The New Zealand medical journal
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The aim of this update is to critically evaluate the evidence for or against the effectiveness of spinal manipulation in patients with any type of clinical condition. ⋯ Collectively these data fail to demonstrate convincingly that spinal manipulation is an effective intervention for any condition.
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The current approach to CPR in New Zealand hospitals is that it is attempted on all patients in cardiac arrest unless a DNR order is in place. Concern has been raised that this approach results in some "unlawful" CPR on the grounds that it is not in the patient's best interests. It has been suggested that policy change is required and one suggestion is a move away from DNR orders to mandatory "For CPR" orders. Ensuring lawfulness of CPR and more importantly quality care for patients is however more likely to be achieved not by policy change but by improved understanding by doctors and patients of the nature of these decisions, and by training programmes and work environments which value and facilitate difficult conversations, mutually respectful relationships and shared decisions.