Early Diagnosis and Personalised Care

Theme Leads:  Dr Andrew Lewington and Dr Kerrie Davies

Background

Early diagnosis of complications from surgery will improve patient outcomes, minimising expensive remedial treatments and increasing quality of life and survival.

In the context of ambitious national targets (e.g., NHS Long Term plan) and the NHS workforce crisis, efforts are focused on identifying individuals or groups who are most at risk and most likely to benefit from additional tests/treatment. Research efforts should be focused on innovations that meet a clear unmet clinical need, target underserved groups, have the potential to be easily implemented within routine clinical practice, and are cost-effective.

Our work on early modelling, target product profiles, adaptive trial designs, and comparative technology evaluations provides an innovative methodology platform for improving the efficient evaluation and adoption of new technologies. We have enhanced our IVD expertise during the pandemic, notably working closely with NHSE, Test and Trace, UKHSA, MHRA and industry on the design and assessment of novel infection IVDs.

 

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Areas of Focus

Sepsis: Clinical decision making is hampered by slow diagnostic methods, such as blood cultures. There is an NHS England drive to improve the blood culture pathway with rapid differentiation of bacterial from viral infection speeding up clinical decision making and timely antimicrobial susceptibility testing to guide appropriate therapy.  Acute Kidney Injury (AKI) is a common sequalae of sepsis, affecting 50% – 70% of critically unwell patients and is associated with adverse outcomes, including long term chronic kidney disease and increased mortality. Early identification of patients at risk of progression to severe AKI or persistent AKI is critical and applying novel diagnostic assays and predictive models are key to improving outcomes.

Urinary tract infections (UTIs): tests available at the point of care (POC) to accurately diagnose UTIs are lacking, as are the rapid antimicrobial susceptibility tests (ASTs) to help guide appropriate antimicrobial therapy. Such tests currently take >18 hours with delays from collecting the sample and shipping to the laboratory, meaning that these laboratory-based tests often have little impact as empirical treatment has already been started. This delay can have long-term consequences.  Accurate POC tests would speed up diagnosis of infection leading to more timely treatment with better preservation of kidney function. They would address the problem of AKI becoming one of the top five causes of premature death by 2040.

Kidney transplantation: there is a huge variation in access to kidney transplant surgery with respect to gender, age and ethnicity and this is partly due to lack of robust diagnostic tests for risk stratification and often overcautious approaches resulting in delay or denial to access.  We will have a particular focus on tackling disparities in access to diagnosis and treatment, particularly in the community setting. Through our current community and patient and public involvement events, we are building relationships with them towards inclusive research activities.