A Magic 8-Ball for Cardiac Arrest
Cardiac arrest is one of the most common ways that people die, and hospitals need to be constantly vigilant about the threat of heart stoppage in their patients. So physicians have long sought to develop a way of predicting who is most at risk for cardiac arrest when checked into the hospital, such that extra care and surveillance can be taken. At the 2011 international meeting of the American Thoracic Society, held this past week in Denver, two Medical Center fellows presented research refining these early warning systems to make them a more effective hospital tool.
In the first study, pulmonary and critical care fellow Gordon E. Carr connected cardiac arrest with another frequent sight on the hospital ward: pneumonia. Carr’s study found that patients admitted with pneumonia are at elevated risk of cardiac arrest over the next three days after admission, and that almost 40 percent of these cardiac arrests occurred while the patient was outside of the intensive care unit. “We found a compelling signal that some patients with pneumonia may develop cardiac arrest outside of the ICU, without apparent shock or respiratory failure,” Carr said in a press release. “If this is true, then we need to improve how we assess risk in pneumonia.”
Adding extra caution about cardiac arrest to the care of patients with pneumonia is a specific way to improve surveillance. But to apply to more patients, a broader scale is needed, one that can be easily assembled from the vital signs that are already routinely measured in the wards. One such scale, called the Modified Early Warning Score or MEWS was tested by pulmonary and critical care fellow Matthew Churpek as a predictor of cardiac arrest, who found it to be better at predicting a cardiac arrest in the next 48 hours than any individual vital sign. But MEWS was designed for general risk of death, not specifically for cardiac arrest, and Churpek suggested a more specialized risk score could be calculated for use by hospitals. The benefits of such a measure, he said in a press release, would be immense.
“Rapid response teams are a complex and resource-intensive intervention, so providing evidence-based criteria for their activation is crucial,” Churpek said. “Our patients will do better if we can detect who is at high risk early enough to intervene and prevent a cardiac arrest.”
Doctors Against Ronald McDonald
Childhood obesity is a growing problem in the United States, and doctors point the finger of blame directly at increased consumption of junk food and fast food. Chains such as McDonalds have made noise about making their food healthier, especially for children, by posting calorie counts on menus and offering snacks such as apples and carrots instead of fries. But according to an open letter signed by over 500 health care professionals and placed in newspapers around the country this week, they have not done enough.
Timed to coincide with the annual shareholders’ meeting for McDonalds, the letter urges McDonald’s to stop spending billions marketing junk food to children through Happy Meals and mascot Ronald McDonald. “Today, your icon is as recognized as Santa Claus,” the letter states, “McDonald’s and industry front groups have refused to address the dangerous toll that fast food and predatory marketing is taking on our kids.” The consequences, according to the CDC, are that one in three children will be diagnosed with Type 2 diabetes in the decades to come. Among the signatories were Deborah Burnet, chair of general internal medicine at the Medical Center, and Ernst Lengyel, associate professor of obstetrics/gynecology. Commentary about the effort was provided at the Huffington Post by columnist Frances Moore Lappe, who asked “Isn’t it time we start listening to doctors and stop listening to clowns?”
The Gene Expression blog at Discover magazine looks at the protein errors and biological complexity study featured here yesterday. Some interesting comments on the post reveal the different perspectives of biochemists and systems biologists.
The Science Times writes about optogenetics, one of the coolest techniques to hit the world of neuroscience in recent years. Scientists using genetic methods in mice can control the activity of neurons with flashes of light, which has allowed them to study neural pathways with a unprecedented selectivity. Reporters Carl E. Schoonover and Abby Rabinowitz examine the potential for the method in humans, perhaps to treat psychiatric diseases that have proved resistant to drugs.