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Hospital routine and the heart patient
Annotations Table II. Triceps skinfold thickness* in young and elderly eastern arctic Eskimo (1964) comparing men from large settlements in Hudson Strait (living mainly off handicraft manufacture and welfare) and North Baffin Island hunting camps 18 to 49years No. North Batlin hunting camps and small settlements Hudson Strait settlement, pre-dominantly living off handicraft and welfare
Mean + S.D.
50 years and over No.
88
5.07 2 0.85
23
17
t 8.12 f 3.34
6
Mean + S.D. 7.24 f 2.18 6.02
f 3.76
‘Similar trends seen in other skinfold measurements but with slightly lesser degreea of significance. tP < 0.001. the majority are wage-employed or live on welfare or by handicraft manufacture, much less difference in physical activity between the various age groups is seen. This background information may help to explain our findings in regard to serum cholesterol (Table I) and skinfold measurements (Table II) in various age groups of Eskimo men living in hunting camps and large settlements. The physically most active younger Eskimo men had, very significantly, lower serum cholesterol and much thinner skinfolds than their opposite number in the larger settlements while differences dwindled in the middle age group and reversed (although not significantly so) in the elderly men from both groups. Observations of low serum cholesterol and other blood lipids and corresponding thin skinfolds in active Eskimo hunters and other physically very active population groups, such as the Bushmen and Masai3s4 with quite different and partly even very fat and cholesterol-rich diets,4 may have to be considered when discussing the relative role of diet and physical activity in our own extremely sedentary Western societies where differences in physical activity between “active” and “inactive” life styles may be quite small compared to less sophisticated societies. Dietary adjustments certainly appear to offer to a majority of our society more easily achieved and therefore probably more practical solutions. That, however, even in our society, physical activity, if exercised long and severe enough, brings
Hospital
routine
by Lopez and
0. Schaefer, M.D. Northern Medical Research Unit Medical Services c/o Charles Camsell Hospital 12815 115 Ave. Edmonton, Alberta, Canada
REFERENCES
1. Marr, J. W., Gregory, J., Meade, T. W., and Alderson, M. R.: Diet, leisure activity and skinfold measurements of sedentary men, Proc. Nutr. Sot. 29 @uppl.):17A, 1970. 2. Morris, J. N., Chane, S. P. W., Adam, C., Sirey, C., Epstein, L., and Sheehan, D. H.: Vigorous exercise in leisure time and the incidence of coronary heart disease, Lancet 1:333, 3.
1913.
Mann, G. V., Shaffer, R. D., Anderson, R. S., et al.: Cardiovascular disease in the Masai, J. Atheroscler. Res. 4:289,1964.
Bliss, K., Ho, K. J., Mikkelson, B., Lewis, L., and Taylor, C. B.: Some uniaue biolocdc characteristics of the Masai of East Africa, N. Engl. i Med. 284:694, 1971. 5. Lopez, S. A., Balart, L. A., and Moore, M. C.: Dietary habits, physical activity index and serum lipid values of medical students, IX Intern. Nutr. Congress, Mexico, Sept. 1972. 4.
and the heart patient
A hospital operates with principles and practices designed to meet most effectively the needs of the average patient. But, seriously ill patients are not average. Therefore, in the management of patients with serious heart disease the routine practices should be suspended temporarily. For example, as a routine, early each morning the patient’s room is cleaned, the water at the bedside is changed, the commode is emptied, temperature and pulse and respiratory rates are obtained, bed clothing is changed, medication is administered, blood, urine and/or stools are collected, the food tray is delivered,
674
a reduction in blood lipids was demonstrated associates5
noises are produced in the corridor, and many other annoyances are introduced which not only awaken and disturb the seriously ill patient who needs rest but often anger him. The physician’s orders for special studies, such as roentgenograms, electrocardiograms and others, are fulfilled. Patients admitted for care and rest, therefore, should be immediately removed from “Hospital Routine.” This is done by writing as the initial order “‘Discontinue all hospital routine” (this includes discontinuing the routine diet), followed by a direct and careful explanation to the chief nurse and other
November, 1974, Vol. 88, No. 5
Annotations
nursea and attendanta the meaning of this order. The physician must in turn carefully indicate the care he wishes for hia patient and why. This can be done without difficulty and with an extremely favorable response from all attendants if they are approached properly and if justification ie made known When private nurses are employed, the order to discontinue hospital routine i8 more readily achieved if the physician will only devote the necemary time to explain to the nurses the reaeom, for the instructions and objectives in therapy. The
American
Heart Journal
type of diet must be explicitly directed to “Hospital Routine,” physician will soon realize that an adequate place for the care tient.
ordered. Unless attention is the patient, his family, and the hospital can be leshl than of the seriously sick heart paG. E. Burch, M.D. Charity Hospdal New Orleans, La.
