Harry Selker

Last updated

Harry Selker is an American physician and medical researcher at Tufts University School of Medicine, where he serves as Dean of the Clinical and Translational Science Institute and Executive Director of the Institute for Clinical Research and Health Policy Studies. [1] [2] [3] He is known for creating a class of "predictive instruments" built into electrocardiograph machines that help hospitals triage cardiac patients, and assist physician decision-making. [4] [5] [6]

Contents

Early life and education

Raised in Seattle, Washington, [4] Selker attended Reed College, [7] followed by medical school at Brown University. He later earned a Masters of Science in Public Health at the University of California Los Angeles, where he was a Robert Wood Johnson Foundation Clinical Scholar. [2]

Career

Starting in the 1990s, Selker devised a series of mathematical models for medical decision-making called "predictive instruments". These software tools can be loaded onto electrocardiograph machines or other medical devices. Using patient demographic information and analysis of the data from the medical device itself, the predictive instrument generates a probability in real-time of whether the patient was having a heart attack, or would likely need a particular treatment. [5] This software was subsequently included a number of common medical devices. [8] [9]

Selker has led a number of studies relating to the glucose-insulin-potassium treatment cocktail known as GIK. [10] In 2012, his IMMEDIATE Trial showed that early administration of GIK made cardiac arrest or death after a heart attack less likely, and reduced the amount of damage to the heart itself by 80%. [4] [11] [12]

Selker is the author of two books: The Affordable Care Act as a National Experiment: Health Policy Innovations and Lessons, and Emergency Diagnostic Tests for Cardiac Ischemia. [13] [14]

Related Research Articles

<span class="mw-page-title-main">Diabetic ketoacidosis</span> Medical condition

Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally loss of consciousness. A person's breath may develop a specific "fruity" smell. The onset of symptoms is usually rapid. People without a previous diagnosis of diabetes may develop DKA as the first obvious symptom.

<span class="mw-page-title-main">Clinical chemistry</span> Area of clinical pathology that is generally concerned with analysis of bodily fluids

Clinical chemistry is a division in medical laboratory sciences focusing on qualitative tests of important compounds, referred to as analytes or markers, in bodily fluids and tissues using analytical techniques and specialized instruments. This interdisciplinary field includes knowledge from medicine, biology, chemistry, biomedical engineering, informatics, and an applied form of biochemistry.

<span class="mw-page-title-main">Electrocardiography</span> Examination of the hearts electrical activity

Electrocardiography is the process of producing an electrocardiogram, a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of the electrical activity of the heart using electrodes placed on the skin. These electrodes detect the small electrical changes that are a consequence of cardiac muscle depolarization followed by repolarization during each cardiac cycle (heartbeat). Changes in the normal ECG pattern occur in numerous cardiac abnormalities, including:

<span class="mw-page-title-main">Torsades de pointes</span> Type of abnormal heart rhythm

Torsades de pointes, torsade de pointes or torsades des pointes is a specific type of abnormal heart rhythm that can lead to sudden cardiac death. It is a polymorphic ventricular tachycardia that exhibits distinct characteristics on the electrocardiogram (ECG). It was described by French physician François Dessertenne in 1966. Prolongation of the QT interval can increase a person's risk of developing this abnormal heart rhythm, occurring in between 1% and 10% of patients who receive QT-prolonging antiarrhythmic drugs.

<span class="mw-page-title-main">Hyperkalemia</span> Medical condition with excess potassium

Hyperkalemia is an elevated level of potassium (K+) in the blood. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia. Typically hyperkalemia does not cause symptoms. Occasionally when severe it can cause palpitations, muscle pain, muscle weakness, or numbness. Hyperkalemia can cause an abnormal heart rhythm which can result in cardiac arrest and death.

<span class="mw-page-title-main">Romano–Ward syndrome</span> Medical condition

Romano–Ward syndrome is the most common form of congenital Long QT syndrome (LQTS), a genetic heart condition that affects the electrical properties of heart muscle cells. Those affected are at risk of abnormal heart rhythms which can lead to fainting, seizures, or sudden death. Romano–Ward syndrome can be distinguished clinically from other forms of inherited LQTS as it affects only the electrical properties of the heart, while other forms of LQTS can also affect other parts of the body.

<span class="mw-page-title-main">Trimetazidine</span> Drug for angina pectoris sold under many brand names

Trimetazidine is a drug for angina pectoris sold under many brand names. Trimetazidine is described as the first cytoprotective anti-ischemic agent developed and marketed by Laboratoires Servier (France). It is an anti-ischemic (antianginal) metabolic agent of the fatty acid oxidation inhibitor class, meaning that it improves myocardial glucose utilization through inhibition of fatty acid metabolism.

