Common evidence gaps in point-of-care diagnostic test evaluation

The authors used Oxford Diagnostic Horizon Scan Programme reports to determine the sequence and timing of evidence for new point-of-care diagnostic tests and to identify common evidence gaps in this process | BMJ Open

We extracted data from 500 primary studies. Most diagnostic technologies underwent clinical performance (ie, ability to detect a clinical condition) assessment (71.2%), with very few progressing to comparative clinical effectiveness (10.0%) and a cost-effectiveness evaluation (8.6%), even in the more established and frequently reported clinical domains, such as cardiovascular disease. The median time to complete an evaluation cycle was 9 years (IQR 5.5–12.5 years). The sequence of evidence generation was typically haphazard and some diagnostic tests appear to be implemented in routine care without completing essential evaluation stages such as clinical effectiveness.

Evidence generation for new point-of-care diagnostic tests is slow and tends to focus on accuracy, and overlooks other test attributes such as impact, implementation and cost-effectiveness. Evaluation of this dynamic cycle and feeding back data from clinical effectiveness to refine analytical and clinical performance are key to improve the efficiency of point-of-care diagnostic test development and impact on clinically relevant outcomes. While the ‘road map’ for the steps needed to generate evidence are reasonably well delineated, we provide evidence on the complexity, length and variability of the actual process that many diagnostic technologies undergo.

Full reference: Verbakel, J.Y. T et al. (2017) Common evidence gaps in point-of-care diagnostic test evaluation: a review of horizon scan reports. BMJ Open 7:e015760.

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Updated confidentiality guidance comes into force for doctors

From 25th April 2017 all doctors practising medicine in the UK will be expected to follow revised, expanded and restructured ethical guidance on confidentiality | GMC

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Image source: GMC

Confidentiality: good practice in handling patient information has been updated following an extensive consultation exercise, and is now more explicit than previously published guidance about working with patients. It now clarifies:

  • The circumstances in which doctors can rely on implied consent to share patient information for direct care.
  • The importance of sharing information for direct care, recognising the multi-disciplinary and multi-agency context doctors work in.
  • The significant role that those close to a patient can play in providing support and care, and the importance of acknowledging that role.
  • The public protection responsibilities of doctors, including when to make disclosures in the public interest.

The full guidance is available here

Women with incurable breast cancer receiving insufficient care

Three quarters (76%) of NHS trusts and health boards say that they do not have enough specialist nursing care for people with incurable secondary breast cancer | OnMedica

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The survey of 155 NHS trusts and health boards by Breast Cancer Care found that 42% of organisations surveyed do not provide specialist nursing care for people with incurable breast cancer, in stark comparison to the majority (95%) of people with primary breast cancer having a named clinical nurse specialist for support.

This is despite half (49%) of NHS trusts and health boards saying a main benefit of specialist nursing is reducing lengthy periods in hospital – often unnecessary if symptoms and treatment are managed well – saving the NHS money by freeing up beds.

Read the overview by OnMedica here

Thousands to benefit from ‘game-changer’ stroke treatment

Some 8,000 people a year who have an ischaemic stroke will benefit from a massive expansion in the number of hospitals offering mechanical thrombectomy – a procedure described by experts as a “game-changer”.

Currently, only a few hundred patients a year receive the treatment and just a handful of hospitals in England offer it, despite its proved effectiveness. NHS England is now working to assess the readiness of 24 neuroscience centres across the country which want to introduce the service.

It is expected the treatment, which uses a stent to remove blood clots from the brain, will be phased in later this year with an estimated 1,000 patients set to benefit in the first year of introduction.

NHS England will work with Health Education England and trusts to build on the expertise that is currently available in these specialised centres, developing the workforce and systems to enable an estimated 8,000 to receive this treatment in coming years.

Stroke experts say the procedure can produce remarkable results, with patients who would otherwise have ended up in a wheelchair instead able to walk out of hospital within 48 hours of treatment.

Full story at OnMedica

Increasing Compassion in Medical Decision-Making: Can a Brief Mindfulness Intervention Help?

Fernando, A.T. et al. (2017) Mindfulness. 8(2) pp. 276–285

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Compassion is an essential component of medical practice but is difficult to sustain over time. This problem is increasingly recognized in medical curricula.

Mindfulness-based interventions have the potential to enhance compassion in medicine but this has not yet been tested. This study evaluated whether a brief mindfulness induction increased compassionate responding to difficult patients among medical students and assessed whether trait self-compassion moderated the impact of this experimental manipulation.

Read the full abstract here

Delivering care under pressure

NHS reality check: Delivering care under pressure | Royal College of Physicians | OnMedica

Around three quarters of doctors (74%) say they are worried about the ability of their service to deliver safe patient care in the next 12 months due to pressures on the NHS, according to a survey carried out by the Royal College of Physicians (RCP).

The RCP launched a report today at its annual conference in which it detailed various concerns raised by the 2,101 doctors who responded to its survey.

The survey asked doctors about their experiences of delivering healthcare and their confidence in being able to raise concerns about patient care.

Focusing on their experiences of care over the past 12 months, 78% of doctors said demand for their service was rising and more than half (55%) of physicians believed patient safety had deteriorated.

More than a third (37%) said the quality of care had fallen while the majority (84%) had experienced staffing shortages in their team, while 82% believed the workforce was demoralised.

Read more on this at OnMedica

Full report: NHS reality check: Delivering care under pressure

Young-onset dementia and the need for specialist care

The political case to improve services for YPD depends upon the establishment of an understanding of the clinical symptoms, an unequivocal evidence base about need and an accurate evaluation of the size of the population affected. This short report assesses the evidence base from international studies regarding service design and delivery. The goal is to raise awareness, advance best practice and galvanise the international community to address the serious underfunding and underprovision of care for this marginalised group.

Conclusion: The current evidence suggests that there are universal problems, regardless of continent, with delays to diagnosis and poor understanding of optimum models for service provision and long-term care.

Full reference: J.E. Carter, J.R. Oyebode & R.T.C.M. Koopmans : Young-onset dementia and the need for specialist care: a national and international perspective. Aging & Mental Health. Published online March 14th 2017.