Radionuclide ventriculography: evaluation of automated and visual methods for regional wall motion analysis

Regional wall motion (RWM) abnormalities are sensitive indicators of left ventricular (LV) dysfunction, but quantitation of RWM with gated radionuclide ventriculography (RVG) has been limited, particularly in the left anterior oblique (LAO) projection. Regional LV performance was studied in 18 patients undergoing LAO RVG immediately prior to contrast ventriculography (CVG). Wall motion was analyzed by semiautomated and visual methods using several coordinate systems. For semiautomated methods, RVG and CVG wall motion were closely related in the two 90 degrees polar sectors at the apex and posterior wall (r = .85) and in the five 45 degrees polar sectors from midseptum through posterior wall (r = .82). The basal sectors on RVG had weak relationship to CVG, due to adjacent vascular structures. Semiautomated and visual grades for polar sectors on both CVG and RVG were closely related (r = .88- .94). Measured regional wall motion on LAO RVG compared favorably with near-simultaneous CVG in nonoverlapping portions of the LV and allowed objective quantitation of regional LV performance.     

The Physician Data Query (PDQ) cancer information system

PDQ is an online database that provides information about the prognosis and treatment of all major types of cancer. It represents a major effort by the NCI to communicate advances in cancer treatment using computer technology, and serves as a major component of the Institute's program to reduce cancer mortality nationwide. PDQ utilizes a modern large-scale computer to provide processing speed, a general purpose database management system to provide retrieval and display functions, and commercial telecommunication networks to provide online access to up-to-date information on cancer treatment. A series of user-friendly menus allow searching, browsing, and displaying without having to learn a specialized search language. PDQ is accessible through the National Library of Medicine's computer system via a computer terminal or personal computer and is available to the medical community at over 2000 medical libraries and centers and through individual access codes. PDQ is also available as an online database under a special license agreement with NCI through two medical information systems produced by commercial database vendors: BRS/Saunders' COLLEAGUE and Mead Data Central's MEDIS.     

Heart failure guidelines and prescribing in primary care across Europe

Background  

Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe.     

Bilateral isokinetic training reduces the bilateral leg strength deficit for both old and young adults

The bilateral limb deficit (BLD) describes the difference in maximal or near-maximal force generating capacity of muscles when they are contracted alone and in combination with the contralateral muscles. This study examined the effects of a 6-week (three times per week) bilateral leg strength training programme on BLD in younger and older adults. Data were collected from 33 subjects during slow (45°/s) isokinetic knee extensions and flexions before and after the training programme. After training, the BLD was reduced for extension (73.3–86.9%; P<0.001) but not for flexion (67.5–71.2%; P=0.13) regardless of age and gender. This study suggests that difficulty in recruiting all muscle units during a task involving bilateral activation can be improved by training, although such an effect appears to depend on the muscle group appreciated.     

Functional assessment of the shoulder following latissimus dorsi muscle donation in the handicapped

The latissimus dorsi muscle, one of the largest muscles in the human body, has gained widespread popularity in microsurgical reconstruction. Because the latissimus serves to adduct and medially rotate the upper extremity, caution in its use has been advocated in handicapped and non-ambulatory patients, although a paucity of information exists in the literature. The purpose of this reported project was to determine whether the loss of the latissimus dorsi could be documented objectively or subjectively, either in the preoperative condition or post-harvesting in the handicapped patients. Two paraplegic patients were studied. Results indicate a lack of objective functional deficit; this includes both the nerve-blocked state and the postoperative condition. In addition, both patients failed to demonstrate the need to change any activities of daily living. This evidence suggests that, although careful decisions must be made on a case-by-case basis, the use of the latissimus dorsi muscle is not necessarily contraindicated in this group of patients.     

Diagnostic triage and the role of natriuretic peptide testing and echocardiography for suspected heart failure: an appropriateness ratings evaluation by UK GPs

Background

Some UK GPs are acquiring access to natriuretic peptide (NP) testing or echocardiography as diagnostic tests for heart failure. This study developed appropriateness ratings for the diagnostic application of these tests in routine general practice.

