Included below are news items from the last six months.
The World Health Organization (WHO) released recommendations on 12 May 2016 that aim to speed up the detection, and improve the treatment of multidrug resistant tuberculosis (MDR-TB). A novel molecular diagnostic test is recommended for use in national TB reference laboratories that can identify genetic mutations in MDR-TB strains within 24 – 48 hours and reliably rule out resistance to second-line TB drugs. Early detection of MDR-TB has been one of the major bottlenecks in tackling the global TB epidemic.
Symptom-free carriers of C difficile admitted to hospital can potentially transmit the bacterium to other patients. Research workers from Québec, Canada took rectal swabs from 7599 patients admitted to their hospital from the emergency department to identify those carrying C difficile from its tcdB gene that codes for B toxin. The 368 (4.8%) who had a positive test result were placed in modified contact isolation. The researchers reported online in JAMA Intern Med on 25 April 2016 that, over the 15 months after the introduction of this intervention, the incidence of hospital-acquired C difficile infection decreased to less than half that experienced during the previous six years, falling from 6.9 to 3.0 cases per 10,000 patient-days.
If a healthcare professional thinks a woman may have pre-eclampsia she is likely to be admitted to hospital for observation. On 11 May 2016 the National Institute for Health and Care Excellence (NICE) published an assessment of four new blood tests based on placental growth factor (P1GF) measurement, that are designed to help with the diagnosis of pre-eclampsia. Although showing promise, none has yet been recommended for diagnosis. However, for women between weeks 20 and 35 of pregnancy, two tests were able to predict with 98 to 99% accuracy that eclampsia could be ruled out for the next 7 to 14 days. NICE advised that either test could be used to help decide whether the anxiety, inconvenience and expense of hospital admission was necessary, and if monitoring could continue in the community.
Improvements recommended for NHS screening programmes that use laboratory tests for bowel cancer, cervical cancer and Down’s syndrome
The UK National Screening Committee published recommendations on 15 January 2016 for improvements to three of the NHS screening programmes that use lab tests. The committee advised that
- a faecal immunochemical test (FIT) should replace the guaiac occult blood test as the primary test for bowel cancer because it detects more cases and is easier to use.
- a test for human papilloma virus (HPV) should replace the liquid cytology test as the first line screen for cervical cancer because it is more accurate.
- a non-invasive prenatal test (NIPT) on maternal blood should be evaluated as a second screen for pregnant women whose initial screen suggests their baby has an increased chance of having Down’s syndrome. NIPT greatly improves accuracy, so that fewer women would need an invasive procedure to make a firm diagnosis.
The large UK Collaborative Trial of Ovarian Cancer Screening in post-menopausal women reported mortality figures after up to 14 years follow-up online in the Lancet on 17 December 2015. The researchers concluded that annual monitoring of CA-125 concentration followed by ultrasound examination when indicated could reduce mortality from ovarian cancer by about 20%, but that further follow-up is needed before firm conclusions can be reached on the long-term efficacy and cost-effectiveness of screening.
A recent study published in the New England Journal of Medicine describes a 21-gene test performed on tumour tissue removed from women with certain types of breast cancer. Results suggest that the test can accurately predict those women who will do well with hormone treatment, without the need for chemotherapy.