The one proposed by Medina is simple and most useful.

In this grading three segments

• Proximal main vessel
• Distal main vessel
• Branch vessel

Are given a code 0, and 1 if  lesion is present or absent .

This grading gives simple and fast method to label a bifurcatiuon lesion and to asssess the response to PCI. The only issue here is the individual  lesions are not graded , for example branch vessel ostium just involved about 20 % is not addressed . Further TIMI flow in these vessels may also be incorporated

How medina grading can be used to assess effectiveness of

angioplasty  ?

A patient with 1.1.1  after the treatment should revert back to 0.0.0.  if converted into 0.0.(.5) may indicate a residual side branch lesion  .5 shall indicate 50% residual lesion, .3 , 30% etc

What is the best management strategy for bifurcation lesions?

The topic has been discussed extensively for over a decade in various forums.

Though the lesions and intervention techniques  appear complex the basic concept is simple.

Following is the 8 point algorithm

1. Assess the bifurcation lesion accurately.

2. Apply the general rule and ask the first question whether PCI is neccessary at all ? if decided for PCI

3. Stent the main vessel.Protect the side branch.  

4. Dilate the side branch with a balloon.(KIss or through the struts) 

5. Very rarely,  if the side vessel is more significant and large  stent it and balloon the main vessel.

6. Use drug eluting stents with caution .

7. Resist the temptation of using two stents unless the situation demands and is absolutely required.

8. Never attempt to do bifurcation angioplasty during ACS as apart of primary angioplasty.( Unless you're extremely competent, even then aim of primary PCI is to salvage myocarium quickly , not to provide TIMI 3 flow in non IRA vessel.)

Dr.S.Venkatesan.Madras medical college.Chennai.

KAMILA SALAZAR

Dr. Willingham, Cognitive Psychologist posted a video, which shares his thoughts on how learning styles don’t exist. I discovered it from Brent S. who discovered it from Clive Shepherd who discovered it from Stephen Downes.

I am certainly on board with challenging the existence of learning styles and am very interesting in finding out more information about what "something close to the theory" is. Please forward resources my way!

“Good teaching is good teaching…teachers do not have to adjust their learning styles.” Dr. Willingham says. I agree on the strength of good analogies and stories, whether auditory, visual or kinesthetic. Although, teachers will obviously need to consider adjustment for special needs.

Browsing through Dr. Willingham’s articles, I wanted to share a Q & A related to the use of stories.

Question: I have read that the mind treats stories differently than other types of information. It seems obvious that people like listening to stories, but it’s not obvious how to use that in the classroom. Is it really true that stories are somehow "special" and, if so, how can teachers capitalize on that fact?

Answer: Research from the last 30 years shows that stories are indeed special. Stories are easy to comprehend and easy to remember, and that’s true not just because people pay close attention to stories; there is something inherent in the story format that makes them easy to understand and remember. Teachers can consider using the basic elements of story structure to organize lessons and introduce complicated material, even if they don’t plan to tell a story in class.

Brain Rules Rocks

I agree with Brent about John Medina’s Brain Rules, which I am listening to as I write this. I am excited to check out his keynote at DevLearn08. Check out his Rules tutorials.

EXERCISE | Rule #1: Exercise boosts brain power.
SURVIVAL | Rule #2: The human brain evolved, too.
WIRING | Rule #3: Every brain is wired differently.
ATTENTION | Rule #4: We don't pay attention to boring things.
SHORT-TERM MEMORY | Rule #5: Repeat to remember.
LONG-TERM MEMORY | Rule #6: Remember to repeat.
SLEEP | Rule #7: Sleep well, think well.
STRESS | Rule #8: Stressed brains don't learn the same way.
SENSORY INTEGRATION | Rule #9: Stimulate more of the senses.
VISION | Rule #10: Vision trumps all other senses.
GENDER | Rule #11: Male and female brains are different.
EXPLORATION | Rule #12: We are powerful and natural explorers.