Cardiac Screening
October 31, 2014
Sudden death among 12 to 25-year-olds is “a low event rate occurrence.”
“There is insufficient information to support the view that ECGs in asymptomatic young people for cardiac disease is appropriate or possible on a national basis for the United States, in competitive athletics or in the general population.”
“At present, there is no mechanism available in the United States to effectively create national programs of such magnitude, whether limited to athletics or including the wider population of all young people.”
“There is insufficient evidence that particularly large-scale/mass screening initiatives are feasible or cost effective within the current US healthcare infrastructure . . .”
“The ECG . . . cannot be regarded as an ideal or effective test when applied to large healthy populations.”
“An additional, but unresolved, ethical issue concerns whether students who voluntarily engage in competitive athletic programs should have advantage of cardiovascular screening, while others who choose not to be involved in such activities (but may be at the same or similar risk) are in effect excluded from the same opportunity.”
The AHA’s Sept. 14 AHA writing group “does not believe the available data support significant public health benefit from using the 12-lead ECG as a universal screening tool. The writing group, however, does endorse the widespread dissemination of automated external defibrillators which are effective in saving young lives on the athletic field and elsewhere.”
Panama Points
January 25, 2012
Author David Kord Murray opines in Borrowing Brilliance that almost all good ideas are borrowed, and the farther afield one roams from the topic at hand the more useful the idea may be (and the more brilliant it may appear to be).
So it didn’t surprise me to discover useful ideas for modern day leadership and management in a book written in the 1970s about a period many years before that – David McCullough’s history of the building of the Panama Canal titled The Path Between the Seas.
I learned first that the primary task of this huge project was not what it appears to be. It was not primarily an engineering feat, but medical. Not removing dirt, but disease. Not conquering the largest obstacles, but the smallest insects. It was only after the diseases were understood and controlled that the construction could advance and the project could be completed.
Second, I learned that once the construction was begun, there was a bigger challenge than digging the pathway clear. It was removing the unwanted dirt and debris to other places. It wasn’t the front end of the project alone that mattered, but the back end as well: where to put the hundreds of millions of tons of rock and dirt on or around this narrow isthmus of land.
For every project there is need to assess what the underlying issues are that might get in the way of accomplishing the more apparent tasks before us.
And for every project there is need to fully assess consequences. We don’t want merely to move the dirt around, creating new problems as we do so.
I will be considering these thoughts as I soon see with my own eyes the Panama Canal, constructed over four decades and completed almost 100 years ago. And gratefully, I will be fully immunized for diseases largely conquered during the completion of this engineering marvel.