Lambert Wu - Academia.edu (original) (raw)
Papers by Lambert Wu
Archives of Pathology & Laboratory Medicine, Jul 1, 2002
Vascular Medicine, Nov 1, 2004
American Journal of Clinical Pathology, Jul 1, 1996
Journal of Clinical Epidemiology, Feb 1, 2001
ABSTRACT Number needed to treat (NNT)-the inverse of the absolute risk reduction resulting from a... more ABSTRACT Number needed to treat (NNT)-the inverse of the absolute risk reduction resulting from an intervention-was introduced as a yardstick to describe the harm as well as the benefit of therapeutic maneuvers. Analysis using NNT works well when comparing two or more interventions that have their impact over the same period of time in similar populations or patients. Under other conditions, however, analysis based on NNT can produce results that diverge widely from the impact that the interventions can be expected to have on risk of death. This can happen either for entire populations or for an individual when comparing NNTs for interventions which have their effects on different subsets of the population or when comparing interventions which have their effects over different periods of time. We demonstrate how this can occur by comparing the NNTs and effect of intervention on deaths in a population for automatic implantable cardioverter defibrillators (AICDs), heart transplantation, and cholesterol lowering through nutritional intervention with plant stanol ester.
Springer eBooks, 2003
Background: We are implementing CardioVision 2020—a comprehensive, population-wide initiative—in ... more Background: We are implementing CardioVision 2020—a comprehensive, population-wide initiative—in Olmsted County, Minnesota to reduce the population burden of coronary heart disease (CHD) and cardiovascular (CVD) disease. In this analysis we compare disease incidence rates expected with CardioVision 2020 to three other scenarios.
Journal of Clinical Epidemiology, May 1, 2002
DFT is performed by assessing ICD shock efficacy for induced VF and is performed in several ways.... more DFT is performed by assessing ICD shock efficacy for induced VF and is performed in several ways. DFT was routinely performed at initial ICD implant with early devices, with ICD system revision performed for inadequate test results. Large randomized trials have failed to demonstrate clinical benefit of routinely performing DFT at implant. DFT still has a role in specific clinical scenarios and remains current standard of care during subcutaneous ICD implants.
Mayo Clinic Proceedings, Oct 1, 2001
BMJ, Feb 26, 2004
nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is ... more nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is the best way to reduce rates of sudden death. However, trials conducted by van Alem et al (p 23) and others have not succeeded in increasing survival rates. The National Heart, Lung, and Blood Institute–sponsored randomized trial testing the strategy of public access to AEDs was only marginally successful: The average intervention effect was one life saved in a community once every three years at a cost of training 800 volunteers and providing them with access to AEDs. Walker et al conclude that even under hypothetical conditions of effectiveness, public access to AEDs is not a cost effective use of resources (p 28). Even giving AEDs to all myocardial infarction survivors would—at most—reduce population rates of sudden death by 5%. Only 50% of all victims of sudden death have a history of heart disease. At least 50% of sudden deaths occur when the victim is alone, and even when a bystander is present, longterm survival after cardiac arrest is 20% at best. On the other hand, there is evidence that a primary care physician can reduce sudden death by 30% or more by taking the following actions: Based on observational data: • Advising and assisting all patients to quit smoking and to avoid environmental tobacco smoke. Smoking has been observed to double the risk of sudden death. • Advising all patients to adopt a program of daily physical activity. Habitual physical activity has been observed to attenuate the risk of sudden death during vigorous physical activity. Based on trial data: • Advising all patients to eat at least two servings of high–omega-3, low-mercury fish each week or to take 1000 mg of omega-3 fatty acid supplements each day. • Prescribing eplerenone for patients with hypertension complicated by left ventricular hypertrophy. • Prescribing spironolactone for patients with congestive heart failure or significant left ventricular dysfunction. Because a small change in risk among a large proportion of the population has a far greater impact than a large change in risk among a small proportion of the population, it can be expected that the largest impact would be derived from increasing fish or fish oil consumption among all patients. The other interventions would be expected to reduce rates of sudden death by 20% to 30% among the patients who qualify for them. ✦ Thomas E Kottke project leader CardioVision 2020
Humana Press eBooks, Nov 14, 2003
Eosinophils were first described by Wharton-Jones’ as coarse granule cells in 1846. It was not un... more Eosinophils were first described by Wharton-Jones’ as coarse granule cells in 1846. It was not until Ehrlich’s2 1879–1880 paper that these cells became known as “eosinophils.” The association between eosinophils and clinical diseases has been known for many years, but only recently, through more detailed analyses, has their role in the pathogenesis of disease been elucidated.
