TB or not TB? That is the question (and here’s the test that can answer it)

Key message: Xpert® MTB/RIF is a diagnostic test which can quickly detect TB in adults with a high degree of accuracy and without the need for laboratory facilities. It can accurately detect rifampicin resistance in adults thought to have multi-drug resistant TB, allowing treatment to be started quickly. It may be useful, too, as an add-on test after smear microscopy in smear-negative patients.

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Take a look: better diagnosis in pancreatic cancer

Key message: When CT scan shows a pancreatic or periampullary cancer that looks like it can be removed by surgery, having diagnostic laparoscopy may decrease the rate of unnecessary surgery by giving more information about whether this is likely to be so.

Pancreatic Cancer Awareness Month is drawing to a close. It’s been an opportunity for Pancreatic Cancer Action to raise awareness of a disease which is the fifth leading cause of cancer death here in the UK, where survival rates are among the worst in Europe and have not changed in over 40 years. The good news is that a new Cochrane review  from the Cochrane Upper Gastrointestinal and Pancreatic Diseases (UGPD) Group has just been published with evidence that a diagnostic technique, laparoscopy, may help to reduce the number of people undergoing surgery unnecessarily.  Continue reading

Can ‘red flags’ help clinicians diagnose vertebral fracture in patients with low-back pain?

Key message:  Based on the small number of studies included in this review, the use of many red flags to screen for vertebral fracture is not supported by the available evidence.

Many people suffer from low-back pain (LBP) and, whilst it is second only to the common cold as a cause of lost working days and can be pretty disabling, for most it is not caused by serious underlying disease. But how can clinicians identify the 1% to 5% of patients presenting with LBP who do have underlying disease (vertebral fracture, malignancy, infection or inflammatory disease) needing further investigation and treatment? Continue reading

Can signs and symptoms guide diagnosis and treatment of community-acquired pneumonia in children? A new Cochrane diagnostic accuracy review

Key message: M. pneumoniae cannot be diagnosed reliably in children and adolescents with community-acquired pneumonia based on individual clinical symptoms and signs. Although absence of wheeze is a statistically significant diagnostic indicator, it does not have sufficient diagnostic value to guide empirical macrolide treatment. Chest pain may be a clinically useful indicator but needs further evaluation.

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