Disappearance of myocardial perfusion defects on prone SPECT imaging: Comparison with cardiac magnetic resonance imaging in patients without established coronary artery disease

<p>Abstract</p> <p>Background</p> <p>It is of great clinical importance to exclude myocardial infarction in patients with suspected coronary artery disease who do not have stress-induced ischemia. The diagnostic use of myocardial perfusion single-photon emission computed tomography (SPECT) in this situation is sometimes complicated by attenuation artifacts that mimic myocardial infarction. Imaging in the prone position has been suggested as a method to overcome this problem.</p> <p>Methods</p> <p>In this study, 52 patients without known prior infarction and no stress-induced ischemia on SPECT imaging were examined in both supine and prone position. The results were compared with cardiac magnetic resonance imaging (CMR) with delayed-enhancement technique to confirm or exclude myocardial infarction.</p> <p>Results</p> <p>There were 63 defects in supine-position images, 37 of which disappeared in the prone position. None of the 37 defects were associated with myocardial infarction by CMR, indicating that all of them represented attenuation artifacts. Of the remaining 26 defects that did not disappear on prone imaging, myocardial infarction was confirmed by CMR in 2; the remaining 24 had no sign of ischemic infarction but 2 had other kinds of myocardial injuries. In 3 patients, SPECT failed to detect small scars identified by CMR.</p> <p>Conclusion</p> <p>Perfusion defects in the supine position that disappeared in the prone position were caused by attenuation, not myocardial infarction. Hence, imaging in the prone position can help to rule out ischemic heart disease for some patients admitted for SPECT with suspected but not documented ischemic heart disease. This would indicate a better prognosis and prevent unnecessary further investigations and treatment.</p

Towards a definition: what does ‘health promotion’ mean to speech and language therapists?

&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; As UK healthcare moves towards the ideals of prevention and enablement, health promotion is more commonly cited as an area of practice. In comparison with its allied health profession peers, physiotherapy and occupational therapy, the speech and language therapy profession has little evidence to demonstrate that it has explored what its members understand health promotion to mean or how they describe their current and future practice in relation to it.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Aims:&lt;/b&gt; To explore how speech and language therapists define health promotion and how they describe their current and future practice in relation to it.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Methods and Procedures:&lt;/b&gt; Individual, semi-structured interviews were conducted with 15 community-based speech and language therapists. Interviews were transcribed verbatim and analysed using inductive coding.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Outcomes and Results:&lt;/b&gt; Participants viewed health promotion as a complex entity representing the processes of education and enablement in relation to responsibility for speech, language and communication skills. Participants viewed health promotion as a means of maximizing the scarce resource they represented. The vast majority of activities described as being illustrative of health promotion in a speech and language therapy context were examples of educational interventions, e.g. training, information provision. Participants believed that the speech and language therapist's role will continue to develop in relation to health promotion and that this will have implications for future workforce preparation.&lt;/p&gt; &lt;p&gt;&lt;b&gt;Conclusions and Implications:&lt;/b&gt; Participants viewed health promotion as both an educational, enabling process and as a strategy that maximizes the potential of speech and language therapy resources. Further research is indicated to develop professional consensus regarding the meaning of health promotion and to support a cohesive approach to workforce development in this area.&lt;/p&gt