BackgroundPhysicians are occasionally faced with patients requesting full resuscitation against medical advice. More commonly, neither patients nor their family members make such a request, but physicians simply presume that providing cardiopulmonary resuscitation comports with the patient’s wishes. In the USA, in contrast to other countries, a unilateral Do-Not-Resuscitate order by the physician is either forbidden by State Statute or not enforced by hospital policy. Unless otherwise specified, performing cardiopulmonary resuscitation on all hospitalized patients, regardless of the severity of the underlying illness, is the default position. Unlike other medical interventions, no deference is given to the medical judgment of the physician even when a patient is in the last days of a terminal illness. We examine the factors that have led to cardiopulmonary resuscitation having this unique status.Main bodyA review of the historical factors leading to cardiopulmonary resuscitation as the default position was undertaken. Articles published in the medical literature, lay-press articles, legislative enactments of law, and judicial opinions involving the issue of Do-Not-Resuscitate and cardiopulmonary resuscitation were reviewed regarding their impact on physician and hospital practice in the USA.ConclusionA critical review of the historical factors reveals that the rapid dissemination of cardiopulmonary training for the public, inaccuracies in the media regarding successful cardiopulmonary resuscitation, well-meaning legislative efforts with inadvertent consequences, and judicial interpretation outside the generally accepted concept of malpractice law have contributed to the situation faced by today’s physicians and hospitals in the USA.

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Osteoporosis is a degenerative bone disease that affects millions of people worldwide. The goal of this study was to test a new ultrasonic technique developed for clinical bone assessment called the backscatter amplitude decay constant (BADC). Ultrasonic backscatter measurements were performed on 97 volunteers at the left and right femoral necks using an ultrasonic imaging system (Terason T3000) equipped with a 3.5 MHz convex array transducer. The backscatter signals were analyzed to determine the backscatter amplitude decay constant (BADC), a parameter that measures the exponential decay in the amplitude of the backscatter signal. For comparison, additional ultrasonic measurements were performed at the left and right heels using an ultrasonometer (GE Achilles EXPII) to measure the stiffness index of the calcaneus. BADC demonstrated weak but statistically significant correlations with stiffness index (R < 0.25, p < 0.05). With further refinement of the measurement technique, BADC may be a useful parameter for ultrasonic bone assessment.

Introduction: Ultrasonic backscatter techniques are being developed to detect changes in bone caused by osteoporosis. The goal of this study was to evaluate the clinical utility of backscatter difference measurements at the femoral neck. Methods: Backscatter signals were acquired from the left and right femoral necks of 97 human volunteers using an ultrasonic imaging system (Terason T3000). The signals were analyzed to measure the normalized mean of the backscatter difference (nMBD), a quantity that represents the power difference between two portions of the same backscatter signal. Also, a bone sonometer (GE Achilles EXPII) was used to measure the stiffness index (SI) of the left and right heel bones. Results: Linear regression analysis was used to compare nMBD measurement at the femoral neck to SI measurements at the heel. A statistically significant (R ≥ 0.2) correlation was observed between nMBD and SI. Conclusion: These results suggest that nMBD is sensitive to naturally occurring variations in bone tissue, and thus may be able to detect larger changes in bone caused by osteoporosis.

PurposeThe Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) reported that the risks of breast cancer treatment in woman smokers may outweigh the benefits. The data used doses from published reports using a variety of treatment techniques. In our study, the risks of lung cancer and heart disease were determined from a modern era tangential-only technique.Methods and materialsDoses to the lung and heart were obtained for tangential radiotherapy to the breast or chest wall. The risk of lung cancer incidence and cardiac mortality were calculated by taking the ratio of our doses to those published by the EBCTG.ResultsA total of 77 women were identified meeting our inclusion criteria. The mean combined whole lung dose was 2·0 Gy. The mean whole heart dose was 0·9 Gy. The estimated risk of lung cancer and cardiac mortality in a 50-year-old life-long smoker was estimated to be 1·5 and <1%, respectively.ConclusionsTangential only radiotherapy delivered substantially lower doses to the combined whole lung and whole heart than those reported by the EBCTCG. In this cohort, the risks of radiation induced lung cancer and heart disease are outweighed by the benefits of radiotherapy even in those that are smokers.