Congestive Heart Failure, May 1, 2004
In the United States congestive heart failure is most commonly due to ischemic cardiomyopathy, bu... more In the United States congestive heart failure is most commonly due to ischemic cardiomyopathy, but nonischemic causes of cardiomyopathy can also result in congestive heart failure. Indeed, nonischemic dilated cardiomyopathy affects approximately 100,000 persons in the United States and is responsible for 45% of heart transplants. Although these patients undergo thorough cardiovascular evaluation, a specific cause is usually not found. Endomyocardial biopsy may yield diagnostic and prognostic information in this setting, and there has been a renewed interest in the use of endomyocardial biopsy in the evaluation of specific subsets of patients with congestive heart failure to identify potentially treatable myocarditides. However, the role of endomyocardial biopsy in the evaluation of patients with nonischemic cardiomyopathy is ill defined. In this review, the authors discuss the latest data on the risks and the utility of endomyocardial biopsy in the management of heart failure in the setting of dilated cardiomyopathy and specific myocarditides. Gaps in present knowledge and the obstacles to research in this area are identified.
Circulation, Mar 1, 2001
P39 Background: Risk factor trends in the United States are not favorable. We determined the pote... more P39 Background: Risk factor trends in the United States are not favorable. We determined the potential population impact of risk factor trends versus achieving Healthy People 2010 goals. Methods: Four possible risk factor scenarios were defined for the year 2020. Scenarios were based on current and past risk factor levels and current national goals: 1) Current risk factor levels in Olmsted County, MN; 2) Continued rise in diabetes and smoking rates; 3) #2 plus loss of blood pressure and cholesterol control; 4)Population meets Healthy People 2010 goals. Risk factors were assigned stochastically to the year 2000 Olmsted County, MN population, ages 30-83. Framingham-based risk functions were then used to calculate cardiovascular (CVD) event rates under each scenario. Conclusions: If diabetes and smoking continue to rise, and hypertension and cholesterol rise to historically high levels, CVD rates could rise as much as 75%. In contrast, meeting Healthy People 2010 goals would reduce CVD rates by 49%.
Archives of internal medicine, May 10, 2004
here is increasing interest in the association between patent foramen ovale (PFO) and documented ... more here is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalvainducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.
Archives of Internal Medicine, 2004
here is increasing interest in the association between patent foramen ovale (PFO) and documented ... more here is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalvainducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.
Circulation, 2001
P39 Background: Risk factor trends in the United States are not favorable. We determined the pote... more P39 Background: Risk factor trends in the United States are not favorable. We determined the potential population impact of risk factor trends versus achieving Healthy People 2010 goals. Methods: Four possible risk factor scenarios were defined for the year 2020. Scenarios were based on current and past risk factor levels and current national goals: 1) Current risk factor levels in Olmsted County, MN; 2) Continued rise in diabetes and smoking rates; 3) #2 plus loss of blood pressure and cholesterol control; 4)Population meets Healthy People 2010 goals. Risk factors were assigned stochastically to the year 2000 Olmsted County, MN population, ages 30-83. Framingham-based risk functions were then used to calculate cardiovascular (CVD) event rates under each scenario. Conclusions: If diabetes and smoking continue to rise, and hypertension and cholesterol rise to historically high levels, CVD rates could rise as much as 75%. In contrast, meeting Healthy People 2010 goals would reduce CVD...
BMJ : British Medical Journal, 2004
nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is ... more nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is the best way to reduce rates of sudden death. However, trials conducted by van Alem et al (p 23) and others have not succeeded in increasing survival rates. The National Heart, Lung, and Blood Institute–sponsored randomized trial testing the strategy of public access to AEDs was only marginally successful: The average intervention effect was one life saved in a community once every three years at a cost of training 800 volunteers and providing them with access to AEDs. Walker et al conclude that even under hypothetical conditions of effectiveness, public access to AEDs is not a cost effective use of resources (p 28). Even giving AEDs to all myocardial infarction survivors would—at most—reduce population rates of sudden death by 5%. Only 50% of all victims of sudden death have a history of heart disease. At least 50% of sudden deaths occur when the victim is alone, and even when a bystand...
