Limitations of inflammatory marker testing

Inflammatory marker testing, such as CRP, ESR, and plasma viscosity, is used to diagnose and monitor various inflammatory and infective conditions, and cancers. Watson and colleagues at the Universities of Bristol and Exeter studied inflammatory markers in almost 140,000 patients registered with the Clinical Practice Research Datalink, assessing their diagnostic value, and providing important conclusions and recommendations. Testing multiple inflammatory markers simultaneously does not increase their ability to rule out disease, and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first line test. An additional report shows that inflammatory markers have poor sensitivity and should not be used as a rule-out test. False-positives are common, and lead to increased follow-on GP consultations, tests, and referrals.

Double jeopardy of heart disease

Patients with heart and circulatory diseases face additional problems because they are vulnerable to more non-cardiac conditions, according to a Dutch study involving almost a quarter of a million patients. Buddeke and colleagues from Utrecht University found that patients with heart failure, ischaemic heart disease, vascular disease, and stroke are more likely to have a number of other significant medical problems, including visual impairment, depression, diabetes, asthma, and COPD. This may be partly due to these conditions sharing similar risk factors, such as smoking, lipid problems, and obesity. The researchers point out that the coexistence of these conditions needs to be considered when planning chronic disease management programmes for patients with cardiovascular disease, and also in designing research studies investigating new treatments.

GP training may need to change

A detailed study of GPs in training found that, although newly-qualified GPs have reasonable confidence in their clinical skills, they are often unprepared for the realities of work in group practices or partnerships, and unfamiliar with wider NHS structures. Spooner and colleagues at the University of Manchester found that many GPs in training report being used as ‘triage monkeys’ and ‘rota pluggers’ in their hospital posts, where training may be inappropriate. Practice-based training is generally highly regarded – described by participants as ‘brilliant’ and ‘world class’ – although some wanted more involvement in practice administration and meetings. These concerns have been identified before, but the message is important: in the present recruitment and retention crisis, GP training schemes need to reflect the changing working patterns of young GPs, who need to be better prepared and more confident in taking on their new roles.

Giving patients USB technology improves prescribing safety

One in five patients experience an adverse event within 3 weeks of discharge from hospital back to the community. Medication error is a major cause of these adverse events and is potentially preventable. In an exploratory study conducted in Cork, Ireland, Walsh and colleagues have shown that giving patients a secure device using USB technology which allows sharing of their clinical and prescribing information between primary and secondary care, resulted in significantly fewer errors, including a complete absence of error relating to patient information data, legibility of prescriptions, and drug quantities. The technology appeared to work well with existing hospital and GP data systems, and the authors recommend a large-scale evaluation which will also include patients bringing the device with them at the time of hospital admission.