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Interestingly, patients with a high VQ-6-NL did not have a higher postinterventional ABI or ABI compared with patients with a low VQ-6-NL score. Keywords: ankle-brachial index (ABI); patient centered; peripheral artery disease (PAD); quality of life; outcomes EN ankle-brachial index (ABI) patient centered peripheral artery disease (PAD) quality of life outcomes 236 238 3 06/13/23 20230601 NES 230601 The evaluation of treatment methods for patients with peripheral artery disease (PAD) usually focuses on technical success, rather than on patient-reported clinical success or quality of life. Correlation of patient-reported outcome measures and the ankle-brachial index in patients who underwent revascularization for peripheral artery disease. [Extracted from the article]

Background: Chest radiography (CXR) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care. Aim: To assess the influence of CXR on patient management in general practice. Design Of Study: Prospective cohort study. Setting: Seventy-eight GPs and three general hospitals in the Netherlands. Method: Patients (n = 792) aged > or =18 years referred by their GPs for CXR were included. The main outcome was change in patient management assessed by means of questionnaires filled in by GPs before and after CXR. Results: Mean age of the patients was 57.3+/-16.2 years and 53% were male. Clinically relevant abnormalities were found in 24% of the CXRs. Patient management changed in 60% of the patients following CXR. Main changes included: fewer referrals to a medical specialist (from 26 to 12%); reduction in initiation or change in therapy (from 24 to 15%); and more frequent reassurance (from 25 to 46%). However, this reassurance was not perceived as such in a quarter of these patients. A change in patient management occurred significantly more frequently in patients with complaints of cough (67%), those who exhibited abnormalities during physical examination (69%), or those with a suspected diagnosis of pneumonia (68%). Conclusion: Patient management by the GP changed in 60% of patients following CXR. CXR substantially reduced the number of referrals and initiation or change in therapy, and more patients were reassured by their GP. Thus, CXR is an important diagnostic tool for GPs and seems a cost-effective diagnostic test. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic performance of radiographers compared to radiologists in the detection of colorectal lesions in MR colonography., Material and Methods: 159 patients at increased risk of colorectal cancer were included. Four different experienced observers, one MR radiologist, one radiologist in training and two radiographers evaluated all MR colonography examinations. The protocol included T1-weighted and T2-weighted sequences in prone and supine position. Colonoscopy was used as reference standard. Mean sensitivity rates with 95% confidence intervals (CIs) were determined on a per-patient and per-polyp basis, segmented by size (>or= 6mm and >or= 10mm). Specificity was calculated on a per-patient basis. The McNemar and chi-square (chi(2)) test was used to determine significant differences., Results: At colonoscopy 74 patients (47%) had normal findings; 23 patients had 40 polyps with a size > or = 6mm. In 10 patients at least 1 polyp >or= 10mm was found (20 polyps in total). Similar sensitivities for patients with lesions >or= 10mm were found for radiologists and radiographers (65% (95%CI: 44-86%) vs. 50% (95%CI: 28-72%)) (p=n.s.). For lesions >or=10mm combined per-patient specificity for radiologists and radiographers was 96% (95%CI: 94-98%) and 73% (95%CI: 68-79%) (p<0.0001). Combined per-patient sensitivity for lesions >or=6mm differed significantly between both groups of observers (57% (95%CI: 42-71%) vs. 33% (95%CI: 19-46%)) (p=0.03)., Conclusion: Radiographers have comparable sensitivity but lower specificity relative to radiologists in the detection of colorectal lesions >or= 10mm at MR colonography. Adequate training in evaluating MR colonography is necessary, especially for readers with no prior experience with colonography., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

Objectives: To compare the diagnostic and therapeutic confidence, patient outcome and costs between MRA and DSA as the initial diagnostic imaging test, in patients with symptomatic arterial disease of the leg., Design: Randomised controlled diagnostic trial., Materials and Methods: Patients were randomly allocated to MRA (n=97) or DSA (n=100). Primary outcomes were: ability to make treatment plan and patients satisfaction. Secondary endpoints were: type of treatment and costs., Results: A treatment plan was determined for each included patient. Additional imaging was necessary in 11% of patients in the MRA group compared to 10% in the DSA group (p=0.5). 84% of the patients who received MRA judged the diagnostic work up as comfortable compared to 57% who had DSA (p=0.013). Within 4 months of randomization 30 patients in the MRA group compared to 34 patients in de DSA group underwent operative procedures; 39 versus 36 patients respectively underwent angioplasty. The mean total in-hospital costs during the first 4 months were euro4768,- in the MRA group compared to euro4697,- in the DSA group (95% CI of difference -1331;1472)., Conclusions: In patients with peripheral arterial disease of the leg an adequate treatment plan can be made with MRA. This diagnostic strategy was experienced as more comfortable and less painful compared to DSA. Total diagnostic and treatment costs of both strategies were comparable.

B-mode ultrasound intima-media thickness (IMT) measurements of carotid and femoral arterial walls are used in atherosclerosis studies. In this study, the components contributing to IMT measurement variability in males with coronary artery disease were investigated by means of repeated B-mode ultrasound scans and repeated off-line video image analyses. For statistical analysis, a mixed-model analysis of variance was used. From sonographer data, it was shown that human subjects and their arterial wall segments contributed 75% of the total IMT measurement variability in this population. Inter-sonographer variance contributed 25%. The intra-sonographer variance was negligible (<1%). In off-line image analysis, variance components due to subjects and segments, inter-analyst variance, and residual fluctuation were 88%, < 1% and 11%, respectively. Intra-analyst variance was negligible (<1%). The major source of B-mode ultrasound IMT measurement variability finds its origin in subjects and their arterial walls. Although sonographers proved a lesser source of variability, in comparative studies they should enter a study well trained and should be randomly assigned to subjects. Follow-up examinations should preferably be done by the same sonographer. Off-line image analysis contributed little to IMT measurement variability.

Analysis of the blood flow velocities in the middle cerebral artery by transcranial Doppler ultrasonography was performed in 158 healthy volunteers (aged 14-70 years; 82 men and 76 women). In a subgroup of 38 men and 21 women the end-tidal [CO2] was also measured. The influence of biological factors such as age, sex, end-tidal [CO2], and pulsatility and resistance indices on the mean blood flow velocity in normal ageing was investigated by multiple regression analysis. In both sex groups the measured mean blood flow velocity decreased significantly with age (P values less than 0.0003 for women and less than 0.0001 for men). Women had significantly higher blood flow velocities than men (P = 0.008) and the age-corrected sex difference of 5.2 cm s-1 did not significantly depend on age (P = 0.93). The age-related linear decline of the mean blood flow velocity could not be explained by a concomitant decrease of the end-tidal [CO2]. In a group of subjects older than 50 years, the decrease of the mean blood flow velocity was significantly related to the increase of the pulsatility or resistance index.

By repeated measurements in each of ten normal subjects and ten patients with mild intermittent claudication, the performance of three transcutaneous oxygen tension (PtcO2) test in the diagnosis of obliterative peripheral arterial disease was studied. PtcO2 resting value, PtcO2 response to oxygen breathing and PtcO2 reperfusion response after tourniquet obstruction were all measured on the dorsum of the foot. We found that PtcO2 resting values were not different between patients and controls, while responses to 100% oxygen breathing and reperfusion responses differed significantly between the two groups. The most prominent difference between the two groups was observed in the latency of PtcO2 rise after reperfusion. Therefore the reperfusion response test may have a place in the assessment of claudication by PtcO2 measurement.