, and interpersonal skills. Students then were asked to nominate one classmate whom they expected might be‘the best’in each area. Self-ratings revealed few differences among men and women. Peer nominations, however, revealed a preponderance of male nominees in ten competence areas. Women dominated nominations only in the category of sensitivity to patients. Patterns persisted when peer nominations were controlled for students’academic standing and self-ratings on parallel dimensions. The data suggest that medical school peer groups share expectations about competencies of men and women as physicians which are consistent with generalized sex stereotypes and career patterns of men and women physicians.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74843/1/1467-9566.ep11340055.pd

Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump

The increasing use of the intra aortic balloon pump is attributed to the relatively easy percutaneous insertion and the low threshold of use over the past few years, especially in elderly patients with multi-vessel diseases and an affected ejection fraction

Predicting the terrestrial flux of sediment to the global ocean: a planetary perspective

Abstract A new model for predicting the long-term flux of sediment from river basins to the coastal ocean is applied to a global data set of 340 river basins. The model is based on relief, basin area (or, averaged discharge), and basin-averaged temperature. Basinaveraged temperature is determined from basin location (latitude, longitude) and the lapse rate across the basin relief (hypsometric approximation). The sediment flux model incorporates climate through basin temperature and hydrologic runoff. Solutions are provided for each of the major hemispheric climate regions (polar, temperate and tropic). The model successfully predicts the pre-anthropogenic flux of sediment to within the uncertainties associated with the global observations (within a factor of two for 75% of rivers that range across five orders of magnitude in basin area and discharge). Most of the ''problem'' rivers are associated with low observational loads (often smaller rivers where anthropogenic impacts are often magnified, and temporal variability is high). Model predictions provide a baseline for researchers: (1) to question the quality of observational data where available and disagreement is greatest, (2) to examine a river basin for unusually large anthropogenic influences (i.e. causes of erosion or causes of hinterland sediment retention), and (3) to uncover secondary factors not addressed by our model (lithology, lakes). The model provides a powerful tool to address the impact of paleo-climate fluctuations (warmer/colder; wetter/drier) on the impact of sediment flux to the coastal ocean.