New England Journal of Medicine, 2003
Archives of Pathology & Laboratory Medicine, Jul 1, 2002
Vascular Medicine, Nov 1, 2004
American Journal of Clinical Pathology, Jul 1, 1996
Journal of Clinical Epidemiology, Feb 1, 2001
ABSTRACT Number needed to treat (NNT)-the inverse of the absolute risk reduction resulting from a... more ABSTRACT Number needed to treat (NNT)-the inverse of the absolute risk reduction resulting from an intervention-was introduced as a yardstick to describe the harm as well as the benefit of therapeutic maneuvers. Analysis using NNT works well when comparing two or more interventions that have their impact over the same period of time in similar populations or patients. Under other conditions, however, analysis based on NNT can produce results that diverge widely from the impact that the interventions can be expected to have on risk of death. This can happen either for entire populations or for an individual when comparing NNTs for interventions which have their effects on different subsets of the population or when comparing interventions which have their effects over different periods of time. We demonstrate how this can occur by comparing the NNTs and effect of intervention on deaths in a population for automatic implantable cardioverter defibrillators (AICDs), heart transplantation, and cholesterol lowering through nutritional intervention with plant stanol ester.
Springer eBooks, 2003
Background: We are implementing CardioVision 2020—a comprehensive, population-wide initiative—in ... more Background: We are implementing CardioVision 2020—a comprehensive, population-wide initiative—in Olmsted County, Minnesota to reduce the population burden of coronary heart disease (CHD) and cardiovascular (CVD) disease. In this analysis we compare disease incidence rates expected with CardioVision 2020 to three other scenarios.
Journal of Clinical Epidemiology, May 1, 2002
DFT is performed by assessing ICD shock efficacy for induced VF and is performed in several ways.... more DFT is performed by assessing ICD shock efficacy for induced VF and is performed in several ways. DFT was routinely performed at initial ICD implant with early devices, with ICD system revision performed for inadequate test results. Large randomized trials have failed to demonstrate clinical benefit of routinely performing DFT at implant. DFT still has a role in specific clinical scenarios and remains current standard of care during subcutaneous ICD implants.
Mayo Clinic Proceedings, Oct 1, 2001
BMJ, Feb 26, 2004
nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is ... more nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is the best way to reduce rates of sudden death. However, trials conducted by van Alem et al (p 23) and others have not succeeded in increasing survival rates. The National Heart, Lung, and Blood Institute–sponsored randomized trial testing the strategy of public access to AEDs was only marginally successful: The average intervention effect was one life saved in a community once every three years at a cost of training 800 volunteers and providing them with access to AEDs. Walker et al conclude that even under hypothetical conditions of effectiveness, public access to AEDs is not a cost effective use of resources (p 28). Even giving AEDs to all myocardial infarction survivors would—at most—reduce population rates of sudden death by 5%. Only 50% of all victims of sudden death have a history of heart disease. At least 50% of sudden deaths occur when the victim is alone, and even when a bystander is present, longterm survival after cardiac arrest is 20% at best. On the other hand, there is evidence that a primary care physician can reduce sudden death by 30% or more by taking the following actions: Based on observational data: • Advising and assisting all patients to quit smoking and to avoid environmental tobacco smoke. Smoking has been observed to double the risk of sudden death. • Advising all patients to adopt a program of daily physical activity. Habitual physical activity has been observed to attenuate the risk of sudden death during vigorous physical activity. Based on trial data: • Advising all patients to eat at least two servings of high–omega-3, low-mercury fish each week or to take 1000 mg of omega-3 fatty acid supplements each day. • Prescribing eplerenone for patients with hypertension complicated by left ventricular hypertrophy. • Prescribing spironolactone for patients with congestive heart failure or significant left ventricular dysfunction. Because a small change in risk among a large proportion of the population has a far greater impact than a large change in risk among a small proportion of the population, it can be expected that the largest impact would be derived from increasing fish or fish oil consumption among all patients. The other interventions would be expected to reduce rates of sudden death by 20% to 30% among the patients who qualify for them. ✦ Thomas E Kottke project leader CardioVision 2020
Humana Press eBooks, Nov 14, 2003
Eosinophils were first described by Wharton-Jones’ as coarse granule cells in 1846. It was not un... more Eosinophils were first described by Wharton-Jones’ as coarse granule cells in 1846. It was not until Ehrlich’s2 1879–1880 paper that these cells became known as “eosinophils.” The association between eosinophils and clinical diseases has been known for many years, but only recently, through more detailed analyses, has their role in the pathogenesis of disease been elucidated.