<span class="mw-page-title-main">Variant angina</span> Medical condition

Variant angina, also known as Prinzmetal angina,vasospastic angina, angina inversa, coronary vessel spasm, or coronary artery vasospasm, is a syndrome typically consisting of angina. Variant angina differs from stable angina in that it commonly occurs in individuals who are at rest or even asleep, whereas stable angina is generally triggered by exertion or intense exercise. Variant angina is caused by vasospasm, a narrowing of the coronary arteries due to contraction of the heart's smooth muscle tissue in the vessel walls. In comparison, stable angina is caused by the permanent occlusion of these vessels by atherosclerosis, which is the buildup of fatty plaque and hardening of the arteries.

<span class="mw-page-title-main">Left bundle branch block</span> Medical condition

Left bundle branch block (LBBB) is a conduction abnormality in the heart that can be seen on an electrocardiogram (ECG). In this condition, activation of the left ventricle of the heart is delayed, which causes the left ventricle to contract later than the right ventricle.

<span class="mw-page-title-main">Percutaneous coronary intervention</span> Medical techniques used to manage coronary occlusion

Percutaneous coronary intervention (PCI) is a minimally invasive non-surgical procedure used to treat narrowing of the coronary arteries of the heart found in coronary artery disease. The procedure is used to place and deploy coronary stents, a permanent wire-meshed tube, to open narrowed coronary arteries. PCI is considered 'non-surgical' as it uses a small hole in a peripheral artery (leg/arm) to gain access to the arterial system, an equivalent surgical procedure would involve the opening of the chest wall to gain access to the heart area. The term 'coronary angioplasty with stent' is synonymous with PCI. The procedure visualises the blood vessels via fluoroscopic imaging and contrast dyes. PCI is performed by an interventional cardiologists in a catheterization laboratory setting.

Hyperosmolar hyperglycemic state (HHS), also known as hyperosmolar non-ketotic state (HONK), is a complication of diabetes mellitus in which high blood sugar results in high osmolarity without significant ketoacidosis. Symptoms include signs of dehydration, weakness, leg cramps, vision problems, and an altered level of consciousness. Onset is typically over days to weeks. Complications may include seizures, disseminated intravascular coagulopathy, mesenteric artery occlusion, or rhabdomyolysis.

Automated insulin delivery systems are automated systems designed to assist people with insulin-requiring diabetes, by automatically adjusting insulin delivery in response to blood glucose levels. Currently available systems can only deliver a single hormone—insulin. Other systems currently in development aim to improve on current systems by adding one or more additional hormones that can be delivered as needed, providing something closer to the endocrine functionality of the pancreas.

<span class="mw-page-title-main">Myocardial perfusion imaging</span> Nuclear medicine imaging method

Myocardial perfusion imaging or scanning is a nuclear medicine procedure that illustrates the function of the heart muscle (myocardium).

<span class="mw-page-title-main">Coronary stent</span> Medical stent implanted into coronary arteries

A coronary stent is a tube-shaped device placed in the coronary arteries that supply blood to the heart, to keep the arteries open in patients suffering from coronary heart disease. The vast majority of stents used in modern interventional cardiology are drug-eluting stents (DES) It is used in a medical procedure called percutaneous coronary intervention (PCI). Coronary stents are divided into two broad types - drug-eluting and bare metal stents, as of 2023 drug-eluting stents were used in more than 90% of all PCI procedures. Stents reduce angina and have been shown to improve survival and decrease adverse events after a patient has suffered a heart attack - medically termed an acute myocardial infarction.

The Hs and Ts is a mnemonic used to aid in remembering the possible reversible causes of cardiac arrest. A variety of disease processes can lead to a cardiac arrest; however, they usually boil down to one or more of the "Hs and Ts".

<span class="mw-page-title-main">Electrocardiography in myocardial infarction</span>

Electrocardiography in suspected myocardial infarction has the main purpose of detecting ischemia or acute coronary injury in emergency department populations coming for symptoms of myocardial infarction (MI). Also, it can distinguish clinically different types of myocardial infarction.

<span class="mw-page-title-main">Management of acute coronary syndrome</span>

Management of acute coronary syndrome is targeted against the effects of reduced blood flow to the affected area of the heart muscle, usually because of a blood clot in one of the coronary arteries, the vessels that supply oxygenated blood to the myocardium. This is achieved with urgent hospitalization and medical therapy, including drugs that relieve chest pain and reduce the size of the infarct, and drugs that inhibit clot formation; for a subset of patients invasive measures are also employed. Basic principles of management are the same for all types of acute coronary syndrome. However, some important aspects of treatment depend on the presence or absence of elevation of the ST segment on the electrocardiogram, which classifies cases upon presentation to either ST segment elevation myocardial infarction (STEMI) or non-ST elevation acute coronary syndrome (NST-ACS); the latter includes unstable angina and non-ST elevation myocardial infarction (NSTEMI). Treatment is generally more aggressive for STEMI patients, and reperfusion therapy is more often reserved for them. Long-term therapy is necessary for prevention of recurrent events and complications.

