Trends in heart failure mortality in England and Wales since 1950.

BACKGROUND: This study aims to analyse trends in heart failure mortality for England and Wales from 1950 to 2003. METHODS: A retrospective observational study was conducted using death certificate and population data from the Office for National Statistics. RESULTS: Unadjusted heart failure deaths rose by a factor of more than four between 1950 and 1974 and then fell by a quarter by 2003. When standardised for changes in the age, sex and size of the population, there was a tripling in mortality rate from 1950 to the mid-1970s and since then, a sustained decline in mortality rate of 50% by 2003. The unadjusted female heart failure death rate has been between 1.5-2 times that of males since the early 1970s, but this is much less marked when the differences in the age distribution and sizes of the male and female populations are taken into account. Heart failure mortality trends are similar to those of coronary heart disease (CHD), but the peak is about 10 years earlier, and the male/female ratios are reversed. There is a continuing rise in deaths from both heart failure and CHD in the very elderly (>85 years). CONCLUSION: Unlike hospital trends, deaths from heart failure in the community in England and Wales show a decline since the early 1970s, in spite of an ageing population. This may reflect genuine changes in heart failure incidence, or parallel changes in CHD.

Development of a decision support system for diagnosis and grading of brain tumours using in vivo magnetic resonance single voxel spectra.

A computer-based decision support system to assist radiologists in diagnosing and grading brain tumours has been developed by the multi-centre INTERPRET project. Spectra from a database of 1H single-voxel spectra of different types of brain tumours, acquired in vivo from 334 patients at four different centres, are clustered according to their pathology, using automated pattern recognition techniques and the results are presented as a two-dimensional scatterplot using an intuitive graphical user interface (GUI). Formal quality control procedures were performed to standardize the performance of the instruments and check each spectrum, and teams of expert neuroradiologists, neurosurgeons, neurologists and neuropathologists clinically validated each case. The prototype decision support system (DSS) successfully classified 89% of the cases in an independent test set of 91 cases of the most frequent tumour types (meningiomas, low-grade gliomas and high-grade malignant tumours--glioblastomas and metastases). It also helps to resolve diagnostic difficulty in borderline cases. When the prototype was tested by radiologists and other clinicians it was favourably received. Results of the preliminary clinical analysis of the added value of using the DSS for brain tumour diagnosis with MRS showed a small but significant improvement over MRI used alone. In the comparison of individual pathologies, PNETs were significantly better diagnosed with the DSS than with MRI alone.

A multi-centre, web-accessible and quality control-checked database of in vivo MR spectra of brain tumour patients.

OBJECTIVE: To describe an Internet-accessible database that contains validated in vivo MR spectra and clinical data of brain tumour patients. MATERIALS AND METHODS: All data from patients entering the INTERPRET project (International Network for Pattern Recognition of Tumours Using Magnetic Resonance, ) were stored in a web-accessible database (iDB) and selected using its query functionality. Criteria for selection were that the case had a single voxel (SV) short-echo (20-32 ms) 1.5 T spectrum acquired from a nodular region of the tumour, that the voxel had been positioned in the same region as where subsequent biopsy was obtained, that the short-echo spectrum had not been discarded because of acquisition artefacts or other reasons, and that a histopathological diagnosis was agreed among a committee of neuropathologists. When the spectra were obtained from normal volunteers or were of abscesses or clinically proven metastases, biopsy was not required. RESULTS: A subset of 304 cases (22 normal volunteers and 282 tumour patients) was obtained. These cases were migrated to another similar database (validated-DB). CONCLUSION: The validated-DB complies with ethics regulations and represents the population studied. It is accessible by neuroradiologists willing to use information provided by MRS to help in the non-invasive diagnosis of brain tumours.