Category Archives: Lab Tests & Diagnostics

Test could boost newborn cystic fibrosis screening

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Illustration of the lungs in blueBy Barbara Feder Ostrov
KHN

Stanford University scientists say they’ve devised a more accurate and comprehensive DNA test to screen newborns for cystic fibrosis, the most common fatal genetic disease in the United States.

Affecting about one in 3,900 babies born in the U.S., cystic fibrosis causes mucus to build up in the lungs, pancreas and other organs, leading to frequent lung infections and often requiring lifetime treatment for patients, whose median lifespan is 37 years.

Every state screens newborns for cystic fibrosis, but the current sequence of tests can miss cases, threatening babies’ lives.

The new method described in a recent article in The Journal of Molecular Diagnostics, promises to be more efficient and cost-effective, researchers said. It may also improve screening for non-white babies, for whom cystic fibrosis is rarer and harder to diagnose.

The new method promises to be more efficient and cost-effective and may also improve screening for non-white babies in whom cystic fibrosis harder to diagnose.

“I think this is a major advance. It offers the promise of potentially eliminating the false negative results that lead to missed cases,” said Dr. Philip Farrell, a former dean of the University of Wisconsin School of Medicine and Public Health, and a nationally-known expert on cystic fibrosis screening for newborns. “If you miss a case, you’ve got a baby out there who has a significant possibility of dying undiagnosed.”

Cystic fibrosis is caused by a defect in the CFTR gene, which regulates the movement of water and salt out of the body’s cells. In California, current genetic screens look for 40 of the most common mutations of the CFTR gene in newborns.

Yet any of the more than 2,000 known mutations in that gene could play a role in the disease, and there are likely others that have not yet been discovered.

The new test uses “next generation” DNA sequencing that can quickly and more cheaply look at the entire CFTR gene, not just selected mutations. It does not require an extra blood sample. Rather, it uses the tiny amount of blood drawn from the common newborn heel stick test that’s already used to screen for a number of diseases, including cystic fibrosis.

The researchers say this advance can enable testing labs to review many newborn samples at a time and reduce costs, allowing a technology previously used only to diagnose individual cases to be applied to a large population. Continue reading

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Heavy use of CT scans raises concerns about patients’ exposure to radiation

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(Illustration by Kai Ti Hsu for The Washington Post)

(Illustration by Kai Ti Hsu for The Washington Post)

By Sandra G. Boodman
KHN/Washington Post

Jean Hanvik decided that enough was enough.

When a painful intestinal inflammation flared in 2014, the 55-year-old benefits communications consultant balked at her doctor’s recommendation that she undergo another abdominal CT scan — her fourth in eight years.

“I’d just read about how abdominal CTs are one of the highest-risk tests [in terms of radiation exposure] and should not be repeated unless there was a major change,” said Hanvik, who lives in Minneapolis.

In the past, antibiotics and a bland diet had quelled her recurrent diverticulitis.

Hanvik said she wanted to follow that approach again but avoid a scan, which contains about 10 millisieverts (mSv) of radiation, the rough equivalent of 200 chest X-rays or 1,500 dental X-rays.

Like X-rays and PET scans, CT scans use ionizing radiation, which can damage DNA and cause cancer.

“I don’t think she appreciated my uncharacteristic behavior,” said Hanvik, adding that her primary care doctor reluctantly agreed, but made her promise to return within 48 hours if she did not improve. Hanvik got better, as she had previously.

Hanvik’s newfound assertiveness and her questions about the necessity of a CT scan reflect a growing awareness of the potential pitfalls of diagnostic imaging, which in the past two decades has exploded into a $100 billion-a-year business.

Imaging has aided diagnosis and helped many patients avoid exploratory surgery, but it has also spawned concerns about misuse. Experts cite ballooning costs, including from duplicate procedures, potential harm from the tests themselves and the overtreatment of harmless conditions found during scans.

These “incidentalomas” — so named because they are found unexpectedly — include benign lung and thyroid nodules and other common conditions that can lead to unnecessary and expensive workups as well as treatment that can cause complications.

