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2018 ; 18
(1
): 18
Nephropedia Template TP
gab.com Text
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Clinical utility of a non-invasive urine test for risk assessing patients with no
obvious benign cause of hematuria: a physician-patient real world data analysis
#MMPMID29523118
Lough T
; Luo Q
; Luxmanan C
; Anderson A
; Suttie J
; O'Sullivan P
; Darling D
BMC Urol
2018[Mar]; 18
(1
): 18
PMID29523118
show ga
BACKGROUND: The non-invasive Cxbladder urine test system has demonstrated
clinical utility in ruling out urothelial carcinoma (UC) in patients with
asymptomatic microscopic hematuria (AMH), suggesting that the number of invasive
diagnostic tests, including cystoscopy, used in this patient population may be
reduced by Cxbladder testing prior to conducting a full urological work-up. The
aim of this study was to demonstrate the enhanced clinical utility of
communicating objective information on diagnostic decisions made by individual
physicians on individual patients with AMH. METHODS: Three hundred ninety-six
physician-patient decisions were generated from twelve participant physicians
evaluating real world case notes from the same 33 patients presenting with AMH.
Each physician reviewed and recommended diagnostic tests and procedures based on
each patient's referral data and then re-evaluated their clinical recommendation
following disclosure of the non-invasive Cxbladder urine test result. Changes
assessed were the total number of requested diagnostic procedures and the number
of invasive procedures, including cystoscopy, following addition of information
from Cxbladder in the Triage and Triage and Detect modalities. RESULTS:
Physicians made significant changes to their diagnostic behavior for patients
with AMH when presented with Cxbladder test results, including a reduction in the
number of total and invasive procedures including cystoscopy for individuals
identified as having a low probability of UC. The intensity of investigation was
targeted and increased, including use of total procedures and cystoscopy, for
patients identified by Cxbladder tests as having a high probability of UC:
urologists increased the level of investigation for both total procedures and
invasive procedures. The outcome resulted in patients with a high risk of UC
receiving appropriate guideline-recommended invasive diagnostic tests. Patients
who tested negative were offered fewer and significantly less invasive
procedures. This change in physician behavior results in an increased clinical
and patient utility, lower risk of missed UC and invasive test-related harm
incidents. CONCLUSIONS: This study demonstrated the potential for increased
clinical resolution and significantly enhanced patient management, when
physicians consider Cxbladder test results in their clinical evaluation. The
change in physician behavior led to more appropriate diagnostic procedure
selection and resource allocation to the benefit of both patients and healthcare
systems.