Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Cardiovascular decompensation
- Anton E Joseph (19 August 2005)
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Mobile phones in hospitals
- Deborah White (20 August 2005)
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Impaired cardiac pump/pump failure
- Mahamood Basharuthulla (21 August 2005)
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not a bad idea
- dr mohan devegowda (22 August 2005)
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Lets start all over
- Naveed S Aziez (24 August 2005)
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Re: Mobile phones in hospitals
- Raymond C Seidler (28 August 2005)
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Heart Inefficiency
- Oliver Sharpley (28 August 2005)
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Re: Cardiovascular decompensation
- Celine M Aranjo (7 September 2005)
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Bacterial contamination of mobile phones; electromagnetic interference is not the only risk.
- Richard R Brady, Western General Hospital, Edinburgh (18 September 2005)
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Epinephrine poisoning has been reported-Sept.19, 2005
- Phillip J. Colquitt (19 September 2005)
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Anton E Joseph, Consultant Radiologist Mayday University Hospital, Croydon CR7 7YE
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Editor, When a diagnostic label confuses doctors and has the ring of finality with a negative psychological effect on the patient, as with the term cardiac failure then the terminology should be critically evaluated. Further, the use of the term cardiac failure rests the entire blame as indicated by David Mitchell in another rapid response, on the heart, which is pathophysiologically inaccurate, since it ignores the rest of the cardiovascular system and many other organs eventually responsible for the full blown picture of cardiac failure. Lehman et. al. in their editorial and your preference expressed in Editor’s choice is cardiac impairment as an alternative. Impairment is defined in the Oxford dictionary as a damage or cause weakening of. It is possible that damage could exist in the absence of any symptoms for example a myocardial infarct. What is proposed I assume to be functional impairment. However functional impairment of the heart may not necessarily give rise to the signs and symptoms of cardiac failure due to the compensatory mechanisms. It is only when the compensatory mechanisms cannot cope that we see evidence of ‘cardiac failure’. A more appropriate title would therefore be cardiovascular decompensation. The drawback of this is that 'decompensation' does not seem to be a word recognised in the English language at least according to the spelling and grammar check in the Word software or in a couple of dictionaries that I looked up. Nevertheless the meaning it conveys would be pretty obvious to anyone reading it, especially when it is taken in context. Therefore even at the risk of being accused of murdering the Queen’s English (makes it worse being a Sri Lankan by birth!), I propose cardiovascular decompensation as an alternative. If one were to recognise the truly multi system involvement in the full blown picture of ‘heart failure’ cardiovascular decompensation syndrome (CDS) may perhaps be more appropriate. Competing interests: None declared |
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Deborah White, Foundation Doctor 1 Aberdeen Royal Infirmary
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An article in the Student BMJ a couple of years ago (McCay L, Smith A. Student BMJ 2003;11:52-3. http://www.studentbmj.com/issues/03/03/education/52.php) seemed to conclude that the ban on mobiles in hospitals was justified and probably a "good thing", for a number of reasons, although evidence was presented that mobiles do not interfere with medical equipment at distances of greater than 2 metres. Text messages from under the sheets were certainly a lifeline for me during a recent spell as an in-patient – despite the fact that I was confident I was not putting anyone in danger by using my mobile, I was sufficiently scared of a telling off by the nurses not to make any voice calls! Competing interests: None declared |
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Mahamood Basharuthulla, Consultant Physician and Cardiologist Bangalore 560078-India
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It is true that the patients and relatives get frightened by the term "heart failure", some even consider as end of life. I am sure the various alternate suggestions are certainly worth considering. I would like to propose that "Impaired cardiac pump" leading up to "pump failure" would cover the failure of cardiac muscle inactivity,which is the main mechanism of heart failure. To lump whole cardiovascular system failure may not be appropriate, but that might result at the end. Competing interests: None declared |
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dr mohan devegowda, GP bnaglore 560038
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Its not a bad idea at all.Most of us write CCF-[congestive cardic failure] on our prescription so that patient doesnot undertand the seriousness of the ilness. the term Cardiac failure in this information age can be more dangerous psychologically than the illnes itself! Cardiac impairment may be appropriate. Competing interests: None declared |
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Naveed S Aziez, ER supervisor Aga Khan University Hospital,Karachi
