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https://www.readbyqxmd.com/read/28446550/national-institute-for-health-and-care-excellence-updates-the-stable-chest-pain-guideline-with-radical-changes-to-the-diagnostic-paradigm
#1
REVIEW
Adam Timmis, Carl A Roobottom
In the 2016 update of the stable chest pain guideline, the National Institute for Health and Care Excellence (NICE) has made radical changes to the diagnostic paradigm that it-like other international guidelines-had previously placed at the centre of its recommendations. No longer are quantitative assessments of the disease probability considered necessary to determine the need for diagnostic testing and the choice of test. Instead, the recommendation is for no diagnostic testing if chest pain is judged to be 'non-anginal' and CT coronary angiography (CTCA) in patients with 'typical' or 'atypical' chest pain with additional perfusion imaging only if there is uncertainty about the functional significance of coronary lesions...
April 26, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28379388/prevalence-of-obstructive-coronary-artery-disease-and-prognosis-in-patients-with-stable-symptoms-and-a-zero-coronary-calcium-score
#2
Tarun K Mittal, Alison Pottle, Ed Nicol, Mahmoud Barbir, Ben Ariff, Saeed Mirsadraee, Michael Dubowitz, Diana A Gorog, Piers Clifford, Soroosh Firoozan, Robert Smith, Simon Dubrey, Harmeet Chana, Jaymin Shah, Nigel Stephens, Christopher Travill, Andrew Kelion, Mini Pakkal, Adam Timmis
Aims: CT calcium scoring (CTCS) and CT cardiac angiography (CTCA) are widely used in patients with stable chest pain to exclude significant coronary artery disease (CAD). We aimed to resolve uncertainty about the prevalence of obstructive coronary artery disease and long-term outcomes in patients with a zero-calcium score (ZCS). Methods and results: Consecutive patients with stable cardiac symptoms referred for CTCS or CTCS and CTCA from chest pain clinics to a tertiary cardiothoracic centre were prospectively enrolled...
March 31, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28246175/symptoms-and-quality-of-life-in-patients-with-suspected-angina-undergoing-ct-coronary-angiography-a-randomised-controlled-trial
#3
Michelle C Williams, Amanda Hunter, Anoop Shah, Valentina Assi, Stephanie Lewis, Kenneth Mangion, Colin Berry, Nicholas A Boon, Elizabeth Clark, Marcus Flather, John Forbes, Scott McLean, Giles Roditi, Edwin Jr van Beek, Adam D Timmis, David E Newby
BACKGROUND: In patients with suspected angina pectoris, CT coronary angiography (CTCA) clarifies the diagnosis, directs appropriate investigations and therapies, and reduces clinical events. The effect on patient symptoms is currently unknown. METHODS: In a prospective open-label parallel group multicentre randomised controlled trial, 4146 patients with suspected angina due to coronary heart disease were randomised 1:1 to receive standard care or standard care plus CTCA...
February 28, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28190514/transluminal-attenuation-gradient-and-corrected-models-in-coronary-ct-angiography-for-determining-stenosis-severity-a-primary-study-using-dual-source-ct
#4
K Peng, N Xu, L Zhang, F Xiao, N Indima, J Zhang, Y Shen, W Peng, G Tang
AIM: To compare the incremental value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (TAG-CCO), and TAG with exclusion of calcified coronary segments (TAG-ExC) in determining the stenosis severity of coronary arteries using coronary angiography (CAG) as the reference standard. MATERIALS AND METHODS: One hundred and fifteen patients who underwent computed tomography coronary angiography (CTCA) and confirmed by coronary angiography (CAG) were included in the retrospective analysis...
