Early diagnosis and detection – Birmingham Health Partners

Launch of new international medical code for presymptomatic type 1 diabetes

Written by Louise Stanley on 17/04/2024. Posted in Early diagnosis and detection, Inflammation and chronic disease.

Researchers at BHP founder-member the University of Birmingham have partnered with NHS England to produce a diagnostic code tailored for individuals in the early phases of type 1 diabetes, enhancing patient prospects for timely healthcare and access to cutting-edge treatments.

Today marks the introduction for a new SNOMED CT code specifically for presymptomatic type 1 diabetes, which will be integrated into the standardised and multilingual set of clinical healthcare terminology. SNOMED codes are crucial in electronic health records, being used to identify a person’s underlying medical conditions. This system acts as the most precise and extensive list in clinical health terminology globally.

Type 1 diabetes progresses gradually through three stages, with the initial two stages termed presymptomatic type 1 diabetes. Individuals in this phase exhibit biological markers, or autoantibodies, indicating the onset of the immune attack that targets insulin-producing beta cells. Given the absence of symptoms, detection relies heavily on screening initiatives such as the ELSA study, a trial led by Professor Parth Narendran at the University of Birmingham, screening children for type 1 diabetes. Screening initiatives such as these will allow for early identification.

Lauren Quinn, who co-leads the ELSA study and assisted in the development of the of the SNOMED code, commented: “The introduction of this SNOMED code facilitates clinical care and follow-up for individuals with presymptomatic type 1 diabetes. It also allows researchers to identify people who could benefit from novel therapies to delay the onset of type 1 diabetes and recruit them to clinical trials of immunotherapies.”

“This will transform type 1 diabetes research by fast-tracking recruitment, unravelling how the condition develops and progresses, and bringing us closer to licensed disease-modifying treatments in type 1 diabetes.”

Dr. David Shukla, a GP and Clinical Research Fellow involved in code development, highlighted its practical implications: “The inclusion of a code for the diagnosis of presymptomatic type 1 diabetes will highlight to healthcare professionals involved in their care the individuals who are at high risk of developing type 1 diabetes. This will help ensure that when these people progress and develop symptomatic type 1 diabetes, it will be picked up and treated at a much earlier stage.”

“This reduces the risk of them presenting or being diagnosed late and developing diabetic ketoacidosis, an emergency complication of type 1 diabetes that can be fatal. This timely pick up and initiation of prompt treatment will lead to substantial improvements in their diabetes and future care.”

Hilary Nathan, Director of Policy and Communications at JDRF UK, added: “This recognition of presymptomatic type 1 diabetes with a SNOMED code is a crucial step towards the implementation of population screening programmes for early detection of type 1 diabetes. Early detection leads to short and long-term health benefits, improved quality of life and cost savings for healthcare providers.”

“The new code will unlock better monitoring, follow-up and education for people in the earliest stages of type 1. It will also help facilitate recruitment into clinical trials of emerging treatments, enabling people developing type 1 diabetes to access therapies that have the potential to claw back valuable time free from the burdens of type 1 diabetes management.”

The code for type 1 diabetes in SNOMED is ‘Diabetes mellitus type 1 – 46635009’. The new code presymptomatic type 1 diabetes, known as ‘‘Presymptomatic diabetes mellitus type 1 – 1290118005′, has now been introduced for inclusion in individuals’ electronic health records.

These codes are now part of the ‘Health conditions’ category in the NHS app, allowing individuals and their families to access them as well.

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New Inflammatory Bowel Disease testing protocol could speed up diagnosis

Written by Louise Stanley on 17/04/2024. Posted in Early diagnosis and detection, Inflammation and chronic disease.

Patients with suspected inflammatory bowel disease (IBD) could benefit from improved testing protocols that could reduce the need (and lengthy wait) for potentially unnecessary colonoscopies, a new study has found.

In a paper published in Frontline Gastroenterology, researchers from the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC) tested a new protocol to improve IBD diagnosis combining clinical history with multiple home stool tests.

In the two-year study involving 767 participants, patients were triaged and had repeated faecal calprotectin (FCP) tests. The research team found that the use of serial FCP tests were able to strongly predict possible IBD as well as Crohn’s Disease and Ulcerative Colitis, and observed that a second FCP test was a strong indicator of a potential need for further investigation including colonoscopy; although the researchers observed that only 20% of patients had two samples submitted prior to referral to secondary care.

Dr Peter Rimmer from the NIHR Birmingham Biomedical Research Centre and corresponding author of the study said: “Patients who experience symptoms associated with inflammatory bowel diseases often have a long wait until getting a diagnosis, and current testing is under immense strain.