Aim

To develop appropriateness ratings for the diagnostic application of NP testing or echocardiography for heart failure in general practice.

Design and setting

An appropriateness ratings evaluation in UK general practice.

Method

Four presenting symptoms (cough, bilateral ankle swelling, dyspnoea, fatigue), three levels of risk of cardiovascular disease (low, intermediate, high), and dichotomous categorisations of cardiovascular/chest examination and electrocardiogram result, were used to create 540 appropriateness scenarios for patients in whom NP testing or echocardiography might be considered. These were rated by a 10-person expert panel, consisting of GPs and GPs with specialist interests in cardiology, in a two-round RAND Appropriateness Method.

Results

Onward referral for NP testing or echocardiography was rated as an appropriate next step in 217 (40.2%) of the 540 scenarios; in 194 (35.9%) it was rated inappropriate. The ratings also show where NP testing or echocardiography were ranked as equivalent next steps and when one test was seen as the more appropriate than the other.

Conclusion

NP testing should be the routine test for suspected heart failure where referral for diagnostic testing is considered appropriate. An abnormal electrocardiogram status makes referral to echocardiography an accompanying, or more appropriate, next step alongside NP testing, especially in the presence of dyspnoea. Abnormal NP testing should subsequently be followed up with referral for echocardiography.     

An extended index to quantify normality of gait in children

Clinical gait analysis aims to quantify and assess the mechanics of walking and identify deviations from ‘normal’ movement patterns. To facilitate the use of clinical equipment, protocols are required to process data and produce a few meaningful summary measurements which can, in turn, be used to flag gait abnormalities. Earlier work produced a one-dimensional index of gait, calculated from sagittal hip, knee and ankle rotation angle patterns. The objective of this study was to extend the original index, incorporating kinematic and kinetic data from multiple planes, while allowing for correlations between component measures. A one-dimensional index of normal gait was developed, based on normative gait data (N = 45 children, aged 3–13 years). The new one-dimensional index was calculated using correlation patterns between seven component indices, each of which has diagnostic interpretation. The effectiveness of the new index was tested using immature normative data (N = 14) and hypotonic data (N = 10). Approximately 85% of immature normative children and 100% of hypotonic children were classified as either unusual or extreme by the one-dimensional index. These data reduction protocols improve objective gait analyses in the clinical setting.     

Incidence and clinical variables associated with streptococcal throat infections: a prospective diagnostic cohort study

Background

Management of pharyngitis is commonly based on features which are thought to be associated with Lancefield group A beta-haemolytic streptococci (GABHS) but it is debatable which features best predict GABHS. Non-group A strains share major virulence factors with group A, but it is unclear how commonly they present and whether their presentation differs.

Aim

To assess the incidence and clinical variables associated with streptococcal infections.

Design and setting

Prospective diagnostic cohort study in UK primary care.

Method

The presence of pathogenic streptococci from throat swabs was assessed among patients aged ≥5 years presenting with acute sore throat.

Results

Pathogenic streptococci were found in 204/597 patients (34%, 95% CI = 31 to 38%): 33% (68/204) were non-group A streptococci, mostly C (n = 29), G (n = 18) and B (n = 17); rarely D (n = 3) and Streptococcus pneumoniae (n = 1). Patients presented with similar features whether the streptococci were group A or non-group A. The features best predicting A, C or G beta-haemolytic streptococci were patient’s assessment of severity (odds ratio [OR] for a bad sore throat 3.31, 95% CI = 1.24 to 8.83); doctors’ assessment of severity (severely inflamed tonsils OR 2.28, 95% CI = 1.39 to 3.74); absence of a bad cough (OR 2.73, 95% CI = 1.56 to 4.76), absence of a coryza (OR 1.54, 95% CI = 0.99 to 2.41); and moderately bad or worse muscle aches (OR 2.20, 95% CI = 1.41 to 3.42).

Conclusion

Non-group A strains commonly cause streptococcal sore throats, and present with similar symptomatic clinical features to group A streptococci. The best features to predict streptococcal sore throat presenting in primary care deserve revisiting.