Pre-exercise screening and health coaching in CHD secondary prevention: a qualitative study of the patient experience.

Secondary prevention programmes can be effective in reducing morbidity and mortality from coronary heart disease (CHD). In particular, UK guidelines, including those from the Department of Health, emphasize physical activity. However, the effects of secondary prevention programmes with an exercise component are moderate and uptake is highly variable. In order to explore patients' experiences of a pre-exercise screening and health coaching programme (involving one-to-one consultations to support exercise behaviour change), semi-structured telephone interviews were undertaken with 84 CHD patients recruited from primary care. The interviews focused on patients' experiences of the intervention including referral and any recommendations for improvement. A thematic analysis of transcribed interviews showed that the majority of patients were positive about referral. However, patients also identified a number of barriers to attending and completing the programme, including a belief they were sufficiently active already, the existence of other health problems, feeling unsupported in community-based exercise classes and competing demands. Our findings highlight important issues around the choice of an appropriate point of intervention for programmes of this kind as well as the importance of appropriate patient selection, suggesting that the effectiveness of health coaching may be under-reported as a result of including patients who are not yet ready to change their behaviours.

Screening gamete donors for cystic fibrosis status.

Gamete donors are currently not tested for cystic fibrosis, even though carriers have a very high risk of producing children with the disease. We recommend that gamete donors be routinely tested for cystic fibrosis. Similar arguments exist for antenatal screening for cystic fibrosis.

Prenatal detection of trisomy 21 and 18 from amniotic fluid by quantitative fluorescent polymerase chain reaction.

Prenatal diagnosis of fetal trisomies is usually performed by cytogenetic analysis on amniotic fluid. This requires lengthy laboratory procedures and high costs, and is unsuitable for large scale screening of pregnant women. An alternative method, which is both rapid and inexpensive and suitable for diagnosing trisomies even from single fetal cells, is the fluorescent polymerase chain reaction using polymorphic small tandem repeats (STRs). In this paper we present the preliminary results of a larger study comparing parallel prenatal diagnoses of trisomies 21 and 18 using cytogenetics with quantitative fluorescent polymerase chain reaction using STR markers. The results obtained by the two techniques were concordant in all cases. This is the first study reporting significant numbers of prenatal diagnoses using the quantitative fluorescent polymerase chain reaction. We believe that further studies on greater numbers of samples will determine the absolute reliability of this technique. These results also provide a model for diagnosis of trisomy from single fetal cells isolated from maternal blood.

Gold 195m in the assessment of the cold pressor test by first pass radionuclide ventriculography.

First pass radionuclide ventriculography was performed with gold 195m in a sequential evaluation of left ventricular ejection fraction during cold pressor stimulation. We studied 10 normal controls, 10 patients with angina pectoris who had proven coronary artery disease and normal left ventricular function during contrast angiography and 10 patients with dilated cardiomyopathy with normal coronary arteries and impaired left ventricular function at contrast angiography. Mean resting ejection fraction was similar in controls and patients with coronary heart disease (57 +/- 2 vs 58 +/- 3) but was significantly lower in the cardiomyopathic subjects (27 +/- 4, P less than 0.001). After 30 seconds cold pressor stimulation, mean left ventricular ejection fraction fell in the normal controls (57 +/- 2 to 52 +/- 2, P less than 0.05) but was unchanged in those with coronary heart disease and dilated cardiomyopathy (58 +/- 3 to 55 +/- 3 and 27 +/- 4 to 24 +/- 4, both NS). No further significant change occurred after 2.5 minutes stimulation (53 +/- 1, 58 +/- 3 and 23 +/- 3, respectively). There was no difference in the pattern of left ventricular ejection fraction response between the groups. Six controls, 4 patients with coronary heart disease and 4 patients with dilated cardiomyopathy had a significant fall in left ventricular ejection fraction and 4, 5 and 6, respectively, developed a new or further deterioration in regional wall motion. Thus neither changes in regional wall motion nor left ventricular ejection fraction response distinguished either patient group from the normal controls. We do not recommend cold pressor stimulation as a diagnostic test for coronary heart disease.

Gold 195m radionuclide ventriculography in the assessment of left ventricular performance in fit elderly men.

We investigated, by radionuclide ventriculography, left ventricular function in 10 fit elderly men and in 11 young volunteers. During exercise in the young subjects left ventricular ejection fraction (LVEF) rose from 63 +/- 3 to 73 +/- 1 (P less than 0.005) and end systolic volume (ESV) fell from 48 +/- 6 to 38 +/- 5 ml (P less than 0 +/- 0.005) but were unchanged in the elderly (57 +/- 3 to 55 +/- 3 and 57 +/- 6 to 64 +/- 7 ml, respectively (NS). End diastolic volume (EDV) did not change in either group; stroke volume rose significantly only in the younger subjects, cardiac output rose in both groups but less in the elderly (5 +/- 0.5 to 12 +/- 1 vs 6 +/- 0.5 to 18 +/- 11 min-1). We conclude that this data lend support to the hypothesis that increasing age is associated with reduced left ventricular contractile performance.