General medicine

Cardiopulmonary resuscitation (CPR) is the default treatment in hospital unless there is a decision to the contrary and this is documented in the patient record. The outcome of CPR in older chronically ill patients is very poor and discharge home is unlikely. Fewer not-for-resuscitation (NFR) orders are written than there are patients who would not benefit from CPR. NFR orders appear to be a marker of death, rather than the result of informed discussion about end-of-life care. There is a legal and ethical framework for the consideration of the suitability of CPR. Discussions about CPR are challenging, and uncertainty is introduced because of the lack of consensus around futility, the emotionally charged nature of the topic, misconceptions about the success of CPR and the failure to recognise that not offering CPR will allow a peaceful and supported death. Discussion around CPR can be misconstrued as a need for consent. A focus on patient and family involvement may result in an expectation that CPR is an entitlement. As part of evidence-based patient-centred care, CPR should only be offered to those for whom it is beneficial. CPR should no longer be the universal default. We propose an opt-in model, which will drive discussion and evaluation of the efficacy and suitability of CPR for the individual. A CPR discussion should occur on admission for all elderly hospital inpatients.

Michele Levinson MD, FRACP, FCICM · Amber Mills PhD, BA(Hons)

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Tania Janusic MB BS, DPH, FRACGP

Nurse practitioners must adapt to changing health priorities

Stacy Leidel MSc(Nurs)

Little data linkage occurs in Australian primary care: we can do better

Danielle Mazza · Lyle R Turner · Christopher Pearce

Online publishing provides new opportunities for today’s medical students to develop their research skills

Megan L Hickie BA, MB BS

Health professionals’ duty of care includes combating racism in society as well as in health care settings

Chelsea J Bond PhD, BAppHSc · Geoffrey K Spurling MB BS, MPH, RACGP · Deborah A Askew BAppSci, MHltSci, PhD

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Mark F Harris MB BS, FRACGP, MD · Nicholas A Zwar MB BS, MPH, PhD

Is debate being constrained by our obsession with universal fee-for-service medical care?

Peter C Arnold

In reply -- We need a more wide-ranging debate about different payment systems

Christopher B Del Mar

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Tammy C Hoffmann PhD, BOccThy(Hons) · France Légaré MD, PhD, FCFP · Magenta B Simmons PhD · Kevin McNamara PhD, MSc, BSc · Kirsten McCaffery PhD, BSc(Hons) · Lyndal J Trevena MB BS(Hons), MPhilPH, PhD · Ben Hudson MB BS, MRCGP, FRNZCGP · Paul P Glasziou MB BS, PhD · Christopher B Del Mar MD, FRACGP

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John B Best AO, MD BS, PhD, DSc(Hon)

How Australia can help achieve universal health coverage in the rest of the world

Michael R Kidd AM, MD, FRACGP

New centre delivers high-quality, culturally safe primary care, research, teaching and access to specialists

Noel E Hayman MB BS, MPH, FAFPHM · Deborah A Askew BAppSci, MHlthSci, PhD · Geoffrey K Spurling MB BS, MPH, DTM

Aboriginal community controlled primary health care services are making a real difference in the Northern Territory

Pasqualina M Coffey · Alex Hope · John D Boffa

Discussions with men about sexual health may also help identify life-threatening disease

Mark Wenitong · Michael Adams · Carol A Holden

Guiding principles of the Council of Australian Therapeutic Advisory Groups should inform off-label prescribing

Madlen Gazarian · Steve Morris

A novel program could prevent a highly infectious and disfiguring disease in remote Aboriginal communities

Buddhi Lokuge MB BS, MPH, PHD · Alex Kopczynski · Angela Woltmann MB BS(Hons), DipRACOG, FRACGP · Faye Alvoen · Christine Connors MB BS, FAFPHM, MPH · Terrence Guyula · Eddie Mulholland · Samantha Cran BA(Comm), BA(Arts) · Tim Foster BEng(Civil)(Hons), LLB(Hons), MSc · Kamalini Lokuge MB BS, PhD · Tanya Burke MA, BA, DipEd · Sam Prince

Community controlled health services outperform mainstream general practice at improving Aboriginal outcomes

Kathryn S Panaretto MB BS, MPH, FAFPHM · Mark Wenitong MD · Selwyn Button BEd · Ian T Ring MPH, FAFPHM, FACRRM