Do i-Gadgets affect pacemakers?

With the success of Steve Jobs and the whole Apple success story, there are many out there, young and old, who have an i-gadgets, be it i-phones, i-pods, etc. There are also many cardiac patients out there who have pacemakers implanted, either for rhythm disorders, or for ventricular dysfunction. We are often asked if these gadgets, especially mobile phones, affect the pacemakers.

At the last Heart Rhythm Society (HRS), Dr H Bassen, an engineer from FDA, reported his study on the small electromagnetic fields (EMF) that surround i-gadgets, including the i-pods and i-phone. He found that the small amount of EMF does not interfere with the proper function of the pacemaker. This was later also confirmed independently by Dr Robert Stevenson. this, I believe will be presented at the years HRS. Basically what I am trying to say is that to the many out there who have an i-pod, i-phone and even the many mobile phone, the small amount of EMF emitted by these gadgets, does not affect the present types of pacemakers.

No more golf on weekends?

The NYTIMES has an article that patients seem to do worse on weekends:

Many public services are less reliable on weekends. But does that apply to medicine as well?

In the past decade, studies have found that patients treated at hospitals on weekends have inferior outcomes when compared with those receiving care on weekdays. In some cases, researchers have found, that can also mean a higher death rate. In one of the largest studies, published last year in The New England Journal of Medicine, scientists followed 231,164 heart attack patients admitted to New Jersey hospitals from 1987 to 2002. They found that those admitted on weekends were less likely to receive aggressive treatment, and had slightly higher death rates (12.9 percent, versus 12 percent for weekday patients).

Another extensive study, in The Annals of Surgery in November, looked at 188,212 patients who had nonemergency surgery. Those who had their operations on a Friday and spent the weekend recovering on a regular hospital floor were 17 percent more likely to die in the following 30 days than those who had their operations earlier in the week.

Anyone have any thoughts on this?

America's Best Hospitals

The most recent issue (23rd July 2007) of US News and World Report, ranked the best hospitals in the USA. First on the honor roll is Johns Hopkins Hospital (Baltimore, MD), although the Mayo Clinic (Rochester, MN) scored a close second.The Cleveland Clinic (Cleveland, OH) led heart-hospital rankings nationally and in the Midwest. Tops in the Northeast was Brigham and Women's Hospital (Boston MA); in the South, Duke University Medical Center (Durham, NC); and in the West, Texas Heart Institute at St Luke's Episcopal Hospital (Houston). There are no surprises here.

I did not write this post in praise of American Hospitals. I was concerned that to rank these hospitals, the surveyors had to look into the outcomes of patients admitted to the centers. While this may sound like a reasonable criteria, at a cursory glance, an indepth look will make one quickly realise that just looking at outcomes without adjusting for the complexity of the case maybe unfair and even, unkind.

Recently, the state of California released their 2003-2004 rate adjusted CABG death rates by hospital and by surgeons. Some of their "senior and good" cardiac surgeons came out worst, obviously because they were taking on high-risk cases. Once they are "blacklisted" by such survey data, they will have trouble with health insurance providers, who may similarly "blacklist" them.

The big problem here is then surgeons will practice defensively and hit back by not taking on high-risk cases. Why should they? It then descends to a question of "my career or your survival", and this will be very bad for patient care no matter which side of the coin lands facing upwards. Who will risk taking on the bad ones?

Nearer to home, I understand that the Ministry of Health is looking on asking specialist to keep a logbook of their cases, noting the outcomes, especially for those who do surgery or invasive procedures. Although it is true that those who are poorly trained will have bad outcomes, those who take on high risk cases will also run the risk of poor outcomes. If MOH does not adjust the outcome data for the complexity of case (personally, I have not seen any easy way of adjusting for these variables internationally), then a good intention policy may risk being unfair and counter-productive. We all know which road is paved with good intentions and it is very important that the MOH takes a good look at where this may lead.