Future mental health care may include diagnosis via brain scan and computer algorithm

 Most of modern medicine has physical tests or objective techniques to define much of what ails us. Yet, there is currently no blood or genetic test, or impartial procedure that can definitively diagnose a mental illness, and certainly none to distinguish between different psychiatric disorders with similar symptoms. Experts are combining machine learning with brain imaging tools to redefine the standard for diagnosing mental illnesses.

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Psychiatric diagnosis 'scientifically meaningless'

A new study, published in Psychiatry Research, has concluded that psychiatric diagnoses are scientifically worthless as tools to identify discrete mental health disorders. Read ScienceDaily article here

New NICE guideline [NG99] Brain tumours (primary) and brain metastases in adults

New NICE guideline [NG99] Brain tumours (primary) and brain metastases in adults


Published date: July 2018    


This guideline covers diagnosing, monitoring and managing any type of primary brain tumour or brain metastases in people aged 16 or over. It aims to improve diagnosis and care, including standardising the care people have, how information and support are provided, and palliative care.


For full guidance
https://www.nice.org.uk/guidance/ng99           

New NICE Diagnostics guidance DG32 Adjunctive colposcopy technologies for assessing suspected cervical abnormalities

NICE Diagnostics guidance [DG32] Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: the DYSIS colposcope with DYSISmap and the ZedScan I.
Published date: April 2018. Next review: April 2021                


This guidance replaces the NICE diagnostics guidance on adjunctive colposcopy technologies for examination of the uterine cervix – DySIS and the Niris Imaging System (DG4) and the NICE medtech innovation briefing on ZedScan as an adjunct to colposcopy in women with suspected cervical intra‑epithelial neoplasia (MIB20).


Read full guidance at: https://www.nice.org.uk/guidance/dg32

Lyme disease [NG95]

New: Guidance


This guideline covers diagnosing and managing Lyme disease. It aims to raise awareness of when Lyme disease should be suspected and ensure that people have prompt and consistent diagnosis and treatment. It does not cover preventing Lyme disease.


https://www.nice.org.uk/guidance/ng95

Pancreatic cancer in adults: diagnosis and management [NG85]

New: Nice Guideline


This guideline covers diagnosing and managing pancreatic cancer in adults aged 18 and over. It aims to improve care by ensuring quicker and more accurate diagnosis, and by specifying the most effective treatments for people depending on how advanced their cancer is.

1.1 Diagnosis

1.2 Specialist pancreatic multidisciplinary teams

1.3 Staging

1.4 Psychological support

1.5 Pain management

1.6 Nutritional management

1.7 Relieving biliary and duodenal obstruction

1.8 Managing resectable and borderline resectable pancreatic cancer

1.9 Managing unresectable pancreatic cancer

NIHR Signal Blood test reduces mortality and shortens antibiotic use among adults with chest infection

It may be feasible to use procalcitonin blood levels to guide antibiotic treatment for adults in hospital with a suspected chest infection. By measuring procalcitonin, an indicator of bacterial infection, clinicians could review their diagnosis earlier.


This reduced antibiotic exposure by 2.5 days with fewer adverse effects and also less mortality. About 14 extra people in every 1,000 who had their management guided by the blood test would be expected to survive the first month, compared with those receiving standard care without this test.


From the NIHR Dissemination Centre

Age-related macular degeneration [NG 82]

New:  NICE guideline

1.1 Classifying age-related macular degeneration

1.2 Information and support

1.3 Risk factors

1.4 Diagnosis and referral

1.5 Pharmacological management of AMD

1.6 Non-pharmacological management of AMD

1.7 Monitoring AMD

Terms used in this guideline

World leading cancer dataset shows improvements in diagnosis

Routes to Diagnosis now includes 10 years’ worth of data, covering more than 3 million cancer cases, making it the most comprehensive diagnosis of its kind in the world.
The data shows a dramatic improvement in the way some cancers are being diagnosed across England, but also pinpoints areas where improvements could still be made.http://www.ncin.org.uk/publications/routes_to_diagnosis

Diagnostic Assessment of Deep Learning Algorithms for Detection of Lymph Node Metastases in Women With Breast Cancer

JAMA. 2017 Dec 12;318(22):2199-2210. doi: 10.1001/jama.2017.14585.

In the setting of a challenge competition, some deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. Whether this approach has clinical utility will require evaluation in a clinical setting.
UHCW Research: Rajpoot N

Breast screening: interval cancers and duty of candour toolkit

Guidance from Public Health England on the role of breast screening and symptomatic services in identifying interval cancer and giving results to female patients.

Diagnosis of displaced scaphoid fractures

Chapter in book Scaphoid fractures: evidence-based management.

