Let's call it cardiac impairment
BMJ 2005; 331 doi: https://doi.org/10.1136/bmj.331.7514.0-f (Published 18 August 2005) Cite this as: BMJ 2005;331:0-fAll rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
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
Competing interests: No competing interests
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
Competing interests: No competing interests
I find "Heart Inefficiency" works well for my patients and imples
that treatment can make the heart more efficient.
Competing interests:
None declared
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Epinephrine poisoning has been reported-Sept.19, 2005
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
Competing interests: No competing interests