The Improving Diagnosis in Healthcare report released last year by The Institute of Medicine suggested that ‘It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences’.

Diagnostic errors may harm patients by preventing or delaying appropriate treatment, or by providing unnecessary or harmful treatment.

A conference in Melbourne next month will examine potential weaknesses in the diagnosis chain and explore strategies to reduce errors.

The 1^st Australasian Diagnostic Error in Medicine Conference brings together global leaders in diagnostic error, safety sciences, health IT, medical indemnity providers and clinicians interested in improving the speed and accuracy of diagnosis.

Incorrect results in Australian pathology laboratories are rare thanks to high quality standards set by the Commonwealth’s National Pathology Accreditation Advisory Council (NPAAC) for NATA accreditation implemented in the 1980s and continually updated.  What happens after a result has left the laboratory can have a major impact on outcomes.

Common sources of error include failed communication of results, results not being fully understood or their findings applied.

The conference’s co-convenor and Pathology Awareness Australia ambassador, Professor Roger Wilson, says an effective way to reduce risk of diagnostic errors is through clearer communication about tests.

‘Ensuring reliable and effective communication between Pathologists and referring doctors before and after examining and testing specimens is one of the most important areas to get right to best ensure patients’ safety.’

Many Pathologists and medical scientists spend a significant proportion of their working day (or night!) on the phone advising clinicians about results interpretation.

Professor Wilson says this is an opportunity to provide valuable insights on results.

‘These conversations may reveal aspects of a case that can be critically important and require clarification or further investigation. Making contact is a critical part of linking the lab to the clinicians on the ward or in the community’.

Patients generally are becoming more curious about their pathology tests and asking questions of their clinicians. Professor Wilson believes this is an encouraging phenomenon that may reduce diagnostic error.

‘Most patients don’t know what’s been ordered and what to ask their doctor, so I think if patients understand more about their tests it can be a positive thing. Patients are heavily invested in their healthcare and asking questions to their clinicians can be a useful prompt to ensure results requiring action are not overlooked’.

Talking about tests is a simple strategy to improve health literacy about pathology and reduce risks of medical mistakes.

Details of the 1^st Australasian Diagnostic Error in Medicine conference can be found here.

The post We need to talk about diagnostic errors first appeared on Know Pathology Know Healthcare.

The organization was founded in 2009 to support mito patients and their families via community activities, advocacy and education, whilst supporting research into diagnosis and treatment in the hope that this will translate into preventions and cures.

So what is mitochondrial disease?

Mitochondria are bean-shaped organelles that float freely inside almost every cell in our body. They have a double membrane – the site of various biochemical reactions, including cellular respiration – the process of converting carbohydrates, fats, and proteins into fuel for cells.

They may be small but each mitochondria requires more than 1400 genes to create it.  Mitochondrial disease (‘mito disease’ for short) is due to a fault in one or more of these genes. Since high energy organs require so many mitochondria within their cells, they are usually the first to be affected in mitochondrial disease. These include the brain, nerves, muscles, eyes, ears, heart, bowels, liver, kidney and pancreas.

Symptoms range from fatigue and weakness to developmental delays, dementia, seizures, movement disorders, blindness and gastrointestinal conditions such as indigestion.

According to recent Australian studies about 1 in 200 people will carry a mitochondrial genetic defect – nearly 120,000 Australians. Not all of these people will develop the illness but the risk of developing serious illness is about 1 in 5,000.

Given the range of organs and functions potentially affected, mitochondrial diseases are difficult to diagnose but they can be made through a combination of clinical observations, diagnostic imaging, and pathology tests including blood tests and muscle biopsies.

There is currently no cure for mito disease but there are treatments and therapies that can alleviate symptoms and slow the progression of the disease, so an accurate diagnosis is important.

The research carried out with the support of AMDF will hopefully make diagnosis easier for future patients. This month, for example, AMDF teamed up with the Australian Genomics Health Alliance to conduct genetic screening on people with suspected mito disease.

The partnership will ensure that all those with suspected mito will have access to genetic testing via a blood test and a conclusive diagnosis – without which fifty per cent of people would have been subject to inconclusive and invasive tests and potentially still no diagnosis.

To find out more about mito disease and the Foundation’s important work in helping patients, you can check out their website here.

The post A genetic defect carried by 1 in 200 people – mitochondrial disease first appeared on Know Pathology Know Healthcare.

According to figures from the Influenza Specialist Group* (ISG) there were over 100,000 laboratory confirmed cases of flu last year, which was an increase in laboratory diagnosis of almost fifty percent on the previous year, in part due to better testing.

Although flu isn’t life threatening for most people, ISG data shows it contributes to between 1,500 – 3,500 deaths a year, and vaccination is recommended for at risk groups. This includes people with underlying health conditions such as asthma or heart disease.

Pathology is the only way to diagnose flu, and this is particularly important as the symptoms are non-specific and mirror those of other conditions.

Influenza is a ‘notifiable disease’ meaning that diagnosed cases are recorded on the National Notifiable Diseases Surveillance System. The data is provided directly from the pathology laboratories that make the diagnosis.