Much of the attention has focused on computed tomography, or CT, scans, which use hundreds of X-rays to create detailed three-dimensional images that enable doctors to see things previously visible only through a biopsy or surgery.

Like X-rays and PET scans, CT scans use ionizing radiation, which can damage DNA and cause cancer. Two other imaging technologies, MRI scans and ultrasound, do not use radiation. CTs are used for a plethora of reasons, among them finding kidney stones, evaluating chest pain and detecting tumors or other abnormalities. Continue reading

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State’s disease outbreak preparedness falls short — report

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Washington Scored Five Out of 10 on Key Indicators Related to Preventing, Detecting, Diagnosing and Responding to Infectious Disease Outbreaks

MERS virus

A new report finds Washington state scored only 5 out of 10 on key indicators related to preventing, detecting, diagnosing and responding to outbreaks.

The state-by-state analysis was prepared by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF)

Twenty-eight states and Washington, D.C. scored 5 or lower out of 10 key indicators.

Five states—Delaware, Kentucky, Maine, New York and Virginia—tied for the top score, achieving eight out of 10 indicators. Seven states — Idaho, Kansas, Michigan, Ohio, Oklahoma, Oregon and Utah — tied for the lowest score at three out of 10.

The report, Outbreaks: Protecting Americans from Infectious Diseases, concluded that the United States must redouble efforts to better protect Americans from new infectious disease threats such as MERS-CoV and antibiotic-resistant Superbugs and resurging illnesses like whooping cough, tuberculosis and gonorrhea. Continue reading

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More getting mammograms under Medicaid expansion

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Doctor inspects mammogram. Photo by Bill Branson/NCI

Doctor inspects mammogram. Photo by Bill Branson/NCI

By Lynne Shallcross
KHN

If you’re a low-income woman, you’re more likely to get screened for breast cancer if you live in a state that expanded Medicaid under the Affordable Care Act than in a state that didn’t.

According to new research, low-income women who lived in a handful of early-adopter states that implemented Medicaid expansion by 2011 were 25 percent more likely to be screened for breast cancer in 2012 than women in non-expansion states.

That’s a big change from 2008, when low-income women in both sets of states had similar odds of being screened. The study was presented Monday at the annual meeting of the Radiological Society of North America. Continue reading

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Dueling recommendations about need for pelvic exams leaves women confused

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Question marksBy Sandra G. Boodman
KHN

It’s the latest battle over screening: Should healthy women skip annual pelvic exams?

controversial recommendation last year by the American College of Physicians, which represents the nation’s internists, strongly urged that doctors stop routinely performing the invasive exam on women without symptoms and who are not pregnant.

Citing 60 years of research, the ACP found no evidence that the screening, performed about 63 million times annually at a cost of approximately $2.6 billion, detects cancer or other serious conditions.

The exam, researchers reported, did cause harm: One-third of women reported discomfort, pain, embarrassment or anxiety — leading some to avoid care altogether.

For roughly 1 percent of women, a suspicious finding triggered a cascade of anxiety-provoking interventions — including tests and surgery, which carry a risk of complications for conditions that nearly always turned out to be benign.

The controversy underscores the difficulty of changing long-established clinical practice and raises questions about the role of payment in shaping physician behavior.

The American College of Obstetricians and Gynecologists (ACOG) fired back. Despite what the group acknowledged was a lack of evidence that “supports or refutes” the exam, ACOG strongly endorsed it, citing the “clinical experiences of gynecologists.”

Patients expect it, the group said, and the screening builds trust, reassures women and encourages them to discuss sensitive matters such as sexual dysfunction. A decision about whether to undergo the exam should be made by doctors and patients, ACOG concluded.

These dueling recommendations leave women in the unenviable position of sorting out what to do. Continue reading

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Buyer Beware: a mammogram’s price can vary by nearly $1,000, study finds

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Doctor views mammograms

By Jordan Rau
KHN

Thinking about getting a mammogram in the Dallas-Fort Worth area? You might check carefully because the cost can vary from $50 to as much as $1,045.

