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Revascularization and outcomes in Veterans with moderate to severe ischemia on myocardial perfusion imaging

Military Medical Research 2017年第3期4卷 127-131页

作者： david e.winchester Alexander J.Bolanos Anita Wokhlu Rebecca J.Beyth Leslee J.Shaw Malcom Randall VAMC North Florida/South Georgia Veterans Health System Division of Cardiovascular Medicine University of Florida College of Medicine Malcom Randall VAMC Department of Medicine University of Florida College of Medicine Division of General Internal Medicine University of Florida College of Medicine Division of Cardiology Emory University School of Medicine

Background： The prevalence of ischemia on nuclear myocardial perfusion imaging （MPI） has been decreasing. Recent research has questioned the benefit of invasive revascularization for patients with moderate to severe ischemia. We hypothesized that patients with moderate to severe ischemia could routinely undergo successful revascularization. Methods： We analyzed data from 544 patients who underwent an MPI at a single academic Veterans Affairs Medical Center. Patients with moderate to severe ischemia, defined as a summed difference score （SDS） 8 or greater, were compared to the rest of the cohort. Results： Of the total cohort （n=544）, 39 patients had MPI studies with resultant moderate to severe ischemia. Patients with ischemia were more likely to develop coronary artery disease （74.4% versus 38.8%, P〈0.0001） and have successful revascularization （38.5% versus 4.0%, P〈0.0001） during the following year. Revascularization was attempted in 31 patients with moderate to severe ischemia, though only 15（47%） of these attempts were successful, Ischemia was predictive of myocardial infarction （5.1% versus 0.8%, P=0.01） within I year. Conclusion： Moderate to severe ischemia is an uncommon finding in a contemporary nuclear laboratory. Among patients with ischemia, revascularization is typically attempted but is frequently unsuccessful. Trial registration： This trial does not appear on a registry as it is neither randomized nor prospective.

关键词： Myocardial ischemia Nuclear myocardial perfusion imaqinq Veterans Revascularization

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Physician-level variation in the diagnosis of myocardial infarction and the use of angiography among veterans with elevated troponin

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Journal of Medical Colleges of PLA(China) 2016年第3期31卷 129-133页

作者： david e.winchester Nayan Agarwal Lucas Burke Steven Bradley Tatiana Schember Carsten Schmalfuss Division of Cardiovascular Medicine University of Florida College of MedicineGainesville FLUSA Malcom Randall Veterans Affairs Medical Center GainesvilleFLUSA Division of Cardiology Department of MedicineVA Eastern Colorado Health Care SystemDenverCOUSA Department of Medicine University of Colorado School of Medicine at the Anschutz Medical CampusAuroraCOUSA.

Background:Cardiac troponin assays have improved the ability to detect myocardial ***,ascertaining whether troponin elevation is due to myocardial infarction(MI) or secondary to another process can be *** aim is to evaluate provider-level variation in the diagnosis of MI and the use of invasive coronary angiography(ICA) among patients with undifferentiated elevations in cardiac ***:We analyzed data from all patients with elevated troponin levels in a single Veterans Affairs(VA) Medical Center between 2006 and *** of several cardiologists prospectively evaluated each patient's presentation and course of *** compared the frequency of MI diagnosis and ICA use between physicians using univariate odds ratios(OR).Results:Among 761 patients,34.0% were diagnosed with MI and 25.9% underwent *** unadjusted rates of MI(23.9% to 56.7%,P=0.02) and ICA(17.3% to 73.3%,Pered between *** the patient cohorts for each physician,baseline characteristics were similar except for chest *** multivariate regression,factors associated with the use of cardiac ICA included an abnormal electrocardiograph(eCG)(OR=1.89,P=0.014),level of troponin(OR=1.71,P=0.004),chest pain(OR=8.60,Pe by non-VA physicians(OR=4.45,P=0.006).One physician had a lower ICA use(OR=0.56,P=0.017).In multivariate regression of MI,no physician-level variation was ***:Among patients with elevated troponin,the likelihood of being diagnosed with MI and undergoing ICA is dependent on their clinical *** adjustment,physician-level variation in care was observed for the use of ICA,but not for the diagnosis of MI.

