The future of laboratory medicine - A 2014 perspective.

Predicting the future is a difficult task. Not surprisingly, there are many examples and assumptions that have proved to be wrong. This review surveys the many predictions, beginning in 1887, about the future of laboratory medicine and its sub-specialties such as clinical chemistry and molecular pathology. It provides a commentary on the accuracy of the predictions and offers opinions on emerging technologies, economic factors and social developments that may play a role in shaping the future of laboratory medicine

The Use of Machine Learning in Assessing Suicide Risk: A Meta-analysis

Suicide is a devastating act in which a person takes their own life. Decades of research into suicide have identified a myriad of risk factors that have been used to create assessments of suicide risk and suicidality. However, more recent research has suggested that these identified risk factors may have no better predictive ability than chance, perhaps because suicide is actually a multi-dimensional, multi-faceted construct that has been viewed too simplistically for prediction’s sake. To try and better appreciate the complex nature of suicide while also increasing prediction accuracy, researchers have turned to machine learning. This study sought to meta-analyze the predictive ability of machine learning in predicting suicide risk. A multi-level, mixed effects meta-analytic model returned a significant model with an effect size of g = 1.36 (p \u3c 0.0001), but with a significant amount of heterogeneity (Q(285 df ) = 66361.51, p \u3c 0.0001). A fully augmented model using three moderators (algorithm type, data source type, and suicide definition) accounted for a significant portion of the variance and also returned a statistically significant model. Meta-regression models showed that algorithm type had a statistically significant effect on the reported effect sizes while data source type and suicide definition did not return significant models. The results of this analysis found not only that machine learning indeed has a significant impact on the accuracy of predicting suicide, but also that the type of algorithm used has a significant impact on the reported accuracies as well. However, high within and between study hetereogeneity warrants more research into other potential moderating variables

Review of Tools for Early Detection and Screening of Diabetes

This paper reviews features of numerous tools, techniques and technologies that help to identify and detect early risk of diabetes. The paper uses systematic literature review (SLR) guidelines and searched most of the popular journals limiting the results tied to studies that discussed the screening and detection of the risk of diabetes. We reviewed the architecture, features and limitations of the various tools and technologies using the following classification: Continuous Glucose Monitoring Systems (CGMS), Flash Glucose Monitoring Systems (FGMS) and the Unobtrusive Systems. Under the unobtrusive system, we studied the Child Health Improvement through Computer Automation (CHICA) system and while there are pieces of evidence that proves its benefits and usefulness, we found some required enhancements in areas of decision support system, data entry automation and flexible integration with other systems. Future work will examine the usage of intelligent automation to detect early risk of diabetes during a patient-physician visit

Measurement of proteinuria

In pregnancy, there is a focus on measurement of proteinuria as it has been regarded as critical to the diagnosis of pre-eclampsia, the most dangerous of the hypertensive disorders of pregnancy. However, it is increasingly recognised that proteinuria is not essential for the diagnosis of pre-eclampsia, which can be based on other end-organ complications (such as elevated liver enzymes). Although heavy proteinuria has been linked with an increased risk of stillbirth in a ‘signs and symptoms only’ model of maternal risk (i.e., miniPIERS), we lack the ability to identify a level of proteinuria above which maternal and/or perinatal risk is heightened. Therefore, at present, we rely on the detection of proteinuria that exceeds what is normally excreted by healthy pregnant women. Proteinuria detection methods are also a matter of keen debate, with all available methods having advantages and disadvantages.Publisher PD

Molecular markers for cervical cancer screening

This review gives an overview of current screening practices for cervical cancer. In the introduction, we will cover approaches of population screening focusing on high-risk Human Papilloma Virus (hrHPV) and the need for a better triage assay. We will further assess the impact of current vaccination programs on screening. Subsequently, the review will cover various technological aspects of nucleic acid- and protein-based biomarker assays. We will then detail different molecular markers in view of their use in triage assays, emphasizing epigenetic and protein markers. Finally, we will place this in the context of cost-effectiveness considerations in view of their implementation in high- as well as in low- to middle-income countries. Introduction: Cervical cancer remains a significant healthcare problem, notably in low- to middle-income countries. While a negative test for hrHPV has a predictive value of more than 99.5%, its positive predictive value is less than 10% for CIN2+ stages. This makes the use of a so-called triage test indispensable for population-based screening to avoid referring women, that are ultimately at low risk of developing cervical cancer, to a gynecologist. This review will give an overview of tests that are based on epigenetic marker panels and protein markers. Areas covered: There is a medical need for molecular markers with a better predictive value to discriminate hrHPV-positive women that are at risk of developing cervical cancer from those that are not. Areas covered are epigenetic and protein markers as well as health economic considerations in view of the fact that most cases of cervical cancer arise in low-to-middle-income countries. Expert opinion: While there are biomarker assays based on changes at the nucleic acid (DNA methylation patterns, miRNAs) and at the protein level, they are not widely used in population screening. Combining nucleic acid-based and protein-based tests could improve the overall specificity for discriminating CIN2+ lesions that carry a low risk of progressing to cervical cancer within the screening interval from those that carry an elevated risk. The challenge is to reduce unnecessary referrals without an undesired increase in false-negative diagnoses resulting in cases of cervical cancer that could have been prevented. A further challenge is to develop tests for low-and middle-income countries, which is critical to reduce the worldwide burden of cervical cancer

