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.”
Sounds of Silence
April 12, 2015
I write in the early morning hours for the same reason birds sing then – it’s quiet. Birds can hear their voices, and I can hear my thoughts.
It is during the uncontested moments of the day that I can try out ideas – test them on paper. Yes, on paper! My most creative and productive process still employs a legal pad, a pencil and an eraser. The physical process of writing the words, looking at them, and often erasing what doesn’t make sense to my mind or sound right to my ear as I read it aloud.
The task of written communication has become more difficult during the four decades I’ve been engaged in this enterprise. While the work has become more complex and requires more nuanced discussion, the space available for careful comment has been reduced. Pretending cleverness or profundity, texts and tweets often do more harm than good to promote creative and productive discourse.
I am rarely provided the luxury of long-form journalism in this modern age. Even a “feature” article in a prestigious national professional journal is expected to be less than 1,500 words.
Modern scribes must boil down complicated matters to brief blogs like this one, hoping in a few short paragraphs to share an insight worth reading and to suggest a response worth doing.
The insight here? Silence is golden.
The suggested response? Seek a solitary space to describe and defend what it is that you hear in that silence.