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If the term "cardiac failure' is so confusing to the treating physicians and their patients and it sounds so "end of life" then imagine what terms like hepatic failure,renal failure,terminal malignancy,total loss of limb or sight would do to us, ordinary mortals and the patients we have to face every day. I think suitable alternate suggestions should include cardiac walk,hepatic talk and renal lock...just to mention a few.Lets rename all of them. Competing interests: None declared |
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Raymond C Seidler, GP Kings cross NSW Australia
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Editor, Mobile phones should be provided by hospitals to in patients. They would facilitate better communication with the outside world and make young patients not feel as though their umbilical cord to their lives had been clamped by bureacrats and officious hospital staff. Furthermore, patients would feel empowered to report medical misadventures as they occurred, rather than two or three days down the track. If only many of my patients had access to easy instantaneous communication, I am sure timely intervention could have forestalled problems in the hospital system. Competing interests: None declared |
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Oliver Sharpley, General Practitioner Burford Surgery OX18 4LS
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I find "Heart Inefficiency" works well for my patients and imples that treatment can make the heart more efficient. Competing interests: None declared |
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Celine M Aranjo, senior G.P. Australia, 2208
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This would be my choice of most appropriate terminology. Dr Anton E Joseph has summed up very well what the full-blown picture of cardiac failure is---it involves many other organ systems than just the heart Competing interests: None declared |
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Richard R Brady, SHO Colorectal Surgery Academic Colorectal Unit, Western General Hospital, Edinburgh
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Editor, Godlee's article requests evidence that using mobile phones in hospital are dangerous (1). I recently performed a study on Health Care workers in Northern Ireland, examining the rates of contamination of mobile phones by bacteria known to cause nosocomial infection. Of the 148 Health care workers sampled, 145 (98.0%) owned a mobile phone, and 105 (70.9%) had their mobile phone available for immediate bacterial sampling(53 doctors, 52 nursing staff). Of those respondents who owned mobile phones, 84.5% brought their mobile phones to the hospital every day and 40.1% used their phone at work at least once every day. In total, 96.2% of the phones sampled demonstrated evidence of bacterial contamination, and 15 (14.3%) of the mobile phones sampled grew bacteria that are known to cause nosocomial infection (6 were contaminated with MRSA).(2) Interestingly, attitudes towards mobile phone use varied,78% of those answering the questionnaire thought that doctors should be allowed to carry and use mobile phones in hospitals without restriction whilst 56% thought nurses and only 49% thought patients should be allowed to do so. The potential for mobile phones to spread infection is an important arguement in any move towards relaxation of the rules regarding permissive use in hospitals and whilst the link has not been completely demonstrated, surfaces which are commonly touched by health care workers and patients may act as sources of hand transfer of bacteria known to cause nosocomial infection (3). Does this provide the evidence Godlee "would love to know"? (1). Richard Brady Colorectal Senior House Officer Academic Colorectal Unit Western General Hospital Edinburgh 1. Godlee F. Let's call it cardiac impairment [Editor's Choice]. BMJ 2005;331:463. (20-27 August.) 2. Brady RR, Wasson A, Stirling I, McAllister C, Damani NN. Is your phone bugged? The incidence of bacteria known to cause nosocomial infection on healthcare workers' mobile phones. J Hosp Infect. 2005 Aug 11; [Epub ahead of print]. 3 Boyce JM, Potter- Bynoe G, Chenevert C, King T. Environmental contamination due to Methicillin-Resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 18 (1997), pp 622-627. Competing interests: None declared |
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Phillip J. Colquitt, RN/Technician Independent Comment
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Would Godlee[1] also love to know, in sympathy with Brady R. et. al.[2], the fresh evidence supplied by Hahn IH. et al.[3], wherein a cellular phone caused epinephrine poisoning in a young patient with septic shock. Hahn’s report describes an infusion device that had overdosed a patient with epinephrine, and that spontaneously went up to a rate of 999 ml/hr under test conditions when exposed to a cellular phone. Nurses have been seeing things like this for years. Most importantly, monitoring infusions is the responsibility of the registered nurse - not the prescriber. So it may be suggested that doctors should be encouraging the collection of evidence, rather than dismissing it’s existence. [1] Godlee F. Let's call it cardiac impairment [Editor's Choice]. BMJ 2005;331:463. (20-27 August.) [2] Bacterial contamination of mobile phones; electromagnetic interference is not the only risk. Richard R Brady, Western General Hospital, Edinburgh (18 September 2005) [3] Hahn IH, Schnadower D, Dakin RJ, Nelson LS. Cellular phone interference as a cause of acute epinephrine poisoning. Ann Emerg Med. 2005 Sep;46(3):298-9. Competing interests: None declared |
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