How about an initial routine gynecological exam? Around Phoenix, those prices can range from $72 to $388.

According to an analysis released Wednesday, it can pay to shop around for women’s health care, with mammograms and other routine services often costing far more in one office than in another. Continue reading

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Do workplace wellness programs lead to overtesting?

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A researcher works with a rack of test tubesBy Julie Appleby
KHN

As health insurance open season heats up for businesses across the country, many employees will discover that participating in their company’s wellness program includes rolling up their sleeves for blood tests.

Half of large employers offering health benefits have wellness programs that ask workers to submit to medical tests, often dubbed “biometrics,” that can involve a trip to a doctor’s office, lab or workplace health fair.

Will the screening exams actually improve health, or merely add to a culture of over-testing that is helping drive up the cost of health care?

While aimed at uncovering potential health risks early to head off serious and costly problems, the programs that involve those biometrics are also controversial. Will the screening exams actually improve health, or merely add to a culture of over-testing that is helping drive up the cost of health care?

So far, research is mixed on whether these programs truly save employers money. The Rand Corp. says most don’t, with the exception of programs targeted at managing specific diseases, such as diabetes. Still, Rand found that programs can help spur employees to quit smoking, get more exercise and lose a bit of weight. Continue reading

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Teamwork key to reducing diagnostic errors, report

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By Julie Appleby
KHN

Almost every American will experience a medical diagnostic error, but the problem has taken a back seat to other patient safety concerns, an influential panel said in a report out today calling for widespread changes.

Diagnostic errors — defined as inaccurate or delayed diagnoses — account for an estimated 10 percent of patient deaths, hundreds of thousands of adverse events in hospitals each year and are a leading cause of paid medical malpractice claims, a blue ribbon panel of the Institute of Medicine (IOM) said in its report.

Photo courtesy of Sanja Gjenero
Continue reading

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Feds call from more scrutiny of Coumadin use in nursing homes

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Inspectors are being asked to pay greater attention following analysis showing mistakes resulting in injuries and deaths

RedBloodCellsBy Charles Ornstein
ProPublica, Aug. 3, 2015
This story was co-published with The Washington Post.

The federal government is asking health inspectors nationwide to be on the lookout for errors by nursing homes in managing the blood thinner Coumadin, including those that lead to patient hospitalizations and deaths.

In a memo sent last month to state health departments, the Centers for Medicare and Medicaid Services cited a report by ProPublica and The Washington Post that focused on the harm caused by homes’ failure to manage the drug.

In some cases, homes gave residents too much of the drug, which caused internal bleeding. In other cases, they gave residents too little, leading to blood clots and strokes.

The analysis of government inspection reports found that, between 2011 and 2014, at least 165 nursing home residents were hospitalized or died after errors involving Coumadin or its generic version, warfarin.

In some cases, homes gave residents too much of the drug, which caused internal bleeding. In other cases, they gave residents too little, leading to blood clots and strokes. Continue reading

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Cataract surgery is fast and safe, but many patients still get costly test before their operation

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EyeBy Michelle Andrews
KHN

Requiring patients to get blood work and other tests before undergoing cataract surgery hasn’t been recommended for more than a dozen years.

There’s good reason for that: The eye surgery generally takes less time than watching a rerun of “Marcus Welby, MD” — just 18 minutes, on average.

“It’s so low risk it’s almost like saying you’re going to get your nails done.”

It’s also incredibly safe, with a less than 1 percent risk of major cardiac problems or death.

Yet more than half of Medicare patients received at least one pre-operative test in the month before undergoing surgery to remove cataracts in 2011, a recent study found. Continue reading

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Video explains panel’s new mammography recommendations

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FACTS AND MYTHS –

By the US Preventive Services Task Force

MYTH: The Task Force recommends against screening for breast cancer in women younger than 50.

FACT: Evidence shows that mammography screening can be effective for women in their 40s. Based on the science, the Task Force’s draft recommendation states that the decision to start regular mammography screening before age 50 is an individual one and should be made by a woman in partnership with her doctor. Continue reading

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