February 9, 2017: Clinical Radiology
https://www.readbyqxmd.com/read/28152969/utilizing-an-a3-project-to-improve-assessment-of-oral-chemotherapy-adherence-across-a-five-site-enterprise
#5
Kathleen Dunn, Debra Kay Allen, Diane Denny, Maurie Markman
136 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of five hospitals that specialize in treating patients fighting complex or advanced-stage cancer. During the fall of 2013, two of the five centers began the pursuit of Quality Oncology Practice Initiative (QOPI) certification. A third site began QOPI certification the spring of 2014 and the remaining two sites followed suit the spring of 2015. This process brought attention to the patient population receiving oral chemotherapy and the importance of careful monitoring of those self-administering their cancer treatment regimens...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152901/adopting-qopi-metrics-into-a-continuous-plan-for-learning-across-a-five-hospital-network
#6
Kathleen Dunn, Marjorie Hepler, Debra Kay Allen, Maurie Markman
268 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced stage cancer. Utilizing metrics from the Quality Oncology Practice Initiative (QOPI), CTCA developed a "QOPI related continuous measures plan" from those areas of opportunity which fell greater than 10% below the QOPI aggregate score based upon its centers initial data abstraction efforts and findings. A total of 20 QOPI related measures were selected...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152864/use-of-an-automated-notification-tool-to-drive-real-time-patient-symptom-intervention
#7
Brandon Bosch, Diane Denny, Maurie Markman
160 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients' perceived symptom burden for real-time clinical intervention, from baseline and every 21 days thereafter. The SIT is comprised of questions utilizing the M.D. Anderson Symptom Inventory tool, a validated assessment instrument with questions added and a free text box by CTCA...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152785/engaging-patients-with-their-self-reported-symptom-outcomes-trended-data
#8
Diane Denny, Carmon Greene, Morgan Hannaford, Maurie Markman
69 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients' perceived symptom burden for real-time clinical intervention. Patients take a baseline SIT assessment at new patient intake and are eligible to take the SIT every 21 days. The SIT is comprised of the M.D. Anderson Symptom Inventory tool, a validated assessment instrument, along with additional questions and a free text box that were created by CTCA...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152730/addressing-patient-needs-through-compilation-of-self-reported-verbatim-comments
#9
Diane Denny, Sarah Hizon, Danielle Kendrick, Maurie Markman
111 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of five hospitals that specialize in the treatment of patients fighting complex or advanced-stage cancer. The Symptom Inventory Tool (SIT) is an assessment that captures the patients' perceived symptom burden, from baseline and every 21 days thereafter. The SIT is comprised of questions utilizing the M.D. Anderson Symptom Inventory tool, with eight questions and a free text box added by CTCA. Patient comments are provided in approximately 5% of all assessments (representing 3,700 comments) since initiation of the SIT...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152698/assessing-patient-experience-in-an-outpatient-multidisciplinary-clinic-setting
#10
Scott Hartman
224 Background: Cancer Treatment Centers of America (CTCA), a national network of five hospitals, implemented a new survey instrument and methodology to gather patient experience data in the outpatient setting. While borrowing many questions from its vendors' client base, the network also added questions considered pivotal to understanding the critical dimensions of care deemed most relevant to the oncology patient. Surveying includes 100% of all patients first contacted via the U.S. mail and subsequently using e-surveys...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152697/establishing-an-oncology-quality-dashboard-for-improvement
#11
Danielle Gross
223 Background: Cancer Treatment Centers of America (CTCA), a national network of five hospitals, formed a Quality Improvement Committee to bring together both clinical and administrative leadership (physician, nursing, pharmacy and quality) across the enterprise vested in the oversight of quality and patient safety. Tasked with facilitating and driving measurement and improvement the group established a Quality dashboard housing metrics of importance given current performance, evidence-based practice, and evolving external standards...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28095950/ct-coronary-angiography-vs-coronary-artery-calcium-scoring-for-the-occupational-assessment-of-military-aircrew
#12
COMPARATIVE STUDY
Iain Parsons, Chris Pavitt, Rebecca Chamley, Jo d'Arcy, Ed Nicol
INTRODUCTION: To ensure flight safety military aircrew undergo regular clinical and occupational assessment. Coronary artery calcium scoring (CACS) has been established as an imaging modality to noninvasively assess coronary artery disease (CAD). CT coronary angiography (CTCA) potentially offers a more accurate assessment of CAD, but has not been formally assessed in military aircrew. This retrospective cohort study is designed to compare the theoretical differences in downstream investigations and occupational outcomes in aircrew with suspected CAD comparing CTCA with existing CACS pathways...