<span class="mw-page-title-main">Monitoring (medicine)</span> Observation of a disease, condition or one or several medical parameters over time

In medicine, monitoring is the observation of a disease, condition or one or several medical parameters over time.


The Revised Cardiac Risk Index (RCRI) is a tool used to estimate a patient's risk of perioperative cardiac complications. The RCRI and similar clinical prediction tools are derived by looking for an association between preoperative variables (e.g., patient's age, type of surgery, comorbid diagnoses, or laboratory data) and the risk for cardiac complications in a cohort of surgical patients (the "derivation cohort"). Variables that have independent predictive value in a logistic regression analysis are incorporated into the risk index. Ideally, the accuracy and validity of the risk index is then tested in a separate cohort (the "validation cohort"). In 1977 Goldman, et al., developed the first cardiac risk index, which included nine variables associated with an increased risk of perioperative cardiac complications. This became known as the Original Cardiac Risk Index (or alternatively the Goldman Index). In 1999, Lee et al. published a cardiac risk index derived from 2893 patients and validated in 1422 patients aged ≥ 50 undergoing major noncardiac surgery, which became known as the Revised Cardiac Risk Index (RCRI). Lee identified six independent variables that predicted an increased risk for cardiac complications. A patient's risk for perioperative cardiac complications increased with number of variables that were present.

Bioinstrumentation or Biomedical Instrumentation is an application of biomedical engineering which focuses on development of devices and mechanics used to measure, evaluate, and treat biological systems. The goal of biomedical instrumentation focuses on the use of multiple sensors to monitor physiological characteristics of a human or animal for diagnostic and disease treatment purposes. Such instrumentation originated as a necessity to constantly monitor vital signs of Astronauts during NASA's Mercury, Gemini, and Apollo missions.

References

  1. ↑ Riemer, Emily (7 May 2021). "Niclosamide, an old drug being put to new use in COVID-19 patients". ABC WCBV5 Boston. Retrieved 11 December 2023.
  2. 1 2 Pilar, Matthew (16 April 2021). "Biologics Clinical Research: The Year's Best". Bioprocess Online. Retrieved 11 December 2023.
  3. ↑ "Harry P. Selker, MD, MSPH".
  4. 1 2 3 Rath, Arun (23 September 2016). "This Doctor Is Trying To Stop Heart Attacks In Their Tracks". National Public Radio. Retrieved 11 December 2023.
  5. 1 2 Campbell, Paulette (Fall 2000). "Improving Emergency Room Diagnosis of Heart Attack Risk". NCRR Reporter. Retrieved 11 December 2023.
  6. ↑ "AFMR Outstanding Investigator Award goes to Harry Selker". Research Activities. January 1998. Retrieved 11 December 2023.
  7. ↑ "Faculty Profile: Harry P. Selker, MD, MSPH".
  8. ↑ "ACI-TIPI Application Note" (PDF).
  9. ↑ "New enhancements to the Philips HeartStart MRx support fast triage of STEMI patients". Cardiovascular News. 1 May 2009. Retrieved 11 December 2023.
  10. ↑ "Study: Medics May Save Lives with Cardiac Cocktail". Journal of Emergency Medical Services. 30 March 2012. Retrieved 11 December 2023.
  11. ↑ Selker, Harry P.; Beshansky, Joni R.; Sheehan, Patricia R.; Massaro, Joseph M.; Griffith, John L.; d'Agostino, Ralph B.; Ruthazer, Robin; Atkins, James M.; Sayah, Assaad J.; Levy, Michael K.; Richards, Michael E.; Aufderheide, Tom P.; Braude, Darren A.; Pirrallo, Ronald G.; Doyle, Delanor D.; Frascone, Ralph J.; Kosiak, Donald J.; Leaming, James M.; Van Gelder, Carin M.; Walter, Gert-Paul; Wayne, Marvin A.; Woolard, Robert H.; Opie, Lionel H.; Rackley, Charles E.; Apstein, Carl S.; Udelson, James E. (9 May 2012). "Out-of-Hospital Administration of Intravenous Glucose-Insulin-Potassium in Patients With Suspected Acute Coronary Syndromes". Journal of the American Medical Association. 307 (18): 1925–1933. doi:10.1001/jama.2012.426. PMC   4167391 . PMID   22452807 . Retrieved 11 December 2023.
  12. ↑ Mandal, Ananya (28 Mar 2012). "Heart attack could be treated best with cheap mix of three injections". News-Medical.Net. Retrieved 11 December 2023.
  13. ↑ Selker, Harry P., ed. (2021). The Affordable Care Act as a National Experiment. doi:10.1007/978-3-030-66726-9. ISBN   978-3-030-66725-2. S2CID   69165961.
  14. ↑ "Book Review: Emergency Diagnostic Tests for Cardiac Ischemia". Annals of Internal Medicine. October 1998. Retrieved 11 December 2023.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.