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"old school" and "semi old school".  Along the same lines as chronic and sub-acute I suppose :). 20th year in now, bitterly accepting I'm teetering into "chronic" :). 

Great thread all!
D

Doug Marcum
RDMS,RDCS,RVT(APS),RPhS
*Advanced Ultrasound Consultants
*Global Vein Solutions
www.advancedusconsultants.com
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On Feb 4, 2011, at 11:41 AM, Nathalie Garbani <[log in to unmask]> wrote:

> Thanks to the old school and semi old school, I second what Don and Bill have stated.
> Let's think through every piece of information we get in the context of the symptoms discussed by the patient and the medical history. Thinking  is the main criteria needed...
> 
> Nathalie
> NSU
> ----- Original Message ----- From: "Don Ridgway" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, February 04, 2011 11:22 AM
> Subject: Re: Arterial Journals
> 
> 
> I'd second Bill's response, and I'm mystified by the argle bargle. Simple answers to the two questions, established long ago:
> 
> 1. Cuff size should be 1.2x limb diameter (a.k.a. 20% bigger than limb diameter).
> 
> I found this in the Rumwell/McPharlin Vascular Technology Review, p. 66, and it's the only number I've ever read or heard (with the odd exception of Zwiebel, which gives "at least 50% greater than limb diameter"-no idea where they got that). Of course any good vascular lab has cuffs in all sizes, 1 cm increments, and a tape measure to get the circumference of each level, and a calculator to convert circumference to diameter, so we can choose the exact size cuff for each level. Of course.
> 
> 
> 2. For plethysmography (air, photo, whatever) and analog Doppler, hanging your hat on waveform height should be done only with great suspicion. What counts is waveform morphology.
> 
> 
> Don Ridgway
> Semi old school
> 
> 
> 
> 
> -----Original Message-----
> From: UVM Flownet on behalf of Bill Johnson
> Sent: Thu 2/3/2011 9:29 PM
> To: [log in to unmask]
> Subject: Re: Arterial Journals
> 
> 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.
> 
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