Included below are news items from the last six months.
William Kremer has written an interesting article in the BBC News Magazine with the title ‘Do doctors understand test results?’. It is based on a new book ‘Risk Savvy’ by controversial psychologist Gerd Gigerenzer that also deals with such topics as the risks of stock market crashes and of travelling by plane. Kremer’s article gives examples of the mistaken interpretation of screening test results that should interest both doctors and patients.
On the 9th of June 2014, NHS England issued a patient safety alert to clinical laboratories recommending the implementation of a standardised algorithm to detect acute kidney injury (AKI). The alert provides a standardised version of the algorithm to ensure the same practice is used across all NHS laboratories in England and is aimed to reducing the damage caused by delayed recognition of the condition.
Between 60 and 80% of patients taken to hospital with chest pain are found not to have had a heart attack. In a news item on 20 November 2011 we reported that a rapid "rule out" blood test appeared to hold promise of making hospital admission unnecessary for many patients. The National Institute for Health and Care Excellence (NICE) has reviewed recent evidence, and on 16 May 2014 published draft guidance that the use of high-sensitivity cardiac troponin could mean a reduced length of hospital stay for people with a normal result, and earlier treatment for those patients with an abnormal troponin result. Following consultation, NICE plans to publish final guidance in October 2014.
We reported in a news item on 20 April 2012 that the UK National Screening Committee was to carry out a pilot study to assess expanding the current five tests on blood spots that are used to screen newborns for rare inherited diseases by a further five tests. On 9 May 2014 Public Health England reported that the Committee had recommended the addition of four of the five tests to the screening programme. During the pilot over 700,000 English newborns were tested and 20 with serious but treatable disorders were discovered.
Researchers adapted a highly sensitive method of analysis to measure a brain protein called tau in blood (plasma) samples. They reported online in JAMA Neurology on 13 March 2014 that following sports-related traumatic brain injury in Swedish ice hockey players, plasma tau protein levels were higher than in control players. They hope the test can be developed to help sports physicians diagnose concussion and predict when those affected can safely return to play.
Pulmonary embolism (PE) is a potentially life-threatening condition caused by fragments from a clot in a deep leg vein being carried to the lung and blocking part of its blood supply. In patients clinically assessed to have a low probability of pulmonary embolism there is a consensus that the diagnosis can be ruled out if the result of a D-dimer blood test is lower than a fixed ‘cut-off’ value.
D-dimer values increase with age. In 2010 a retrospective study by a European group showed that adjusting the cut-off value for age would increase the proportion of elderly patients with a low clinical probability who had a negative test. The practical application of this strategy was reported in the Journal of the American Medical Association on 19 March 2014. In 673 patients aged over 75 with a low clinical probability, the fixed cut-off ruled out pulmonary embolism in 43 (6.4%) while an age-adjusted cut-off ruled it out in 200 (29.7%) with no false negative results.
The highly successful Lab Tests Online-UK app launched in June 2013 has now been revised and updated to improve functionality and performance. Upgrades to navigation menus and a new instant search function allow users to pinpoint the information they require in seconds. Users can now share any article quickly and easily by email or via social media platforms, such as Facebook and Twitter.