When Care Is Worth It, Even if End Is Death

From the New York Times:

The more nuanced reality is that some aggressive treatment delivers value and is appropriate, even though some patients who receive such care die; other treatment is too aggressive and should be curtailed no matter what the short-term outcome. No one knows how many patients are more like my patient, who could have died but whose life was saved, and how many undergo treatments and tests even though there is no meaningful chance they will benefit from them. The important thing is that it’s not all of one and it’s not all of the other.

Kids’ CT scans raise fears of cancer risk as use soars

From USA Today:

The number of CT scans for children brought to a hospital emergency room increased fivefold from 1995 to 2008, according to a study published this year in the medical journal Radiology. Nearly 5 percent of all children who went into an emergency room got a scan in 2008, compared with 1 percent in 1995. CT scans, also known as CAT scans, use radiation to create cross-sectional pictures of the body.

The American Medical Association House of Delegates last month endorsed new policies aimed at reducing radiation exposure from diagnostic imaging for all patients. The policies call for tracking a patient’s lifetime exposures, raising standards for technicians who use the devices and boosting awareness among patients about radiation risks.

Penn Medicine Contest Challenges Philadelphians to Help Save Lives With Their Cell Phones

From PR Newswire (press release):

A group of Penn Medicine researchers is set to save lives with cell phone cameras — and they’re challenging the public to help. The MyHeartMap Challenge, a month-long contest slated to take place beginning in mid January, will send thousands of Philadelphians to the streets and to social media sites to locate as many automated external defibrillators (AEDs) as they can. The contest is just a first step in what the Penn team hopes will grow to become a nationwide, crowd-sourced AED registry project that will put the lifesaving devices in the hands of anyone, anywhere, anytime.

Armed with a free app installed on their mobile phones, contest participants will snap pictures of the lifesaving devices — which are used to restore cardiac arrest victims’ hearts to their normal rhythm – wherever they find them in public places around the city. Participants will use the app to geotag the photos with their location and details about the device like its manufacturer. Then, they’ll send them to the research team via the app itself or the project’s web site. The data collected will be used to create an updated app linking locations of all public AEDs in the city with a person’s GPS coordinates to help them locate the nearest AED during an emergency.

The stakes are high: The person or team who finds the most AEDs during the contest will win $10,000, and the fruits of their efforts could save lives in the critical minutes following cardiac arrest. Participants who find various pre-located “golden ticket” AEDs around the city will also win $50 for identifying each of those devices.” The project is modeled after the DARPA Network Challenge, a crowd-sourcing experiment in which social media users raced to be the first to submit the locations of 10 moored, 8-foot, red, weather balloons at 10 fixed locations throughout the United States.

“More and more, scientists are learning that we can benefit from the wisdom of the crowd,” said MyHeartMap Challenge leaderRaina Merchant, MD, MS, an assistant professor of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Health Economics at the Perelman School of Medicine at the University of Pennsylvania. “Participation from ordinary citizens will allow us to answer questions and make the city safer than our team could ever do on its own.”

Used in conjunction with CPR, AEDs are an important part of the “chain of survival” needed to save cardiac arrest victims. Even people with no medical training can easily take those steps to help, since many AEDs provide audio instructions that talk users through the process of performing CPR.

In most cities across the United States, less than 10 percent of cardiac arrest victims survive. The MyHeartMap Challenge aims to tap the ingenuity of Philadelphia residents — and others worldwide — for what promises to become a resource that will ferret out thousands of ways to buoy those dismal statistics.

“Philadelphia is home to a vibrant medical community, some of the nation’s top institutions of higher education, and is a growing hub for
new technology development. The MyHeartMap Challenge brings all those elements together to improve the health of our people,” said Donald F. Schwarz, MD, MPH, Health Commissioner and Deputy Mayor for Health and Opportunity for the City of Philadelphia. “The city has a rich tradition of innovation, and we have what it takes to lead the nation in this new form of lifesaving community engagement.”

There’s an estimated one million AEDs across the nation, hung clearly on the walls in airports and casinos, but also tucked away in restaurant closets and under cash registers in coffee shops. Unlike implantable medical devices like pacemakers and artificial joints whose model or serial numbers are reflected in a patient’s medical record in order to notify them in the event of a manufacturer’s recall or other problem, AEDs are not subject to regulations that would allow their makers to know where or when their devices are being used. Instead, anyone can buy the devices (they cost about $1,500), and there’s no uniform system to track their location. A grateful cardiac arrest survivor, for instance, might buy one for their gym to keep on hand — but if no one at the gym knows where it is, or that it’s in the building at all, it can’t be counted on in an emergency.

My HeartMap Challenge participants can register as individuals or teams, and the Penn researchers suggest participants develop creative ways to maximize their chances of winning. If, for instance, a team can figure out how to use their social networks via Twitter and Facebook to engage people who work in public locations in Philadelphia to take photos of AEDs, the team could win $10,000 dollars without even leaving their desks. These “virtual teams” could prove to be faster and more efficient than any individual working alone. Participants can also organize AED scavenger hunts or mini-contests to locate all the AEDs in a workplace building, or compete against friends to see who can find the most devices.

The multi-disciplinary project combines the expertise of investigators from Penn’s Center for Resuscitation Science, the Leonard Davis Institute of Health Economics, the Wharton School, the Cartography Modeling Lab, and the Organizational Dynamics Program, and the Children’s Hospital of Philadelphia. The Penn team is also collaborating with resuscitation scientists at the University of Washington and crowdsourcing experts at MIT.

The free contest app will be available for download for iPhones and Droids on the MyHeartMap Challenge web site in January. The researchers encourage participants to start strategizing and forming teams now so they can be first out of the gate to win.

For more information about the contest, please visit: http://www.med.upenn.edu/myheartmap/
On Facebook: https://www.facebook.com/myheartmap
On Twitter: http://twitter.com/MyHeartMap

Car crashes through emergency department

From the Sydney Morning Herald:

People had to flee the Rockingham hospital emergency department this morning after a car smashed through the front window.

Sergeant Graham Clifford said the department had to be evacuated after the vehicle crashed through the front doors of the Rockingham General Hospital emergency department about 6am today, causing a water main to burst.

The driver of the car was taken into custody but no charges have been laid yet. Police are investigating the possibility that the car was driven into the building deliberately.