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<p class="MsoNormal">This is exactly the point I made before in the PERT. I am surprised this issue is still going on. This is wrong language and will not be part of the form. We would need only the following and no more:<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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<li class="MsoListParagraph" style="margin-left:0in;mso-list:l0 level1 lfo1">RV: LV ratio as a number. Helpful only as a measure of RV strain. Positive troponin and proBNP serve the same role biochemically.
<o:p></o:p></li><li class="MsoListParagraph" style="margin-left:0in;mso-list:l0 level1 lfo1">There is no need for mentioning clot burden as massive or sub-massive. It will only create misunderstanding. It is a clinical/hemodynamic diagnosis, not a radiological one. Dr. Ramakrishnan’s
suggestion regarding location of thrombus is an appropriate one. <o:p></o:p></li></ol>
<p class="MsoListParagraph"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal"><b>From:</b> pert <pert-bounces@lists.upstate.edu> <b>On Behalf Of
</b>Kartik Ramakrishna<br>
<b>Sent:</b> Monday, May 3, 2021 10:53 AM<br>
<b>To:</b> Harvir Singh Gambhir <GambhirH@upstate.edu><br>
<b>Cc:</b> pert@lists.upstate.edu; Sherri A. Adamo-Turner <AdamoTuS@upstate.edu><br>
<b>Subject:</b> Re: [pert] Updates<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Hi,<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">I’m confused by the points in the image you sent. <o:p></o:p></p>
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<p class="MsoNormal">1. Location: left ventricle, right ventricle…<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Are we asking if the PE is in the left or right ventricle???<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">2. Clot burden: massive, submissive…<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">I object to this language…. Massive and submissive are specific clinical definitions used to stratify severity of a PE. Using this language for radiographic descriptions is going to lead to confusion. <o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">To comment on LV/RV ratio and mean PA diameter for review purposes later is reasonable. <o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Regarding clot burden, my suggestion would be to have options such as subsegmental, segmental, lobar, saddle, number of segments involved. Or we should check with radiology to see if they have a more standardized way of quantifying clot
burden.<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Regards,<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Kartik <o:p></o:p></p>
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<p class="MsoNormal"><br>
<br>
<o:p></o:p></p>
<blockquote style="margin-top:5.0pt;margin-bottom:5.0pt">
<p class="MsoNormal" style="margin-bottom:12.0pt">On May 3, 2021, at 10:22 AM, Harvir Singh Gambhir <<a href="mailto:GambhirH@upstate.edu">GambhirH@upstate.edu</a>> wrote:<o:p></o:p></p>
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<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif">Good Morning All,
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">Epic Team is looking feedback from all and complete this.
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">EPIC team:-“</span><i><span style="font-family:"Avenir Next LT Pro",sans-serif;color:black">We just need to know what the group thinks is best. The three fields in question are
at the top of the PERT form”</span></i><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Avenir Next LT Pro",sans-serif;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><image001.jpg><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Avenir Next LT Pro",sans-serif;color:black">Would we like to remove one or all of these questions, or keep them and change the verbiage? Once this is confirmed, we should be able to move forward</span></i><i><span style="font-family:Cavolini;color:#4472C4">.</span></i><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">This was discussed in one of the meetings:</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">CTA thorax based:-
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">LV/RV Ratio =
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">Clot Burden =
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif;color:black">Thank you for time and attention.
</span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif"> </span><o:p></o:p></p>
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<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif"> </span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif"> </span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">HSG</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Regards,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif;color:#5B9BD5">Harvir Singh Gambhir MD, FACP, CPL, CPHQ</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Associate Program Director, Internal Medicine Residency Program,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Associate Vice Chair for Quality Improvement & Patient Safety, Department of Medicine,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Quality Officer, Division of Hospital Medicine,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Assistant Professor & Hospitalist,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">SUNY Upstate Medical University,</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">750 E Adams Street,
</span></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-family:"Tahoma",sans-serif">Syracuse, NY 13210.</span></i><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif"> </span><o:p></o:p></p>
<p class="MsoNormal"><span style="font-family:"Tahoma",sans-serif"> </span><o:p></o:p></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><b><span style="font-size:12.0pt;color:black">From:
</span></b><span style="font-size:12.0pt;color:black">pert <</span><a href="mailto:pert-bounces@lists.upstate.edu"><span style="font-size:12.0pt">pert-bounces@lists.upstate.edu</span></a><span style="font-size:12.0pt;color:black">> on behalf of Christopher
T. Tanski <</span><a href="mailto:TanskiC@upstate.edu"><span style="font-size:12.0pt">TanskiC@upstate.edu</span></a><span style="font-size:12.0pt;color:black">><br>
<b>Date: </b>Monday, April 26, 2021 at 3:03 PM<br>
<b>To: </b></span><a href="mailto:pert@lists.upstate.edu"><span style="font-size:12.0pt">pert@lists.upstate.edu</span></a><span style="font-size:12.0pt;color:black"> <</span><a href="mailto:pert@lists.upstate.edu"><span style="font-size:12.0pt">pert@lists.upstate.edu</span></a><span style="font-size:12.0pt;color:black">><br>
<b>Subject: </b>[pert] Updates</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Hi-</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">The PERT committee met last week and approved finalized versions of the policy and procedure, which I have attached. These have now been submitted to the following groups/councils/committees for
approval: medicine shared governance, surgery shared governance, procedural shared governance, ICU governance, critical care shared governance, resuscitation and legal. </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">In addition, our membership in the PERT Consortium is proceeding. I will need to submit a project request to our IRB for approval to send anonymous data to the registry. They may or may not require
some sort of consent document.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Lastly, the hospital is moving toward high sensitivity (fifth generation) troponin T as opposed to "conventional" troponin. We will need to see how/if that makes a difference in how we use troponin
in the assessment of PE burden.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Thanks.</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">Chris</span><o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black"> </span><o:p></o:p></p>
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<p class="MsoNormal">_______________________________________________<br>
pert mailing list<br>
<a href="mailto:pert@lists.upstate.edu">pert@lists.upstate.edu</a><br>
<a href="http://lists.upstate.edu/mailman/listinfo/pert">http://lists.upstate.edu/mailman/listinfo/pert</a><o:p></o:p></p>
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