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Appendix 9ES (Information Resources, 5% for 6 months) will supervise systematic reviewing.DN (University of Edinburgh, Cardiology, 2% for 15 months) and ST (University of Sheffield, VascularRadiology, 2% for 15 months) will provide cardiology and vascular radiology expert input.FM, JK and PC will provide emergency medicine and chemical pathology expertise, but will be fundedthrough NIHR NHS support.Other expenses will include:• z Computing equipment, including licences for systematic review and decision analysissoftware = £1250.• z Information resources support: literature searches, document retrieval, photocopying = £3000• z Office expenses for the research team @ £1,500 per wte per year (total 2.5 wte years) = £4687• z Travel for the expert panel and project management group, £2000, and for conference attendance,£1000.The University of Sheffield has joined phase 3 of the Carbon Trust’s Higher Education CarbonManagement Programme. This programme is designed to deliver improved energy management ofacademic, accommodation and leisure buildings and vehicle fleets. It also provides practical support toorganisations by helping them identify carbon saving opportunities, providing software to analyse energyconsumption and delivering workshop support for staff and senior managers to improve their awarenessof energy efficiency.Our proposal is a secondary research project that will be largely undertaken in a single centre, sogreenhouse gas emissions directly related to the project will be relatively small. Indeed, this is anotheradvantage of using modelling techniques. We will further minimise emissions by:1. conducting project management and expert panel meetings by teleconference where possible2. conducting meetings in a central location that is accessible by public transport3. disseminating findings using electronic media where possible4. using public transport to travel to conferencesReferences1. National Clinical Guidelines Centre for Acute and Chronic Conditions. Chest pain of recent onset:assessment and investigation of recent onset chest pain or discomfort of suspected cardiac origin.Full Guideline – Consultation Version, 13 May 2009.2. The National Service for Coronary Heart Disease. Department of Health, 2000. London.3. Goldberg RJ, Currie K, White K, Brieger D, Steg PG, Goodman SG, Dabbous O, Fox KA, Gore JM.Six-month outcomes in a multinational registry of patients hospitalized with an acute coronarysyndrome (the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol 2004;93:288–93.4. Goodacre S, Cross E, Arnold J, Angelini K, Capewell S, Nicholl J. The health care burden of acutechest pain. Heart 2005;91:229–230.5. Thygesen K, Alpert JS, White HD; Joint ESC/ACCF/AHA/WHF Task Force for the Redefinitionof Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol2007;50(22):2173–95.6. Ebell MH, Flewelling D, Flynn CA. A systematic review of troponin T and I for diagnosing acutemyocardial infarction. J Fam Pract 2000;49:550–56.186NIHR Journals Library
DOI: 10.3310/hta17010 Health Technology Assessment 2013 Vol. 17 No. 17. Ebell MH, White LL, Weismantel D. A systematic review of troponin T and I values as a prognostictool for patients with chest pain. J Fam Pract 2000;49:746–53.8. Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractoryunstable angina in relation to serum troponin T levels. N Engl J Med 1999;340:1623–99. Balk EM, Ioannidis JPA, Salem D, Chew PW, Lau J. Accuracy of cardiac biomarkers to diagnoseacute cardiac ischaemia in the emergency department: a meta-analysis. Ann Emerg Med2001;37:478–94.10. Mitchell AM, Brown MD, Menown IBA, Kline JA. Novel protein markers of acute coronary syndromecomplications in low-risk outpatients: a systematic review of potential use in the emergencydepartment. Clinical Chemistry 2005;51:2005–11.11. Goodacre S & Calvert N. Cost effectiveness of diagnostic strategies for patients with acute,undifferentiated chest pain. Emerg Med J 2003;20:429–33.12. Mant J, McManus RJ, Oakes RAL, Delaney BC, Barton PM, Deeks JJ, Hammersley L, et al. Systematicreview and modelling of the investigation of acute and chronic chest pain presenting in primarycare. Health Technol Assess 2004;8(2).13. Choi YF, Wong TW, Lau CC. The diagnostic value and cost effectiveness of creatine kinase-MB,myoglobin and cardiac troponin-T for patients with chest pain in emergency departmentobservation ward. Hong Kong Journal of Emergency Medicine 2004;11:85–90.14. Zarich S, Bradley K, Seymour J, Ghali W, et al. Impact of troponin T determinations on hospitalresource utilization and costs in the evaluation of patients with suspected myocardial ischemia.Am J Cardiol 2001;88:732–6.15. Task Force on the Management of Acute Coronary Syndromes of the European Society forCardiology. Management of acute coronary syndromes in patients presenting without ST elevation.Eur Heart J 2002;23:1809–40.16. Mowatt G, Cummins E, Waugh N, et al. Systematic review of the clinical effectiveness and costeffectivenessof 64-slice or higher computed tomography angiography as an alternative to invasivecoronary angiography in the investigation of coronary artery disease. Health Technol Assess2008;12(17).17. Hoffmann U, Nagurney JT, Moselewski F, Pena A, et al. Coronary multidetector computedtomography in the assessment of patients with acute chest pain. Circulation 2006;114:2251–60.18. Coles DR, Wilde P, Oberhoff M, Rogers CA, et al. Multislice computed tomography coronaryangiography in patients admitted with a suspected acute coronary syndrome. Int J CardiovascImaging 2007;23:603–14.19. Johnson TR, Nikolaou K, Wintersperger BJ, Knez A, et al. ECG-gated 64-MDCT angiography in thedifferential diagnosis of acute chest pain. AJR Am J Roentgenol 2007;188:76–82.20. Rubinshtein R, Halon DA, Gaspar T, Jaffe R, et al. Usefulness of 64-slice cardiac computedtomographic angiography for diagnosing acute coronary syndromes and predicting clinicaloutcome in emergency department patients with chest pain of uncertain origin. Circulation2007;115:1762–8.21. Ladapo JA, Hoffmann U, Bamberg F, Nagurney JT, et al. Cost effectiveness of coronary MDCT in thetriage of patients with acute chest pain. AJR Am J Roentgenol 2009;191:455–63.22. Khare RK, Courtney DM, Powell ES, Venkatesh AK, et al. Sixty-four slice computed tomographyof the coronary arteries: cost effectiveness analysis of patients presenting to the emergencydepartment with low-risk chest pain. Acad Emerg Med 2008;15:623–32.© Queen’s Printer and Controller of HMSO 2013. This work was produced by Goodacre et al. under the terms of a commissioning contract issued by the Secretary of Statefor Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journalsprovided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should beaddressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton SciencePark, Southampton SO16 7NS, UK.187
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ContentsAppendix 5 Expected discoun
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BackgroundTABLE 1 Hospital admissio
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Background2. investigation of the c
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BackgroundComputed tomographic coro
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Research questionsiii. the diagnost
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Assessment of diagnostic and progno
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Discussionspecificity were 62% (95%
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Discussionneed for revascularisatio
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Discussionchanges in sensitivity an
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Discussionuncertainty about these p
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Discussiontroponin assays have bett
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ConclusionsSuggested research prior
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Appendix 144. heart-type fatty acid
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