Repeat thyroid function tests for healthy older people are not needed
Older adults with normal thyroid function or subclinical thyroid dysfunction show notable long-term stability of their thyroid hormone levels. This suggests that it is safe for GPs not to routinely retest older adults unless they have risk factors or develop clinical symptoms of overt thyroid dysfunction.
Over five years, about 0.2% older adults with normal thyroid function will develop overt hypothyroidism and about 3.5% will develop subclinical hypothyroidism. Amongst those with subclinical h...
Stool test is useful before GPs refer for possible inflammatory bowel disease
A stool test by GPs has been shown to support referral decisions for young adults, not suspected of cancer, to investigate possible inflammatory bowel disease (IBD - which includes Crohn’s Disease and Ulcerative Colitis). This study supports current NICE guidelines that the calprotectin stool test can usefully inform patient referral pathways and reduce unnecessary invasive tests such as colonoscopy.
High levels of faecal calprotectin are associated with gut inflammation, as occurs in IBD...
Delirium is common among adults receiving palliative care and could be better recognised
Between a quarter and two-thirds of adults admitted to specialist palliative care units experience delirium, or acute confusion.
The findings come from a mixed methods project which included a systematic review of the number of people living with delirium. Estimates are mostly applicable to older adults with advanced cancer.
The project also included interviews with nurses in Australian palliative care units to look at delirium assessment and use of screening tools. The findings highlighted th...
‘Artificial pancreas’ improves glucose control in hospital patients with type 2 diabetes
Closed-loop insulin pumps, which continuously monitor blood glucose and administer insulin accordingly, can improve blood glucose control among patients with type 2 diabetes admitted to hospital for non-critical care. Those using the system spent about six hours longer in the target range, and this could hasten their recovery and reduce staff workload.
The number of hospitalised patients with type 2 diabetes is increasing. Glucose control often worsens during illness. Closed-loop pumps have bee...
MRI scan does not help to find the cause of pelvic pain in women
MRI scans are not sufficiently accurate to find the cause of chronic pelvic pain in women and should not replace laparoscopy (keyhole surgery), which can be used for diagnosis and often treatment. MRI only correctly ruled out a gynaecological condition in half of women judged to have no obvious cause and missed half of women who did have a treatable gynaecological condition.
Pinpointing the origin of chronic pelvic pain is often difficult due to the number of possible causes. If initial tests a...
Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines.
This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out...
Ultrasound shows potential for confirming the diagnosis of pneumonia in children
Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances.
A review of the published evidence found that lung ultrasound was more sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation.
Ultrasound also spares the child...
Self-monitoring improves control of high blood pressure compared with GP monitoring alone
Allowing patients who have inadequately controlled high blood pressure to monitor their own blood pressure at home helps their GPs to optimise their management. Patients who self-monitor and visit or talk to their GP when needed for medication adjustments achieve 4mmHg lower systolic blood pressure over 12 months compared with those relying only on the measurements made by a GP without self-monitoring.
Effects are similar if patients write down their measurements to send to the GP or do so via ...
Atraumatic needles reduce headaches following lumbar puncture
Use of atraumatic needles rather than conventional needles for lumbar puncture more than halves the rate of post-procedure headache. Moreover, this improvement does not come at the expense of procedure success rates.
Lumbar puncture involves inserting a needle in the lower back into the spinal canal to collect cerebrospinal fluid for diagnosis, or to inject a treatment or anaesthetic into it.
A common side effect is a headache, often from leakage of fluid from the puncture. Atraumatic needles ...
Imaging is the only way to diagnose blood clots in pregnancy
No blood test can accurately tell if a pregnant or recently pregnant woman has a blood clot. All pregnant women with a suspected clot should continue to have imaging investigations as per current UK guidelines.
This NIHR-funded study recruited 328 pregnant or postpartum women with a suspected blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis). They had a blood test to measure the levels of 13 biomarkers, such as the D-dimer, to see if they could rule a blood clot in or ou...