Evaluation of CaDet, a computer-based clinical decision support system for early cancer detection: a comparison with the performance of clinicians.

Based on an analysis of the epidemiologic and clinical attributes of individual patients, the CaDet computer program presents physicians with data patterns that may require clinical attention with regard to early cancer detection. This study evaluated the performance of the program as a possible tool to aid clinicians in the latter. Patient data were obtained by a questionnaire from 160 healthy volunteers. Scored cancer alerts generated by the computer program in response to this data were evaluated in comparison to similar alerts provided by five expert internists who reviewed the same information in blinded fashion. The alert profiles generated by the computer for each of the patients examined were highly correlated to those provided by the clinicians. The computer's alert rate increased with the number of physicians who raised corresponding alerts (20%, 32%, 54%, 73% and 91%, respectively, for 1, 2, 3, 4 and 5 physicians, p < 0.0001) and with the overall weight assigned by the physicians to these alerts (22%, 56%, 84% and 90% for cumulative scores of 1-4, 5-8, 9-12 and 13 or more points, respectively, p < 0.0001). It is concluded that the CaDet computer program may have a role in improving early detection, pending the results of further clinical research.

Heart rate variability in sarcoidosis: a frequency domain analysis.

BACKGROUND: Little is known about autonomic dysfunction in patients with sarcoidosis. Heart rate variability (HRV) studies provide information regarding sympathetic and vagal tone and are both noninvasive and relatively simple to perform. The objective of this study was to compare HRV in sarcoidosis patients and in healthy controls. METHODS: We prospectively analyzed data from 12 sarcoidosis patients and 12 healthy volunteers. Electrocardiographic (ECG) data were recorded from all study participants, and HRV analysis was performed in the frequency domain. The sarcoidosis patients underwent echocardiography as well. RESULTS: Mean values for HRV in the high-frequency (HF) domain were significantly reduced in sarcoidosis patients (182+/-102 ms(2) vs. 758+/-457 in controls, p=0.001). We also observed a trend (p=0.055) towards an increased ratio of low-frequency (LF) to high-frequency power in sarcoidosis patients. CONCLUSIONS: Our findings indicate the possibility of altered sympathovagal balance in sarcoidosis. Since 5 of these 12 sarcoidosis patients had mild echocardiographic abnormalities, possibly related to sarcoidosis, we were unable to conclude whether the HRV findings were attributable solely to an autonomic dysfunction in sarcoidosis or whether they were related to a structural myocardial involvement of the disease.

Exercise Radionuclide Cineangiography for Predicting Long Term Prognosis in Elderly Post Coronary Artery Bypass Graft Patients.

ISSUE: The immediate benefits of coronary artery bypass grafting may only be transient. Recent studies which showed that exercise radionuclide cineangiography studies may predict cardiac events and survival had evaluated post coronary artery bypass grafting patients of all ages. This prospective study was done on an elderly subgroup. METHODS: The results of exercise radionuclide cineangiography performed early (4-8 months) post coronary artery bypass grafting were correlated over six years of follow up with mortality, major surgical and nonsurgical cardiac events, and cardiac event free survival in 87 consecutive patients at or above 65 years. RESULTS: The rest to peak exercise difference in left ventricular ejection fraction correlated with later cardiac death and the need for surgical interventions, while rest left ventricular ejection fraction correlated only with the latter parameter. CONCLUSIONS: Assessment of left ventricular ejection fraction at rest and at exercise has prognostic values after coronary artery bypass grafting in elderly patients. Exercise radionuclide cineangiography carried out soon after coronary artery bypass grafting might be considered an useful tool to assess patient prognosis. The efficacy of exercise radionuclide cineangiography carried out soon after coronary artery bypass grafting should be confirmed in larger and more varied patient subgroups. (c) 2000 by CVRR, Inc.