675
Mean + S.D.
50 years and over No.
88
5.07 2 0.85
23
17
t 8.12 f 3.34
6
Mean + S.D. 7.24 f 2.18 6.02
f 3.76
‘Similar trends seen in other skinfold measurements but with slightly lesser degreea of significance. tP < 0.001. the majority are wage-employed or live on welfare or by handicraft manufacture, much less difference in physical activity between the various age groups is seen. This background information may help to explain our findings in regard to serum cholesterol (Table I) and skinfold measurements (Table II) in various age groups of Eskimo men living in hunting camps and large settlements. The physically most active younger Eskimo men had, very significantly, lower serum cholesterol and much thinner skinfolds than their opposite number in the larger settlements while differences dwindled in the middle age group and reversed (although not significantly so) in the elderly men from both groups. Observations of low serum cholesterol and other blood lipids and corresponding thin skinfolds in active Eskimo hunters and other physically very active population groups, such as the Bushmen and Masai3s4 with quite different and partly even very fat and cholesterol-rich diets,4 may have to be considered when discussing the relative role of diet and physical activity in our own extremely sedentary Western societies where differences in physical activity between “active” and “inactive” life styles may be quite small compared to less sophisticated societies. Dietary adjustments certainly appear to offer to a majority of our society more easily achieved and therefore probably more practical solutions. That, however, even in our society, physical activity, if exercised long and severe enough, brings
Hospital
routine
by Lopez and
0. Schaefer, M.D. Northern Medical Research Unit Medical Services c/o Charles Camsell Hospital 12815 115 Ave. Edmonton, Alberta, Canada
REFERENCES
1. Marr, J. W., Gregory, J., Meade, T. W., and Alderson, M. R.: Diet, leisure activity and skinfold measurements of sedentary men, Proc. Nutr. Sot. 29 @uppl.):17A, 1970. 2. Morris, J. N., Chane, S. P. W., Adam, C., Sirey, C., Epstein, L., and Sheehan, D. H.: Vigorous exercise in leisure time and the incidence of coronary heart disease, Lancet 1:333, 3.
1913.
Mann, G. V., Shaffer, R. D., Anderson, R. S., et al.: Cardiovascular disease in the Masai, J. Atheroscler. Res. 4:289,1964.
Bliss, K., Ho, K. J., Mikkelson, B., Lewis, L., and Taylor, C. B.: Some uniaue biolocdc characteristics of the Masai of East Africa, N. Engl. i Med. 284:694, 1971. 5. Lopez, S. A., Balart, L. A., and Moore, M. C.: Dietary habits, physical activity index and serum lipid values of medical students, IX Intern. Nutr. Congress, Mexico, Sept. 1972. 4.
and the heart patient
A hospital operates with principles and practices designed to meet most effectively the needs of the average patient. But, seriously ill patients are not average. Therefore, in the management of patients with serious heart disease the routine practices should be suspended temporarily. For example, as a routine, early each morning the patient’s room is cleaned, the water at the bedside is changed, the commode is emptied, temperature and pulse and respiratory rates are obtained, bed clothing is changed, medication is administered, blood, urine and/or stools are collected, the food tray is delivered,
674
a reduction in blood lipids was demonstrated associates5
noises are produced in the corridor, and many other annoyances are introduced which not only awaken and disturb the seriously ill patient who needs rest but often anger him. The physician’s orders for special studies, such as roentgenograms, electrocardiograms and others, are fulfilled. Patients admitted for care and rest, therefore, should be immediately removed from “Hospital Routine.” This is done by writing as the initial order “‘Discontinue all hospital routine” (this includes discontinuing the routine diet), followed by a direct and careful explanation to the chief nurse and other
November, 1974, Vol. 88, No. 5
Annotations
nursea and attendanta the meaning of this order. The physician must in turn carefully indicate the care he wishes for hia patient and why. This can be done without difficulty and with an extremely favorable response from all attendants if they are approached properly and if justification ie made known When private nurses are employed, the order to discontinue hospital routine i8 more readily achieved if the physician will only devote the necemary time to explain to the nurses the reaeom, for the instructions and objectives in therapy. The
American
Heart Journal
type of diet must be explicitly directed to “Hospital Routine,” physician will soon realize that an adequate place for the care tient.
ordered. Unless attention is the patient, his family, and the hospital can be leshl than of the seriously sick heart paG. E. Burch, M.D. Charity Hospdal New Orleans, La.
675