Abiraterone acetate: a potential source of interference in testosterone assays.

Prostate cancer is the second most common cause of cancer in the UK with one in eight men diagnosed during their lifetime. Prostate cancer is typically dependent on androgens for growth, survival and metastasis. Androgen deprivation therapy targets this dependency through drugs such as luteinizing hormone-releasing hormone (LHRH) agonists, which result in inhibition of testicular testosterone. Castrate-resistant prostate cancer (CRPC) describes tumour growth occurring when serum testosterone levels are maximally suppressed. The multiple mechanistic drivers of CRPC include extra-testicular sources of testosterone such as the adrenal glands (dehydroepiandrosterone – peripherally converted into testosterone) and/or local tumour synthesis. In addition, cytochrome P450 17A1 (CYP17A1), which is crucial for androgen synthesis, may be up-regulated in prostate cancer cell

Abiraterone acetate: a potential source of interference in testosterone assays.

Prostate cancer is the second most common cause of cancer in the UK with one in eight men diagnosed during their lifetime. Prostate cancer is typically dependent on androgens for growth, survival and metastasis. Androgen deprivation therapy targets this dependency through drugs such as luteinizing hormone-releasing hormone (LHRH) agonists, which result in inhibition of testicular testosterone. Castrate-resistant prostate cancer (CRPC) describes tumour growth occurring when serum testosterone levels are maximally suppressed. The multiple mechanistic drivers of CRPC include extra-testicular sources of testosterone such as the adrenal glands (dehydroepiandrosterone – peripherally converted into testosterone) and/or local tumour synthesis. In addition, cytochrome P450 17A1 (CYP17A1), which is crucial for androgen synthesis, may be up-regulated in prostate cancer cell

Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point of care testing

Aims The demand for test requests from general practice to laboratory services remains high. Tests performed at the point of care could reduce turnaround time and speed up clinical decision making. Replicating laboratory testing in the community would require panels of tests to be performed simultaneously, which is now approaching technological feasibility. We assessed frequencies and combinations of test requests from community settings to inform the potential future development of multiplex point of care panels. Methods We assessed all laboratory test requests made from general practice in Oxfordshire, UK, January 2014-March 2017. We summarised test request frequency overall and in combination, using heat maps and hierarchical cluster analysis. Results are also presented by age/sex subgroups. We further assessed patterns of tests requested within 7 and 14 days after an initial test request. Results 11,763,473 test requests were made for 413,073 individuals (28% age&gt;65). Of more than 500 test types, 62 were requested at least 5,000 times, most commonly Renal Function Tests (approximately 296,000/year), Full Blood Count (278,000/year) and Liver Function Tests (237,000/year). Cluster analysis additionally identified a clear grouping of tests commonly used to investigate anaemia. Follow-up test frequency was much lower than the frequency of multiple tests ordered at initial presentation. Conclusions The current high volume of single and combination test requests highlights an opportunity for reliable multiplex point of care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.</p

Variation in diagnostic test requests and outcomes: a preliminary metric for OpenPathology.net

Efforts to reduce healthcare costs have led to the development of metrics to identify unwarranted variation in care. Previous work assessing diagnostic tests is limited, despite their substantial contribution to expenditure. We explored C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) tests ordered across Oxfordshire NHS General Practices, and the proportion of tests that yielded an abnormal result, and identified practices that had a proportion of abnormal CRP and ESR results 3 standard deviations below the mean. We estimated the adjusted average proportion of abnormal CRP and ESR tests that yielded abnormal results from each practice, after adjusting for differences in practice populations. These proportions were plotted against the total CRP and ESR requests per practice. We constructed funnel plots to identify practices 3 standard deviations below the mean proportion of abnormal CRP and ESR tests. We analysed 143,745 CRP and 30,758 ESR requests from 69 practices. Twelve (17%) and 7 (10%) practices were more than 3 standard deviations below the mean for CRP and ESR testing respectively. Two practices (3%) were below the 99.8% limit for both CRP and ESR ordering. Variation in the proportion of tests with an abnormal result shows promise for auditing variation in care

Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point of care testing

Aims The demand for test requests from general practice to laboratory services remains high. Tests performed at the point of care could reduce turnaround time and speed up clinical decision making. Replicating laboratory testing in the community would require panels of tests to be performed simultaneously, which is now approaching technological feasibility. We assessed frequencies and combinations of test requests from community settings to inform the potential future development of multiplex point of care panels. Methods We assessed all laboratory test requests made from general practice in Oxfordshire, UK, January 2014-March 2017. We summarised test request frequency overall and in combination, using heat maps and hierarchical cluster analysis. Results are also presented by age/sex subgroups. We further assessed patterns of tests requested within 7 and 14 days after an initial test request. Results 11,763,473 test requests were made for 413,073 individuals (28% age>65). Of more than 500 test types, 62 were requested at least 5,000 times, most commonly Renal Function Tests (approximately 296,000/year), Full Blood Count (278,000/year) and Liver Function Tests (237,000/year). Cluster analysis additionally identified a clear grouping of tests commonly used to investigate anaemia. Follow-up test frequency was much lower than the frequency of multiple tests ordered at initial presentation. Conclusions The current high volume of single and combination test requests highlights an opportunity for reliable multiplex point of care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.</p

Variation in diagnostic test requests and outcomes: a preliminary metric for OpenPathology.net

Efforts to reduce healthcare costs have led to the development of metrics to identify unwarranted variation in care. Previous work assessing diagnostic tests is limited, despite their substantial contribution to expenditure. We explored C-reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) tests ordered across Oxfordshire NHS General Practices, and the proportion of tests that yielded an abnormal result, and identified practices that had a proportion of abnormal CRP and ESR results 3 standard deviations below the mean. We estimated the adjusted average proportion of abnormal CRP and ESR tests that yielded abnormal results from each practice, after adjusting for differences in practice populations. These proportions were plotted against the total CRP and ESR requests per practice. We constructed funnel plots to identify practices 3 standard deviations below the mean proportion of abnormal CRP and ESR tests. We analysed 143,745 CRP and 30,758 ESR requests from 69 practices. Twelve (17%) and 7 (10%) practices were more than 3 standard deviations below the mean for CRP and ESR testing respectively. Two practices (3%) were below the 99.8% limit for both CRP and ESR ordering. Variation in the proportion of tests with an abnormal result shows promise for auditing variation in care