Most people who contract the flu will get better at home but a minority of people will get sick enough to visit their doctor or even need admission to hospital.

Initial pathology testing is important to ensure that flu is the cause of symptoms. Further testing can also ascertain any secondary infection the patient may have, such as bacterial pneumonia or staphylococcus infection, which would require antibiotic treatment.

The flu virus is detected using a method known as Polymerase Chain Reaction (PCR) where the sample is processed in a thermocycler machine that makes lots of copies of the flu virus RNA (genetic make up) which is then examined.

Samples may also be sent for more detailed testing to isolate the specific type of flu virus. This information is sent from hospital laboratories to the World Health Organisation’s (WHO) reference centre located in Melbourne.

Although many flu cases will be diagnosed in hospitals, in some instances General Practitioners will also order flu tests, particularly if they are part of a surveillance network.

These surveillance networks help to monitor trends, including the instance of flu in the community and the severity of symptoms, by testing patients with flu-like symptoms.

As well as being provided to state and federal health departments this data will also be provided to the WHO.

The RNA of the flu virus mutates quickly and new strains can appear from year to year, which means that the flu vaccine must be reviewed each year to keep up with the virus and continue offering protection.

The data provided by Australian hospitals and GPs is combined with other global data and used by the WHO to help develop the vaccine for the following year.

Any new strains emerging will be catalogued and named. Flu viruses are categorised into A and B as they have different characteristics, for example influenza B strains do not circulate in animals.

New strains are usually named after the place where they appeared, hence this year’s quadrivalent (QIV) flu vaccine, protects against four strains of the flu;

• A/California
• A/Hong Kong
• B/Brisbane
• B/Phuket

Despite the exotic destination names, anyone catching one of these will most likely be staying in bed.

* http://www.isg.org.au/index.php/media/flu-fact-sheet/

^{Image of influenza under microscope: http://www.who.int/influenza/gisrs_laboratory/en/}

The post California, Hong Kong or Brisbane; where are you headed this flu season? first appeared on Know Pathology Know Healthcare.

She’d turned 40 just months earlier and was in a “good place” with her health, fitness and family. So when she noticed a hint of dull, “dusty pink” blood on her toilet paper one day — with no other symptoms — she didn’t think to act on it. Even when she eventually went to have it checked out, Deb was sure nothing was wrong, and her doctor was equally unconcerned.

“She said, ‘We’ll just do a stool test… you’re pretty fit and healthy and young so it’s probably nothing sinister, but we’ll just check it out anyway’,” the mum of two recalls.

This test detected a small amount of blood, so Deb was referred to a surgeon at her local hospital on the NSW south coast who put her on the waiting list for a colonoscopy. It was at this point she began to notice more blood.

“I started to worry, but I still didn’t feel sick. I still didn’t feel off. Like, my bowels were normal and I didn’t feel unwell in the slightest,” she recalls.

Deb ended up booking in at a private clinic in a nearby town to speed up the process. When she awoke from the colonoscopy, Deb was told her symptoms had most likely been caused by polyps, but that she would receive her test results the following week.

However, within days she was back in her GP’s office receiving some unthinkable news. “[My doctor] was very apologetic, very upset. She couldn’t even tell me… she’s just pushing this pathology result in front of me saying, ‘You read it’,” Deb, now 43, says.

Her own reaction was one of shock, and worry for the future of her daughters Kelsey, 20, and Stevie-Rae, 16.

“My first thought was how hard this is going to be for them. I felt like my life was over… To me it was a death sentence,” she recalls.

“You know when you watch a movie and they show when someone gets told they get cancer and everything around them goes hazy and muffled? That’s exactly what happened.”

Fortunately, after four surgeries and six gruelling months of chemotherapy, a scan revealed Deb was “all clear” and that her cancer hadn’t grown back. Three years on, she knows all too well the role her stool test, colonoscopy and regular blood tests played in her diagnosis and treatment.

Deb knows exactly how easy it is to be deterred from having screening tests in the first place. Some of them, like a faecal occult blood test, can be off-putting.

Pathology Awareness Australia (PAA) is currently on a mission to raise understanding of the importance of pathology; as its Chair John Crothers points out, 100 per cent of cancer diagnoses and 70 per cent of all clinical diagnoses are based on pathology services.

“The critical role of healthcare is early intervention, early diagnosis or even prevention overall. Pathology is central to that,” he explains.

Three years on from her cancer diagnosis, Deb is doing her own bit to increase awareness of the role of pathology in early diagnosis. She now works with the Jodi Lee Foundation, a leading bowel cancer awareness charity, using her experience to raise funds and spread an important message about screening.

“For me, it’s about teaching people in my own little community that you have to look after your bowel. I said this at a trivia night last year — ‘If I didn’t look at my toilet paper when I went to the toilet, I may not be here today’,” she says.

“People go, ‘Oh, I can’t look at that, that’s disgusting,’ and I get that it is, but it saved my life.”

This is an edited version of an article from The Glow 17th February 2016 – read the original source here: http://www.theglow.com.au/health/pathology-bulk-billing-incentive/

The post Why paying attention to her toilet movements saved Deb Weeks’ life first appeared on Know Pathology Know Healthcare.