February 1, 2017: Aerospace Medicine and Human Performance
https://www.readbyqxmd.com/read/28025267/coronary-artery-aneurysms-detected-by-computed-tomography-coronary-angiography
#13
Ernesto Forte, Marco Aiello, Marianna Inglese, Teresa Infante, Andrea Soricelli, Carlo Tedeschi, Marco Salvatore, Carlo Cavaliere
AIMS: Coronary artery aneurysms (CAAs) are incidentally revealed by coronary angiography and consist in a localized dilation of a coronary artery. Although invasive coronary angiography (ICA) is the gold standard imaging technique, it can lead to the underestimation of CAAs diameter in presence of parietal thrombi. Computed tomography coronary angiography (CTCA) is a very sensitive tool in CAAs detection and provides a clear visualization of coronary lumen highlighting intraluminal thrombi...
December 26, 2016: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/27999826/the-diagnosis-of-silent-myocardial-ischemia-motion-frozen-or-morphing-myocardial-perfusion-imaging
#14
EDITORIAL
Cheng Chang, Bo Ye, Wenhui Xie, Daoliang Zhang, Bei Lei, Xiaodan Ye
Silent myocardial ischemia is typically defined as objective evidence of myocardial ischemia in patients without subjective ischemia symptoms. Currently, coronary artery angiography is the gold standard for diagnosis of asymptomatic coronary artery disease (CAD). Computed tomography coronary angiography (CTCA) can visually demonstrate the morphology, trend and extent of coronary stenosis and is commonly used in clinical screening of CAD. Myocardial perfusion imaging can be used not only to identify whether anatomical stenosis causes myocardial dysfunction, but to also assess the risk stratification and prognosis of myocardial disease (MD)...
September 2016: Hellenic Journal of Nuclear Medicine
https://www.readbyqxmd.com/read/27923390/the-rapid-ctca-trial-rapid-assessment-of-potential-ischaemic-heart-disease-with-ctca-a-multicentre-parallel-group-randomised-trial-to-compare-early-computerised-tomography-coronary-angiography-versus-standard-care-in-patients-presenting-with-suspected-or-confirmed
#15
Alasdair J Gray, Carl Roobottom, Jason E Smith, Steve Goodacre, Katherine Oatey, Rachel O'Brien, Robert F Storey, Lumine Na, Steff C Lewis, Praveen Thokala, David E Newby
BACKGROUND: Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk...
December 7, 2016: Trials
https://www.readbyqxmd.com/read/27894070/the-strategy-study-stress-cardiac-magnetic-resonance-versus-computed-tomography-coronary-angiography-for-the-management-of-symptomatic-revascularized-patients-resources-and-outcomes-impact
#16
COMPARATIVE STUDY
Gianluca Pontone, Daniele Andreini, Andrea I Guaricci, Cristina Rota, Marco Guglielmo, Saima Mushtaq, Andrea Baggiano, Virginia Beltrama, Laura Fusini, Anna Solbiati, Chiara Segurini, Edoardo Conte, Paola Gripari, Andrea Annoni, Alberto Formenti, Maria Petulla', Federico Lombardi, Giuseppe Muscogiuri, Antonio L Bartorelli, Mauro Pepi
BACKGROUND: Computed tomography coronary angiography (cTCA) and stress cardiac magnetic resonance (stress-CMR) are suitable tools for diagnosing obstructive coronary artery disease in symptomatic patients with previous history of revascularization. However, performance appraisal of noninvasive tests must take in account the consequent diagnostic testing, invasive procedures, clinical outcomes, radiation exposure, and cumulative costs rather than their diagnostic accuracy only. We aimed to compare an anatomic (cTCA) versus a functional (stress-CMR) strategy in symptomatic patients with previous myocardial revascularization procedures...