UHCW Research: Kanai Garala

Psychologist examines methods of classifying mental disorders

A new article presents the challenges in using three major diagnostic manuals from a scientific perspective and offer some recommendations for re-conceptualizing the mental disorders they describe. Click here for ScienceDaily article

European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency

Eur Respir J. 2017 Nov 30;50(5). pii: 1700610. doi: 10.1183/13993003.00610-2017

α1-antitrypsin deficiency (AATD) is the most common hereditary disorder in adults. It is associated with an increased risk of developing pulmonary emphysema and liver disease. The pulmonary emphysema in AATD is strongly linked to smoking, but even a proportion of never-smokers develop progressive lung disease. A large proportion of individuals affected remain undiagnosed and therefore without access to appropriate care and treatment.The most recent international statement on AATD was published by the American Thoracic Society and the European Respiratory Society in 2003. Since then there has been a continuous development of novel, more accurate and less expensive genetic diagnostic methods. Furthermore, new outcome parameters have been developed and validated for use in clinical trials and a new series of observational and randomised clinical trials have provided more evidence concerning the efficacy and safety of augmentation therapy, the only specific treatment available for the pulmonary disease associated with AATD.As AATD is a rare disease, it is crucial to organise national and international registries and collect information prospectively about the natural history of the disease. Management of AATD patients must be supervised by national or regional expert centres and inequalities in access to therapies across Europe should be addressed.

UHCW Research: Parr, D

Non-invasive Diagnosis of Pancreatic Cancer Through Detection of Volatile Organic Compounds in Urine

Gastroenterology, 2017, doi.org/10.1053/j.gastro.2017.09.054.

UHCW Research: Ramesh Arasaradnam

Cystic fibrosis: diagnosis and management [NG78]

New Guidance from NICE:

This guideline covers diagnosing and managing cystic fibrosis.  It specifies how to monitor the condition and manage the symptoms to improve quality of life. There are also detailed recommendations on treating the most common infections in people with cystic fibrosis.

This guideline includes recommendations on:

• diagnosis
• service delivery, including how to organise services and multidisciplinary teams
• annual and routine reviews
• monitoring, assessment and management, including for lung disease, pulmonary infection, distal intestinal obstruction syndrome, liver disease and cystic-fibrosis-related diabetes
• preventing cross-infection

The evidence base for circulating tumour DNA blood-based biomarkers for the early detection of cancer: a systematic mapping review

BMC Cancer. 2017 Oct 23;17(1):697. doi: 10.1186/s12885-017-3693-7

The presence of circulating cell-free DNA from tumours in blood (ctDNA) is of major importance to those interested in early cancer detection, as well as to those wishing to monitor tumour progression or diagnose the presence of activating mutations to guide treatment. In 2014, the UK Early Cancer Detection Consortium undertook a systematic mapping review of the literature to identify blood-based biomarkers with potential for the development of a non-invasive blood test for cancer screening, and which identified this as a major area of interest. This review builds on the mapping review to expand the ctDNA dataset to examine the best options for the detection of multiple cancer types.

UHCW Research: Kikuchi H

Clinical radiology UK workforce census 2016 report

Key findings of the Clinical radiology UK workforce census 2016 report include;

• Nearly one-in-ten UK radiologist posts (8.5%) were vacant during 2016, nearly two-thirds of which (61%) were unfilled for a year or more
• The need for scans continues to grow. In England from 2013-16 the number of computed tomography (CT) and magnetic resonance imaging (MRI) scans respectively rose by more than 30% - three times more than the rate of workforce growth. Technological advances mean that these scans are more complex than ever before and take longer to interpret
• The high proportion of retirements versus new consultant numbers means the UK’s radiologist workforce will expand by just 1% year-on-year
• Last year, only 3% of NHS imaging departments were able to report all their patient scans within normal working hours
• The NHS spent nearly £88 million in 2016 paying for backlogs of radiology examinations to be reported – the same amount could have paid for at least 1,028 full-time consultants

Changes to cancer waiting times system and dataset

NHS England is planning changes to the cancer waiting times (CWT) system and dataset, which will come into effect from April 2018.

The changes are part of a programme of work to implement the new 28 day faster diagnosis standard by 2020. The CWT system enables CCGs to monitor and manage pathways of care for cancer patients. An information standards notice published on 28 September sets out the forthcoming changes, and an updated guidance document for CWT standards will be published later this year.

Refining the diagnostic criteria of the postural orthostatic tachycardia syndrome (POTS) using power spectral indices

EP Europace, Volume 19, Issue suppl_1, 1 October 2017, Pages i12

Postural orthostatic tachycardia syndrome (POTS) is characterised by frequent symptoms and rise in heart rate of ≥ 30bpm within 10min of standing, in absence of significant orthostatic hypotension. Clinical evaluation of patients with suspected POTS includes detailed history and non-invasive investigations such as head-up tilt (HUT). The pathophysiology of POTS remains ill-understood, but increased sympathetic expression may cause the multitudinous symptoms. Heart rate (HR) and blood pressure (BP) variability characterise the sympathovagal balance. High frequency (HF) reflects vagal tone and low frequency (LF) and LF/HF ratio reflect sympathetic tone and sympathovagal balance. We investigated autonomic responses of POTS patients to HUT and compare them with negative controls (NEG) and vasovagal syncope (VVS) patients.

UHCW Research: S. Hayat,