Congestive Heart Failure, May 1, 2004
In the United States congestive heart failure is most commonly due to ischemic cardiomyopathy, bu... more In the United States congestive heart failure is most commonly due to ischemic cardiomyopathy, but nonischemic causes of cardiomyopathy can also result in congestive heart failure. Indeed, nonischemic dilated cardiomyopathy affects approximately 100,000 persons in the United States and is responsible for 45% of heart transplants. Although these patients undergo thorough cardiovascular evaluation, a specific cause is usually not found. Endomyocardial biopsy may yield diagnostic and prognostic information in this setting, and there has been a renewed interest in the use of endomyocardial biopsy in the evaluation of specific subsets of patients with congestive heart failure to identify potentially treatable myocarditides. However, the role of endomyocardial biopsy in the evaluation of patients with nonischemic cardiomyopathy is ill defined. In this review, the authors discuss the latest data on the risks and the utility of endomyocardial biopsy in the management of heart failure in the setting of dilated cardiomyopathy and specific myocarditides. Gaps in present knowledge and the obstacles to research in this area are identified.
Circulation, Mar 1, 2001
P39 Background: Risk factor trends in the United States are not favorable. We determined the pote... more P39 Background: Risk factor trends in the United States are not favorable. We determined the potential population impact of risk factor trends versus achieving Healthy People 2010 goals. Methods: Four possible risk factor scenarios were defined for the year 2020. Scenarios were based on current and past risk factor levels and current national goals: 1) Current risk factor levels in Olmsted County, MN; 2) Continued rise in diabetes and smoking rates; 3) #2 plus loss of blood pressure and cholesterol control; 4)Population meets Healthy People 2010 goals. Risk factors were assigned stochastically to the year 2000 Olmsted County, MN population, ages 30-83. Framingham-based risk functions were then used to calculate cardiovascular (CVD) event rates under each scenario. Conclusions: If diabetes and smoking continue to rise, and hypertension and cholesterol rise to historically high levels, CVD rates could rise as much as 75%. In contrast, meeting Healthy People 2010 goals would reduce CVD rates by 49%.
Archives of internal medicine, May 10, 2004
here is increasing interest in the association between patent foramen ovale (PFO) and documented ... more here is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalvainducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.
Archives of Internal Medicine, 2004
here is increasing interest in the association between patent foramen ovale (PFO) and documented ... more here is increasing interest in the association between patent foramen ovale (PFO) and documented stroke of unknown cause, commonly referred to as cryptogenic stroke. We reviewed the literature and, on the basis of the available data, designed a diagnostic and treatment algorithm for patients with PFO and cryptogenic stroke. Patent foramen ovale is relatively common in the general population, but its prevalence is higher in patients with cryptogenic stroke. Importantly, paradoxical embolism through a PFO should be strongly considered in young patients with cryptogenic stroke. There is no consensus on the optimal management strategy, but treatment options include antiplatelet agents, warfarin sodium, percutaneous device closure, and surgical closure. High-risk features in the patient's history (ie, temporal association between Valsalvainducing maneuvers and stroke, coexisting hypercoagulable state, recurrent strokes, and PFO with large opening, large right-to-left shunt, or right-to-left shunting at rest, and a coexisting atrial septal aneurysm) should prompt PFO closure.
Circulation, 2001
P39 Background: Risk factor trends in the United States are not favorable. We determined the pote... more P39 Background: Risk factor trends in the United States are not favorable. We determined the potential population impact of risk factor trends versus achieving Healthy People 2010 goals. Methods: Four possible risk factor scenarios were defined for the year 2020. Scenarios were based on current and past risk factor levels and current national goals: 1) Current risk factor levels in Olmsted County, MN; 2) Continued rise in diabetes and smoking rates; 3) #2 plus loss of blood pressure and cholesterol control; 4)Population meets Healthy People 2010 goals. Risk factors were assigned stochastically to the year 2000 Olmsted County, MN population, ages 30-83. Framingham-based risk functions were then used to calculate cardiovascular (CVD) event rates under each scenario. Conclusions: If diabetes and smoking continue to rise, and hypertension and cholesterol rise to historically high levels, CVD rates could rise as much as 75%. In contrast, meeting Healthy People 2010 goals would reduce CVD...
BMJ : British Medical Journal, 2004
nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is ... more nal defibrillators (AEDs) into the hands of trained first responders and untrained bystanders is the best way to reduce rates of sudden death. However, trials conducted by van Alem et al (p 23) and others have not succeeded in increasing survival rates. The National Heart, Lung, and Blood Institute–sponsored randomized trial testing the strategy of public access to AEDs was only marginally successful: The average intervention effect was one life saved in a community once every three years at a cost of training 800 volunteers and providing them with access to AEDs. Walker et al conclude that even under hypothetical conditions of effectiveness, public access to AEDs is not a cost effective use of resources (p 28). Even giving AEDs to all myocardial infarction survivors would—at most—reduce population rates of sudden death by 5%. Only 50% of all victims of sudden death have a history of heart disease. At least 50% of sudden deaths occur when the victim is alone, and even when a bystand...
New England Journal of Medicine, 2003