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.”
The Old Is New Again
October 23, 2015
In the hidden back reaches of my closet at home I’ve kept some ties, suits and pants I have not worn for many years, forgotten as I purchased or was given newer and more fashionable clothes. Needing space, and heeding my wife’s suggestion that it was time to donate what I never wear, I gave my wife a fashion show of my long-neglected wardrobe. I wanted her help to decide what to discard.
Some of the items I modeled brought back memories of happy times, like weddings and reunions; others of sadder times, like funerals. Some items were laughably out of style. But, surprisingly, some of the oldest items looked the best ... almost as good as the most recent additions to my wardrobe. They were, in fact, back in fashion.
This caused me to recall that some of the discarded policies of educational athletics are working their way back in fashion. For example …
- For many years, even after many states changed their rules, the MHSAA was criticized for prohibiting member schools’ students from wearing full equipment at and participating in the full-contact summer football camps of universities and commercial organizations. Now, with greater attention to improving acclimatization and reducing head contact in football, other states are returning to the policies we never discarded: contact-free out-of-season football camps and clinics.
- Equally “dishonored” by those who believe there is never too much of a good thing have been MHSAA rules that limit the number of contests and the distance of travel. After years of more and more of everything, the new normal of severely limited school sports budgets makes our modest schedules more virtuous than ever.
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For many years, MHSAA policy has stood apart from most states by limiting students to competing in only one level of a sport in a single day … no JV and varsity in the same day, no fifth or sixth quarter rule. Now, with even greater attention to reducing head and overuse injuries and other student health and safety issues, our rules look both protective and progressive, not overly restrictive.
If a man waits long enough, even his narrowest tie or widest lapel will be back in fashion; so what makes me cling to old clothes also makes me think twice about changing established rules. It is just as difficult to restore a discarded rule as it is to wear a discarded jacket.
It’s always easier to relax a policy than to restore it when we rediscover we need it.