Background: Appropriate use criteria (AUC) for single-photon emission computed tomographic myocardial perfusion imaging (SPECT MPI) were revised in 2009 to include 15 new clinical scenarios. We assessed multivariable predictors and overall appropriateness of MPI studies performed in a rural tertiary care setting. Hypothesis: We hypothesized that appropriate utilization rates of SPECT MPI imaging in a rural tertiary care center are similar for cardiology and non cardiology providers. Methods: We reviewed all SPECT MPI studies performed for over a 6-month period at our center. Using 67 scenarios in AUC, we categorized these studies as appropriate, inappropriate, uncertain, or unclassifiable. Results: Of 328 MPI studies, 287 (88%) studies were classified as appropriate, 18 (5.5%) as inappropriate, 23 (7%) as uncertain, and none as unclassifiable. Preoperative testing accounted for 44% of the inappropriate studies; 61% of uncertain tests were ordered for cardiovascular risk assessment in patients with prior normal coronary angiography or normal stress tests. The ordering provider specialty did not show any relation with appropriateness of the test (P = 0.46). Patients with inappropriate and uncertain studies were younger than patients with appropriate studies (P = 0.007). Conclusions: We found that a majority of MPI studies are performed for appropriate indications regardless of ordering provider specialty. Few common scenarios accounted for the majority of the inappropriate or uncertain studies.
BackgroundPrevious investigators have reported a significant increase in the utilization of imaging studies in cardiovascular medicine, disproportionate to the prevalence of cardiovascular disease. 1 As a result, utilization of imaging studies is now being closely scrutinized by the healthcare payers, often necessitating preauthorization. The Deficit Reduction Act of 2005 implemented a new cap system for reimbursement of imaging studies, which includes cardiac radionuclide imaging and echocardiography.
<p>Conventional approaches to alleviating hyperphosphatemia in patients with Chronic Kidney Disease (CKD) include dietary phosphorus restriction and use of phosphate binders. These approaches are, however not enough to control hyperphosphatemia and hence the need for novel nutritional approaches arises. Dietary phosphorus, protein and phytate values of some common food ingredients were obtained. Phosphates to protein ratio and net phosphorus absorption from the gut were reported on the basis of the phytate content of these ingredients. Among some common Indian food ingredients, phosphate to protein ratio was high in cereals, millets and dairy products. However due to presence of high amount of phytate, the net absorption of phosphate was lower from plant based sources of phosphorus as compared to animal based sources. It can be concluded that phosphorus to protein ratio is a metric which helps to ensure dietary phosphorus restriction with sufficient intake of proteins. Tables providing phosphorus to protein ratio along with phytate and per cent absorption may prove to be beneficial in achieving desired target levels of phosphorus for renal dieticians in case of CKD patients with hyperphosphatemia.</p>
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