Gunsalus, C. K

Hanioğlu, M. Şükrü

Mandel, Debra

Mansfield, Natalie

Chapman, Elwood N

Childs, G. W. (Musician)

Teixeira, Joe

Vitale, Joe, 1953-

Boland, Mary L

Filmer, Deon, author

International Labour Conference (93rd : 2005 : Geneva, Switzerland)

Pruitt, Lesley J

Krzaklewska, Ewa , author

Hoffman, Joan Serra, 1960-

Chase, Michael

Krupnik, Igor

Anglin, Douglas George

González, Roberto J. (Roberto Jesús), 1969-

Vågnes, Øyvind, 1972-

Cousineau, Robert Henri

Gaboury, Paul R

Lam, Harry C. S

Pickover, Clifford A

Morrell, Sachiko Kaneko, 1930-

Badger, Michael

Badger, Michael

Sawyer, R. Keith (Robert Keith)

This prespecified secondary analysis of the MOMENTUM 3 randomized clinical trial aims to determine whether clinical outcomes of patients with 2 different left ventricular assist devices differed based on preoperative categories of bridge to transplant/bridge to candidacy vs destination therapy.

This study develops and validates a quantitative method to predict the pulmonary to systemic flow ratio in patients with congenital heart disease from chest radiographs using deep learning.

Increased attention has focused on shared decision-making (SDM) and use of decision aids for treatment decisions in cardiology. In this issue of JAMA Cardiology, Coylewright et al report the results of a rigorously performed pilot study on the use of a decision aid to facilitate SDM for patients with symptomatic severe aortic stenosis (AS) at high or prohibitive risk for surgery considered for transcatheter aortic valve replacement vs medical therapy. Comparisons were made between encounters before clinicians were trained to use a decision aid and the first and fifth encounters after a decision aid was used. The patient-clinician interactions were audio recorded and later coded by independent reviewers using a validated measure to assess SDM. This mixed-methods study found that SDM significantly improved in a stepwise manner from the initial usual care encounter (before use of a decision aid) to the first and then fifth encounters after implementation of the decision aid. Along with this improvement in SDM, patients (n = 35) demonstrated increased knowledge about their treatment choices and reported increased satisfaction in their care with no increase in decisional conflict. In contrast, clinicians (n = 6) reported that they believed they already engaged in SDM prior to use of the decision aid and, after multiple uses of the decision aid, believed patients did not understand or benefit from this tool. The disconnect between clinician and patient perspectives was sobering and has implications for the adoption of decision aids or other tools to facilitate SDM in the clinical setting. Notable limitations of the study, which are acknowledged by the authors, include (1) small sample size (of clinicians and patients); (2) the decision aid is most useful for the relatively smaller number of patients at high or prohibitive risk for surgery for whom transcatheter aortic valve replacement and medical therapy may both be reasonable options; and (3) the lack of diversity in the clinicians (all male), which reflects the current demographics of interventional cardiology and cardiac surgery.

This mixed-methods pilot study examines whether the repeated use of a decision aid by heart teams was associated with greater shared decision-making, along with improved patient-centered outcomes and clinicians’ attitudes about decision aids.

To the Editor We read the recent article by Klauser et al with great interest. While the potential implications of the findings are exciting, we have several concerns. First, the authors do not explicitly state whether electrocardiogram gating was used in their study. This is an important detail because cardiac motion artifact is a source of artifactual coloration with dual-energy computed tomography (DECT), particularly with dual-source scanners given the approximately 80-millisecond temporal difference between the 2 radiography beams. Furthermore, beam hardening artifact from calcified atheromas and partial volume effect, known sources of artifacts in the 2-material decomposition algorithm of DECT, may largely explain the findings. While patients with gout had higher prevalence of coronary calcification (55 of 59 patients [93%]) and cardiovascular monosodium urate (MSU) deposition (51 of 59 patients [86%]) than controls, the authors do not report whether the 4 patients with gout without coronary calcifications exhibited MSU deposition nor the number of controls or cadaveric hearts with coronary calcification. The images from the article show areas of green pixelization occurring adjacent to calcified plaques on grayscale computed tomography images (eg, Figure 2A and D, left anterior descending artery [yellow arrowhead]), which would favor this artifact hypothesis without additional data.

In Reply We appreciate the valuable comments of Becce et al on our article. We applied prospective electrocardiography gating using a thin-slice cardiac protocol to ensure highest spatial resolution with minimal motion artifact. A noncontrast electrocardiography-gated computed tomography (CT) examination with standardized scan parameters was performed using a 128-slice dual-source CT (SOMATOM Definition Flash; Siemens) with a detector collimation of 2 × 64 × 0.6 mm, rotation time of 0.28 seconds, and prospective electrocardiography triggering for heart rates less than 65 beats per minute (diastolic padding, 70% of RR interval) and more than 65 beats per minute (systolic padding, 40% of RR interval). Axial images were reconstructed with 0.75-mm slice width, increment of 0.5, and a medium-smooth convolution kernel (B26f). When motion artifact was present, it was distinguished by visual analysis of an experienced observer and colorized pixels related to motion were excluded.

Secondary mitral regurgitation (MR) has long been recognized as prognostically important. Even mild MR is associated with adverse outcomes. Yet, surgical trials have not shown improved survival with invasive therapy whereas medical therapy and cardiac resynchronization therapy are associated with improved outcomes. The 2018 publication of the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) and Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation (MITRA-FR) trials and their apparently discordant results have focused attention on the differences in trial design as well as patient populations.

Latin jazz musician and band leader Machito (circa 1908-1984) was active on the New York City jazz scene with his innovative band the Afro-Cubans from 1940 to the early 1980s, forming an influential legacy that includes salsa music and Afro-Cuban jazz. The collection contains approximately 150 manuscript and published compositions and arrangements performed by the ensemble, as well as clippings,...

Journalist and editor. Correspondence, writings, speeches, articles, clippings, notes, photographs, newspapers, and other papers relating primarily to Yudain's career as the founder and publisher of Roll Call.

Online Resource

Hayden Library - PQ7082.P7 C23 2018

Hayden Library - PQ7296.J6 Z8928 2018