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Absolutely Bill, basics are what knowledge is built upon. As a
teacher/program chair I feel that true understanding sometimes falls victim
of the "need for speed" both clinically as well as educationally. You make
very good points.
Thanks,
Jay Shafer

On Thu, Feb 3, 2011 at 11:29 PM, Bill Johnson <[log in to unmask]>wrote:

> Bill Johnson, Port Townsend, WA
>
> I am sorry, but something in this thread raises my hackles (not that I have
> hackles).  It seems that after 30 years of noninvasive vascular testing,
> technologist credentialing and lab accreditation, we still do not have
> standardization of practice of our profession, in my opinion.
>
> Somehow this thread has incorporated photoplethysmographic findings, PVR
> and Doppler waveforms without any regard to the lack of standards.  The
> standards do exist, and have been established with decent research to back
> them, albeit some “>10 years old”.  Well, things do change, and if one
> wishes to question what is established, I would suggest it is time to
> re-evaluate the standards if they do not appear to be acceptable.   Do the
> study, present your findings for peer review, and I will possibly even
> accept them.
> Personally, I would think that it does not matter how old a standard is
> until a new standard is shown to be better.  Yes, I am “old school” on
> that and I still trust my Doppler ears more than the spectral analyzers, or
> PVR/PPG waveforms.  The issues of collateral flow, cuff size vs. limb
> diameter, medial calcification, gains and even chart speed all need to be
> considered.  We must never remove our brains from our sensors.   I agree
> with Terry wholeheartedly.
> No offense intended to any on this list.  But seems the issue Nicole asked
> had to do with cuff size and adjusting the size of the waveforms we record.
> I am still not sure of the answer we gave her, if any.
>
> On Thu, Feb 3, 2011 at 3:08 PM, Terry Zwakenberg <[log in to unmask]> wrote:
>
>> We seem to have forgotten the PVR is best utilized to evaluate
>> collaterals.  Doppler waveforms, segmental pressures, and exercise are
>> better tools to evaluate the underlying PAD in the primary vessels.  PVR
>> will be compromised in the acute patient but can be virtually normal in the
>> chronic PAD patient.
>>   On Feb 3, 2011 4:42 PM, "JASON r" <[log in to unmask]> wrote:
>> >
>> > Kudos?
>> >
>> >
>> > Jason
>> >
>> >> Date: Thu, 3 Feb 2011 15:46:46 -0500
>> >> From: [log in to unmask]
>> >> Subject: Re: Arterial Journals
>> >> To: [log in to unmask]
>> >>
>> >> Kudos to you Matt!!
>> >>
>> >> ________________________________
>> >>
>> >> From: UVM Flownet on behalf of Smith, Matthew G.
>> >> Sent: Thu 2/3/2011 3:38 PM
>> >> To: [log in to unmask]
>> >> Subject: Re: Arterial Journals
>> >>
>> >>
>> >>
>> >> Jason,
>> >>
>> >> The issue is that with a significant SFA stenosis, or occlusion, the
>> calf PVR waveform will be smaller than the thigh; if you jack around with
>> the gain this will not be as obvious (regardless of dicrotic notch, because
>> the thigh cuff is over the same area of disease, so it would also lack the
>> notch; for that matter almost any patient who's an oldie but a goodie will
>> have less than textbook perfect waveforms, it doesn't mean they need an
>> angio). I personally like PVR and Doppler waveforms better than pressures
>> any day to determine level of disease (unless you have a patient with a
>> jimmy leg). In a perfect world, there would be a nice 20mmHg drop in
>> pressures between levels or from side to side when significant disease is
>> present, but unfortunately, in a world of diabetic/renal patients with
>> varying degrees of vessel compressibility, and diffuse disease, I find this
>> is rarely the case. Normal is easy to interpret, abnormal is not.
>> >>
>> >> Matt
>> >>
>> >>
>> >>
>> >> ________________________________
>> >>
>> >> From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of JASON
>> r
>> >> Sent: Thursday, February 03, 2011 15:19
>> >> To: [log in to unmask]
>> >> Subject: Re: Arterial Journals
>> >>
>> >>
>> >>
>> >>
>> >> I do not see a problem with increasing or decreasing the gain on a PVR
>> amplitude. I do agree that there should be a standard setting. However, if a
>> PVR waveform has a upstroke, downstroke, and dicrotic notch its technicall
>> normal...right.. So is one extremity waveform is smaller than the other cuff
>> placement may be the issue. Given that limbs are not created equal, one limb
>> will always be bigger than the other, thus, the issue of dissimilar PVR
>> amplitudes. With this said, there should be not reason the gain cannot be
>> adjusted within reason to accentuate the waveform. Think about this, a
>> doppler waveform is Triphasic, who cares if it looks bigger or smaller on
>> the screen. Also, a physiologic test encompasses many other inforamtics as
>> well.
>> >> While i am constantly looking a research data, the referenced data in
>> many of these thoughts is old >10years, and should be revised. Does turning
>> up the spectral doppler a little bit overly increase the velocities, yes and
>> no. It could but, it will never degredate the the overall look of the
>> spectral envelope.
>> >>
>> >> I thinks this topic should be revised, and the original data be
>> revisited as well. I believe in standards modes of measures, but alittle bit
>> of a skew will not hurt the overall test. Besides its a quantitative test.
>> :)
>> >>
>> >>
>> >>
>> >>
>> >>
>> >>
>> >> Jason
>> >>
>> >> ________________________________
>> >>
>> >>
>> >>
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