October 2016: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27672064/ethnic-differences-in-coronary-plaque-and-epicardial-fat-volume-quantified-using-computed-tomography
#17
Daniel B Adams, Om Narayan, Ravi Kiran Munnur, James D Cameron, Dennis T L Wong, Andrew H Talman, Richard W Harper, Sujith K Seneviratne, Ian T Meredith, Brian S Ko
Epidemiological studies observed a higher prevalence of coronary atherosclerosis in South Asians when compared to Caucasians, but quantitative computed tomography differences in aggregate plaque volume (APV) and epicardial fat volume (EFV) between South Asians, Southeast or East Asians (SEEAs) and Caucasians remain unknown. We aimed to compare APV and EFV quantified on computed-tomographic-coronary-angiography (CTCA) between South Asian, SEEA and Caucasian populations residing in Australia. Age, gender and body-mass-index matched subjects from three ethnic groups who underwent clinically indicated 320-detector CTCA were retrospectively analysed...
September 26, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27667384/forty-years-of-chest-pain-a-case-report-and-contemporary-review-of-the-diagnostic-and-therapeutic-options-for-myocardial-bridging
#18
Emily Tat, Richard Cheng, Jeffrey S Helfenstein
A 48-year-old woman with 40 years of intermittent squeezing chest pain presented with worsening symptoms. Results of an ambulatory electrocardiogram, echocardiogram, and exercise treadmill were unremarkable. Persistent symptoms prompted a computed tomography coronary angiogram (CTCA) that revealed mid-left anterior descending artery myocardial bridging (MB) that was not physiologically significant by exercise single-photon emission CT. Conservative treatment was pursued. Anatomic MB is prevalent in a large proportion of the general population and are increasingly identified by CTCA...
2016: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/27622565/virtual-monochromatic-imaging-in-patients-with-intermediate-to-high-likelihood-of-coronary-artery-disease-impact-of-coronary-calcification
#19
Patricia Carrascosa, Jonathon A Leipsic, Alejandro Deviggiano, Carlos Capunay, Javier Vallejos, Alejandro Goldsmit, Macarena C De Zan, Gaston A Rodriguez-Granillo
RATIONALE AND OBJECTIVES: We sought to explore the image quality and diagnostic performance of virtual monochromatic imaging derived from dual-energy computed tomography coronary angiography (DE-CTCA) in patients with intermediate to high likelihood of coronary artery disease (CAD) and the influence of calcification. MATERIALS AND METHODS: Consecutive symptomatic patients with suspected CAD referred for invasive coronary angiography who underwent DE-CTCA and a coronary artery calcium scoring before the invasive procedure comprised the study population...
September 9, 2016: Academic Radiology
https://www.readbyqxmd.com/read/27500095/imaging-of-coronary-atherosclerosis-in-various-susceptible-groups
#20
REVIEW
Ravi Kiran Munnur, Nitesh Nerlekar, Dennis T L Wong
Coronary artery disease (CAD) is the leading cause of death and disability worldwide. Atherosclerosis, which is the primary pathophysiologic mechanism for the development of plaque leading to CAD, is a multifactorial process resulting from a complex interplay between genetic susceptibility and various risk factors such as hypertension (HT), dyslipidaemia, diabetes mellitus (DM) and smoking. In addition, influences from other disease states such as chronic kidney disease (CKD), obesity and the metabolic syndrome as well as gender and ethnic diversity also contribute to the disease process...
August 2016: Cardiovascular Diagnosis and Therapy
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