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Objectives: Cardiac computed tomography angiography (CCTA) is a commonly used diagnostic test for coronary artery disease. Despite its considerable clinical value, few studies have explored the psychological value of CCTA from the perspective of patients undergoing testing. This study aimed to investigate the patient-perceived value of diagnostic CCTA testing, specifically in relation to patients' perceptions of their heart health and health behaviours., Design: The study used a qualitative methodology incorporating thematic analysis before and after testing., Methods: Semi-structured interviews were conducted before and after the receipt of CCTA test results among 13 non-acute patients attending a heart clinic in New Zealand for diagnostic CCTA. Data analysis followed a thematic analysis approach applied at each interview time point., Results: Three themes were identified from the pre-diagnostic interviews: expectations that testing would facilitate heart-related understanding; the role of CCTA as an essential requirement for considering the use of cardiac medication; and awareness of the importance of heart-healthy behaviours. Post-diagnostic interview analysis identified four themes: positive psychological responses to cardiac diagnosis; perceived value of viewing scan images; the potential impact of testing on health behaviour intentions; and patients' reflections on the procedure., Conclusions: These results suggest that CCTA has the potential to meet knowledge-gaining expectations that patients bring to clinic and may increase motivation of health-protective behaviours. Diagnostic CCTA may therefore provide an ideal opportunity to address patients' illness understanding and behavioural intentions. The effective utilization of scan images as a supplement to consultation may enhance such practice objectives and warrants further investigation., Statement of Contribution: What is already known on this subject? Cardiac computed tomography angiography (CCTA) is an advanced diagnostic test that is particularly useful for early diagnosis of coronary artery disease. Cardiac computed tomography angiography is able to produce highly detailed images of the formation and build-up of calcium deposits in coronary vasculature, thus providing a window into an otherwise unseen disease process. Although CCTA is increasingly utilized by clinicians, little is known about its psychological value for cardiac patients undergoing the test. What does this study add? Cardiac computed tomography angiography testing can be a potentially important experience for cardiac patients in understanding their cardiac health. Cardiac computed tomography angiography could provide an opportune time to address patients' health behaviour intentions and treatment beliefs. Effective utilization of CCTA scan images in consultation may help to enhance consultation objectives., (© 2013 The British Psychological Society.)

Objective: To investigate whether providing information about normal findings before a diagnostic test improves patients' reassurance and reduces anxiety about symptoms., Design: Randomised controlled trial., Setting: Outpatient cardiology clinic., Participants: 92 patients with chest pain referred for a diagnostic exercise stress test., Intervention: Before undergoing testing patients were randomised to receive standard information (n=28; control group), a pamphlet explaining the function of the test and the meaning of normal test results (n=30; pamphlet group), or the pamphlet and a brief discussion about the meaning of normal test results (n=34; discussion group)., Main Outcome Measures: The primary outcome was patients' reported reassurance on a 5 item scale immediately after the test and at one month. Secondary outcomes were the proportion of patients still with chest pain and still taking cardiac drugs at one month., Results: The mean levels of reassurance after testing and feedback from the doctor were significantly higher in the discussion group (42.0, 95% confidence interval 39.7 to 44.2) than in the pamphlet (39.2, 36.1 to 42.3) and control groups (35.8, 31.6 to 39.9). This difference was maintained at one month. The proportion of patients still reporting chest pain at one month decreased significantly in the discussion group (to 17%) and pamphlet group (to 28%) but not in the control group (to 36%). A trend was for fewer patients in the discussion group to be taking cardiac drugs at one month., Conclusion: Providing patients with information about normal test results before testing can improve rates of reassurance and reduce the likelihood of future reports of chest pain., Trial Registration: Current Controlled Trials ISRCTN87589121 [controlled-trials.com].

Natural abundance of (15)N and [N] was studied in thalli of mat-forming lichens collected from tundra and heathland sites in the northern and southern hemispheres. The study includes samples of British Cladonia portentosa from sites in regions of high and low N-loading and in heathland growing both directly on peat and independently of the soil substratum, in a canopy of prostrate gorse ( Ulex minor). In the mat-forming lichens examined, a non-random pattern in [N] and delta(15)N was characterised by a minimum in delta(15)N, which occurred most frequently at 20-40 mm below the thallus apex. Nitrogen concentration increased above this point, towards the apex, though remained invariably low towards the thallus base. We discuss the significance of the pattern in [N] and delta(15)N for current theories describing the uptake and recycling of nitrogen by mat-forming lichens in oligotrophic habitats. Our data are incompatible with the suggested uptake of soil organic-N depleted in (15)N, though are consistent with possible internal recycling and the development of a structural necromass. The study emphasises the internal fractionation of nitrogen isotopes and provides a caveat against the assumption that values of delta(15)N provide an unequivocal indicator of source-sink relationships in nitrogen cycling.