Royal College of Physicians: National care of the dying audit of hospitals

National care of the dying audit of hospitals

Holding Hands with Elderly PatientThis report has found significant variations in care across hospitals in England.  The audit shows that major improvements need to be made to ensure better care for dying people, and better support for their families, carers, friends and those important to them. While previous audits had been based on the goals of care within the Liverpool Care Pathway for the Dying Patient (LCP), the new audit sampled the care of dying people in hospital, regardless of whether they were supported by the LCP or other care pathways or frameworks, and included more hospitals than the previous audits.

Miller C.A.; Naish J.H; Egdell, R; Journal of Cardiovascular Magnetic Resonance, January 2014

Voxel-wise quantification of myocardial blood flow with cardiovascular magnetic resonance: Effect of variations in
methodology and validation with positron emission tomography
Journal of Cardiovascular Magnetic Resonance, January 2014, vol./is. 16/1, 1097-6647;1532-429X (24 Jan 2014)
Author(s): Miller C.A.; Naish J.H.; Ainslie M.P.; Tonge C.; Tout D.; Arumugam P.; Banerji A.; Egdell R.M.; Clark D.; Weale P.; Steadman C.D.; McCann G.P.; Ray S.G.; Parker G.J.; Schmitt M.

Abstract:  Quantitative assessment of myocardial blood flow (MBF) from cardiovascular magnetic resonance (CMR) perfusion images appears to offer advantages over qualitative assessment. Currently however, clinical translation is lacking, at least in part due to considerable disparity in quantification methodology. The aim of this study was to evaluate the effect of common methodological differences in CMR voxel-wise measurement of MBF, using position emission tomography (PET) as external validation.

Methods. Eighteen subjects, including 9 with significant coronary artery disease (CAD) and 9 healthy volunteers prospectively underwent perfusion CMR. Comparison was made between MBF quantified using: 1. Calculated contrast agent concentration curves (to correct for signal saturation) versus raw signal intensity curves; 2. Mid-ventricular versus basal-ventricular short-axis arterial input function (AIF) extraction; 3. Three different deconvolution approaches; Fermi function parameterization, truncated singular value decomposition (TSVD) and first-order Tikhonov regularization with b-splines. CAD patients also prospectively underwent rubidium-82 PET (median interval 7 days).

Results: MBF was significantly higher when calculated using signal intensity compared to contrast agent concentration curves, and when the AIF was extracted from mid- compared to basal-ventricular images. MBF did not differ significantly between Fermi and Tikhonov, or between Fermi and TVSD deconvolution methods although there was a small difference between TSVD and Tikhonov (0.06 mL/min/g). Agreement between all
deconvolution methods was high. MBF derived using each CMR deconvolution method showed a significant linear relationship (p < 0.001) with PET-derived MBF however each method underestimated MBF compared to PET (by 0.19 to 0.35 mL/min/g).

Variations in more complex methodological factors such as deconvolution method have no greater effect on estimated MBF than simple factors such as AIF location and observer variability. Standardization of the quantification process will aid comparison between studies and may help CMR MBF quantification enter clinical use. 2014 Miller et al.; licensee BioMed Central Ltd.
Publication Type: Journal: Article
Source: EMBASE
Full Text: Available from EBSCOhost in Journal of Cardiovascular Magnetic Resonance (BioMed Central)