关键词： Acute coronary syndrome Coronary angiography Variation in care Cardiac troponin

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Quality Improvement in Cardiovascular Imaging

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Cardiovascular Innovations and Applications 2019年第B04期4卷 1-7页

作者： david e.winchester,MD,MS R.Beyth,MD,MS Malcom Randall VA Medical Center GainesvilleFL 32608USA

Implementation of quality improvement(QI)activities is growing in health care settings across the *** cardiovascular imaging,areas for improvement include consistency of result reporting,greater patient safety through reductions in radiation exposure,and greater effi ciency of care delivery by elimination of wasteful practices and elimination of low-value or rarely appropriate *** in health care is often driven through one of several endorsed frameworks,such as Lean,Six Sigma,and the Model for *** examples of how to teach QI to medical trainees and physicians have been *** this narrative review,we explore the growth and impact of QI in cardiovascular imaging,providing specifi c examples of successful projects,barriers to conducting QI,and rewards of persistent effort toward improving care.

关键词： quality improvement cardiovascular non-invasive imaging graduate medical education audit and feedback

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Better Than You Think—Appropriate Use of Implantable Cardioverter-Defi brillators at a Single Academic Center:A Retrospective Review

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Cardiovascular Innovations and Applications 2021年第2期5卷 235-243页

作者： Nikhil H.Shah Steven J.Ross Steve A.Noutong Njapo Justin Merritt Andrew Kolarich Michael Kaufmann William M.Miles david e.winchester Thomas A.Burkart Matthew McKillop UF Division of Cardiovascular Medicine 1600 SW Archer RdPO Box 100277GainesvilleFL 32610USA UVA Division of Cardiovascular Medicine PO Box *** Lee St.CharlottesvilleVA 22908-0158USA The Johns Hopkins Hospital Department of Radiology 601 N Caroline StBaltimore 21287USA The Heart Center 930 Franklin Street SEHuntsvilleAL358015USA Intermountain Medical Center 1380 E Medical Center DrSte 1500St.GeorgeUT 847906USA Carolina Cardiology Consultants Prisma Health1005 Grove RoadGreenvilleSC 29605USA

Background:Implantable cardioverter-defi brillators(ICDs)can be life-saving devices,although they are expensive and may cause *** 2013,several professional societies published joint appropriate use criteria(AUC)assessing indications for ICD *** evaluating the clinical application of AUC are *** registry-based studies estimated that 22.5%of primary prevention ICD implantations were“non-evidence-based”*** the basis of AUC,we aimed to determine the prevalence of“rarely appropriate”ICD implantation at our institution for comparison with previous ***:We reviewed 286 patients who underwent ICD implantation between 2013 and *** of each ICD implantation was assessed by independent review and rated on the basis of ***:Of 286 ICD implantations,two independent reviewers found that 89.5%and 89.2%,respectively,were appropriate,5.6%and 7.3%may be appropriate,and 1.8%and 2.1%were rarely *** AUC indication was found for 3.5%and 3.4%of ICD implantations,*** prevention ICD implantations were more likely rarely appropriate(2.6%vs.1.2%and 3.6%vs.1.1%)or unrated(6.0%vs.1.2%and 2.7%vs.0.6%).The reviewers found 3.5%and 3.4%of ICD implantations,respectively,were non-evidence-based *** difference in rates between reviewers was not statistically signifi ***:Compared with prior reports,our prevalence of rarely appropriate ICD implantation was very *** high appropriate use rate could be explained by the fact that AUC are based on current clinical *** AUC could benefi t from additional secondary prevention *** importantly,clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

关键词： Appropriate use appropriate use criteria implantable cardioverter-defi brillator

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A Review of the Taxonomy and Palaeoecology of the Anurognathidae(Reptilia,Pterosauria)

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Acta Geologica Sinica(english edition) 2020年第5期94卷 1676-1692页

作者： david W.e.HONe School of Biological and Chemical Sciences Queen Mary University of LondonLondonE14NSUK

The anurognathids are an enigmatic and distinctive clade of small,non-pterodactyloid pterosaurs with an unusual combination of anatomical traits in the head,neck,wings and *** are known from very limited remains and few have been described in detail,and as a result,much of their biology remains *** is despite their importance as potentially one of the earliest branches of pterosaur evolution or even lying close to the origins of *** review covers the taxonomy and palaeoecology of the anurognathids,which remain an interesting branch of pterosaurian evolution.

关键词： non-pterodactyloid palaeobiology flight Ornithodira

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On evidence-Based Practice in Disaster Risk Reduction

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International Journal of Disaster Risk Science 2021年第6期12卷 919-927页

作者： david e.Alexander Institute for Risk and Disaster Reduction University College LondonLondon WCIE 6BTUK

Disaster science and scholarship are forever expanding and there are increasing calls to base disaster risk reduction policies on the evidence produced by such *** examples and argument,this opinion piece examines the nature of *** defines evidence-based practice and considers how it has developed and become important to disaster risk reduction.A definition of what constitutes evidence is difficult to achieve but it must be made in relation to whether the data and information collected can usefully be interpreted and employed to change things for the *** histories from past and present centuries show that evidence can sometimes be argued over *** other cases it is roundly *** yet other instances,false conclusions derived from evidence can become evidence in their own ***,there are situations in disaster risk reduction in which evidence is sorely needed but is clearly *** effectiveness of counter-terrorism measures is one such *** conclusion,evidence is valuable,above all if there is willingness to use it to support policy formulation,especially in a simple,transparent *** interpretation can never be entirely removed from the use of evidence,and evidence alone will not stimulate the policy formulators to improve their decision making.

