Publications by authors named "Jennifer Nobes"
Aim: Since December 2015, a faecal immunochemical test (FIT) has been provided to primary care in NHS Tayside as an adjunct to clinical acumen in the assessment of new-onset bowel symptoms. The aim of this work was to assess the impact of this approach on time to diagnosis of colorectal cancer (CRC).
Method: NHS Tayside Cancer audit data from January 2013 to December 2019 were reviewed to identify all CRC patients diagnosed via the primary-care referral pathway for a period before and after the introduction of FIT.
Background & Aims: In community pathways for detection of liver disease the most common reason for referral is fibrosis assessment. We investigated the impact of adding the Enhanced Liver Fibrosis (ELF) score as a second-line test (subsequent to an indeterminate or high Fibrosis-4 index [FIB-4] and/or non-alcoholic fatty liver disease fibrosis score) to guide referral and prognostication in our multi-aetiology pathway.
Methods: Patients with ELF results from the intelligent Liver Function Testing (iLFT) pathway were recruited.
Article Synopsis
- The intelligent Liver Function Testing (iLFT) pathway is an innovative system that uses algorithms to automate liver function tests and provide feedback on abnormal results, implemented in NHS Tayside since August 2018.
- It was introduced to address the high number of abnormal LFTs that often went uninvestigated, amid increasing deaths from chronic liver disease.
- The iLFT has been utilized over 11,000 times in its first three years, and the study discusses its development, impact on diagnostic services, and potential for future 'intelligent' medical investigations.
Introduction: Adults aged 70 years and over account for almost 60% of colorectal cancer (CRC) diagnoses in the United Kingdom. Whilst emergency presentation of CRC is known to be associated with poorer outcomes across all ages, older adults are less likely to be treated with curative intent and have poorer overall survival (OS). We aimed to investigate whether presentation, management, or outcome differed in older (≥70 years) versus younger (<70 years) adults in our population.
View Article and Find Full Text PDFArticle Synopsis
- The study assessed the impact of faecal immunochemical testing (FIT) on colorectal cancer (CRC) diagnosis in NHS Tayside since its introduction in 2015.
- A review of cancer audit data from 2016 to 2019 showed that 75.7% of primary care patients diagnosed with CRC underwent FIT prior to referral, with an increase in FIT usage over the years.
- While FIT triage led to a higher rate of non-emergency presentations for CRC, it did not affect the stage at which the cancer was diagnosed.
Background: Thrombocytosis is often an incidental finding in primary care with a range of causes. Despite evidence of a strong association between thrombocytosis and malignancy, guidelines for investigating thrombocytosis in the absence of red flag symptoms remain unclear. A novel automated system of laboratory analysis, intelligent Liver Function Testing (iLFT), launched in Tayside in 2018 and has identified a patient group with thrombocytosis and abnormal liver test (LFT) results.
View Article and Find Full Text PDFChronic liver disease (CLD) is a significant health problem affecting millions of people worldwide. In Scotland, CLD is a major cause of premature mortality. Liver function tests (LFTs) are a panel of frequently requested blood tests which may indicate liver disease.
View Article and Find Full Text PDFBackground: Patients in whom a diagnosis of pulmonary embolism (PE) is suspected and whose D-dimers are elevated frequently require CT pulmonary angiogram (CTPA) for diagnosis. Because D-dimer rises with age, an age-adjusted D-dimer threshold may prevent unnecessary radiation exposure from CTPA in older patients.
Objective: To determine the efficacy and safety of implementing an age-adjusted D-dimer threshold to exclude PE.