Fatigue in radiology : a fertile area for future research

Fatigue in radiologists may be responsible for a large number of medical errors. This review describes the latest research on fatigue in radiology. This includes measurement methods, and recent evidence on how fatigue affects accuracy in laboratory test conditions and in clinical practice. The extensive opportunities for future research in the area are explored, including testing interventions to reduce fatigue-related error, and further understanding of which fatigue measures correlate with errors. Finally we explore the possibility of answering these questions using large population based observational studies and pragmatic integrated randomised controlled trials

A short endoscopic Secretin test for the diagnosis of chronic pancreatitis

Background: The diagnosis of CP is not yet clearly defined. Many national guidelines exist, but - as in many other not clearly defined diseases - there is no worldwide consensus. In CP, evaluation of exocrine pancreatic function is crucial because symptoms are often diffuse and overlooked by the doctors. Additionally, early diagnosis of exocrine pancreatic failure is important as its consequence, malnutrition and commonly abdominal pain, leads to serious complications and reduced life expectancy. Direct pancreas function testing with analyses of enzymes in duodenal juice may give this information. Aims: The main aim was to develop and establish a multimodal algorithm for the diagnoses of CP, accurate and easy to handle in clinical practice. Secondary, we wanted to simplify direct pancreas function testing including a): the performance of a short endoscopic test (article I) and b): the analyses of ingredients in duodenal juice by automation: bicarbonate (article II), Amylase (article III) and Lipase (article IV). Materials and Methods: We examined consecutively healthy controls and patients referred to our outpatient clinic due to symptoms suspicious of CP. We assessed patients with a modified Layer (Mayo) score, which includes imaging, pancreas function testing and medical history. We established a short endoscopic secretin test and analysed bicarbonate, Amylase and Lipase in duodenal juice as markers for ductal and acinar exocrine pancreatic function. In article I, we determined sensitivity, specificity and accuracy of bicarbonate and faecal-elastase, using our modified secretin-stimulated upper endoscopy (short endoscopic secretin test, or EST). In article II, III, IV, we describe correlation between automation of analyses of Bicarbonate, Amylase and Lipase in duodenal juice to labour-intensive manual methods. Results: I. Short endoscopic secretin test: Fifty-two patients aged 19 to 67 years and 25 healthy controls aged 19 to 64 years were included. Twenty-four patients fulfilled the modified Layer score for CP or non-CP. The overall accuracy of the EST versus FE1 test was 85%/71%, with positive and negative predictive values of 100%/79% and 80%/69%, respectively. II. Automation of bicarbonate measurement: 177 samples from 71 patients were analysed. Correlation coefficient of all measurements was r = 0.98 (p < 0.001). Correlation coefficient of fresh versus frozen samples conducted with automatic spectrophotometry (n = 25): r = 0.96 (p < 0.001). III. Automation of amylase measurement: We analysed 52 samples for assay of amylase in pairs. Correlation between measurements with the two methods was r = 0.99 (p < 0.001). IV. Automation of lipase measurement: We tested stability of 54 samples from 21 patients. Diluting samples with MOPS buffer, added BSA gave stable results, and was superior to diluting samples in saline. We compared the two assays in 50 samples from 20 patients and found a good correlation between the two assays (r=0.91, p < 0.001). Conclusions: I: Short EST is rapid and easy to perform and can be incorporated in daily routine in every clinical endoscopic unit. EST is superior to FE1 in the assessment of pancreatic insufficiency, leading to earlier diagnosis of moderate and early or mild CP. II: The measurement of bicarbonate in fresh and thawed samples by automatic spectrophotometric analysis correlates excellent with the back-titration gold standard. III and IV: Quantification of duodenal amylase and lipase activity with automated spectrophotometry has excellent correlation to measurements made by the manual methods. Overall, Endoscopic secretin test is easy to perform, and can be incorporated in a diagnostic endoscopic examination. Automated measurement of bicarbonate, lipase and amylase in duodenal juice simplifies the analytical methods and shortens time from test to result substantially. Standardized, centre-independent analyses of duodenal juice with quantification of ductal and acinar function in any unit with basic endoscopic and laboratory services is within reach

Management of Urinary Tract Infections: Problems and Possible Solutions

In clinically suspected urinary tract infections (UTIs), empirical antibiotic treatment is usually started long before the laboratory results of urine culture and antibiogram are available. Although molecular diagnostic approaches are being applied to the diagnosis of many infections, UTIs are generally diagnosed by traditional culture methods. Patient care could greatly benefit from the development of a rapid, accurate, inexpensive test that could be done at patient’s bedside, allowing the practitioner to plan targeted, more effective therapy. Such a test would potentially reduce incorrect or unnecessary use of antibacterial drugs and reduce the emergence of bacterial resistance. In response to this pressing and unmet clinical need, several methods have been developed in the last few years. Among these, the new point-of-care test (POCT) for detecting UTIs named Micro Biological Survey (MBS) UTI CHECK holds promise, as it allows semi-quantitative determination of bacterial load in urine leading to a fast detection of UTIs and to evaluation of bacterial antibiotic susceptibility. This new technology operates through a colorimetric survey performed in low-cost, ready-to-use, disposable vials, in which 1 ml of urine is inoculated without any preliminary treatment and requiring neither specialized personnel nor a specialized equipment