关键词： Case histories Disaster risk reduction evidence-based practice Policy formulation

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On the Meaning of Impact in Disaster Risk Reduction

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International Journal of Disaster Risk Science 2022年第5期13卷 822-827页

作者： david e.Alexander Institute for Risk and Disaster Reduction University College LondonLondon WC1E 6BTUK

This article offers a discussion of the meaning,assessment,and measurement of impact in disaster risk *** begins with a historical perspective on the impact of learned work in times when orthodoxy posed severe limits on the impact of new *** the modern age,the article explains why impact is considered important and how it might be recognized when it occurs,including a tentative classification of types of *** question of whether impact can truly be measured remains pending,as the answer is diffuse and dependent on many different *** sections consider the relationship between impact and mainstreaming and the question of whether a piece of work should be regarded as having impact if its effects are negative rather than ***,impact is considered in terms of whom it *** the large number of possible reservations about the concept,the question is raised as to whether too much emphasis is given to the impact of research and ***,some suggestions are offered regarding how to obtain a better indication of what the impact of an academic study actually is.

关键词： Assessing impact Disaster risk reduction Disruptive thinking Impact of research Mainstreaming disaster risk reduction Measuring impact

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Pterosaur Research:Recent Advances and a Future Revolution

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Acta Geologica Sinica(english edition) 2012年第6期86卷 1366-1376页

作者： david W.e.HONe Department of earth Sciences University of Bristol School of Biological and Chemical Sciences Queen Mary University of London

In the years since the first description of a pterosaur specimen in 1784, pterosaur research has inevitably advanced considerably. However the last decade has arguably seen a much greater increase in our knowledge than the preceding two centuries. Since the turn of the new millennium, more than 40 new pterosaur genera and species have been described and whole new clades have been discovered, in addition to much new data being developed on pterosaur anatomy, functional morphology, palaeobiology, systematics, ecology and more. We are perhaps at the start of a golden age of pterosaur research and much as the dinosaurs underwent a revolution in the 1970s through to the early 1990s, now the Pterosauria are taking their turn. There is also a new and wider interest in pterosaur work as it attracts both more researchers and greater public interest. Pterosaurs appear to be an increasingly popular aspect of paleontology in popular culture and of interest to the media, both mainstream and digital.

关键词： paleontology Pterosauria science history of research academia

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Opinion: the use of natural hazard modeling for decision making under uncertainty

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Forest ecosystems 2015年第2期2卷 139-142页

作者： david e Calkin Mike Mentis Forestry Sciences Laboratory US Forest Service Rocky Mountain Research Station Business & the environment Postnet Suite

Decision making to mitigate the effects of natural hazards is a complex undertaking fraught with uncertainty. Models to describe risks associated with natural hazards have proliferated in recent years. Concurrently, there is a growing body of work focused on developing best practices for natural hazard modeling and to create structured evaluation criteria for complex environmental models. However, to our knowledge there has been less focus on the conditions where decision makers can confidently rely on results from these models. In this review we propose a preliminary set of conditions necessary for the appropriate application of modeled results to natural hazard decision making and provide relevant examples within US wildfire management programs.

关键词： the use of natural hazard modeling for decision making under uncertainty

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Bmi-1, stem cells and prostate carcinogenesis

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Asian Journal of Andrology 2011年第3期13卷 353-354页

作者： david Moscatelli e Lynette Wilson Department of Cell Biology NewYork University School of Medicine New York NY 10016 USA NYU Cancer Institute New York University School of Medicine New York NY 10016 USA Department of Urology New York University School of Medicine New York NY 10016. USA

Malignant transformation is likely to arise in a subset of organ-specific primitive cells that are subverted to acquire the properties of uncontrolled self-renewal. It is therefore likely that stem cells and tumorinitiating cells share many properties and that an understanding of the biology of normal stem cells and the identification of the pathways and molecules that regulate their self-renewal may result in our ability to design inhibitors that control the growth of tumor cells.

关键词： Cells Lymphocytes Regulations Stems Property Properties

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