“Using a comprehensive 13-point symptom checker and multiple FCP tests, we have been able to identify much more accurately patients who had IBD and other diseases. The rollout of this protocol could reduce the time taken to get a diagnosis and start treatment for IBDs as much more of the screening and testing can be done through primary care. The sensitivity of multiple FCP tests can be used to flag those patients who urgently need referral into secondary care.”

Dr Rachel Cooney, Consultant Gastroenterologist at University Hospitals Birmingham NHS Foundation Trust, researcher at the NIHR Birmingham BRC and co-author of the study, added: “In its simplest form, this study may help improve referral triage for IBD patients.

“But as we plan new care pathways, it could open up new exciting possibilities: with the growing availability of home FCP testing, these tests’ results combined with simple symptom questionnaires could feed into algorithms that allow patients to self-refer to secondary care services, reducing strain on primary care.

“This is something we’re going to explore in a large follow-up study we’re currently initiating.”

The NIHR Birmingham Biomedical Research Centre is hosted by BHP founder-member University Hospitals Birmingham NHS Foundation Trust in partnership with fellow BHP founder-member the University of Birmingham. Its roster of partner organisations also includes BHP members Birmingham Women’s and Children’s NHS Foundation Trust; Sandwell and West Birmingham NHS Trust; and Aston University.

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Objective biomarker test could predict heart disease risk for patients with common arrhythmia

Written by Louise Stanley on 13/04/2024. Posted in Early diagnosis and detection, Inflammation and chronic disease.

Patients with atrial fibrillation (AF) – a common heart arrhythmia – could have one blood test to assess their risk of cardiovascular events in the following five years, new research has found.

Published in Cardiovascular Research and presented at the Frontiers in CardioVascular BIology Congress 2024 conference in Amsterdam, the research suggests that a blood-based biomolecule test alone could assess the risk of having a cardiovascular event in the next five years.

The study of 1,586 AF patients found that a cluster of high-risk patients who recorded high levels of 13 biomolecules had five times more cardiovascular events than those in the low-risk cluster.

Professor Larissa Fabritz, from the Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf and an Honorary Professor at BHP founder-member the University of Birmingham said: “These validated findings show that one blood test could be used to help predict the risk of cardiovascular events for patients with atrial fibrillation, helping to differentiate healthcare where it’s most needed. Through a further validation study carried out in Birmingham, we are confident that the blood test can give a useful understanding of those in greatest need of interventions to avoid strokes, acute heart failure and death.”

The international team developed a profile of 13 specific biomarkers that were used to differentiate risk in atrial fibrillation. Using samples from AF patients, they analysed likely target biomarkers and through the trial and validation in the Birmingham BBC-AF registry found that a combination of elevated biomarkers corresponded with risk variation in patients.

The findings are taken from a subset of the EAST – AFNET 4 (Early Treatment of Atrial Fibrillation for Stroke Prevention) trial which demonstrated that early rhythm control – with antiarrhythmic drugs or atrial fibrillation ablation – delivered within one year after AF diagnosis improves outcomes in 2,789 patients with early AF and cardiovascular risk factors compared to usual care (UC) over a 5-year follow-up time.

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Birmingham scientists win funding to develop ‘lollipops’ for mouth cancer diagnosis

Written by Louise Stanley on 22/03/2024. Posted in Cancer outcomes, Early diagnosis and detection.

A ‘lollipop’ that can diagnose mouth cancer early could become a reality, thanks to a pioneering project funded by Cancer Research UK and the Engineering and Physical Sciences Research Council (EPSRC).

Scientists at BHP founder-member the University of Birmingham have been awarded £350,000 over the next three years to develop a prototype flavoured ‘lollipop’ from a material called a smart hydrogel.

Smart hydrogels – previously developed by the University’s Dr Ruchi Gupta and her team – work a bit like a fishing net: they absorb large quantities of water while ‘catching’ larger molecules, such as proteins. The ‘net’ can then be cut open to release the larger molecules for analysis in the lab. The idea is that patients suck on the lollipop, transferring a saliva sample into the hydrogel. Scientists can then release the ‘caught’ proteins by blasting the hydrogel with UV light and then analyse the liquid for saliva proteins which indicate the early stages of mouth cancer.

Around 12,400 people are diagnosed with cancers of the head and neck in the UK every year*. Currently, diagnosing mouth cancer can involve putting a flexible camera on the end of a tube through the nose or mouth and taking a biopsy for testing. This procedure is invasive, time-consuming and requires an endoscopist.

Mum of five, Rachel Parsons, needed a biopsy after being referred to Coventry University Hospital with a lump on her cheek in 2008. She admits she was unprepared for the procedure which, in her case, turned out to be painful.

“I had no idea what a biopsy really was,” said Rachel, from Coventry. “I had the kind of injection you get at the dentists and, when it wore off, it was really sore because I’d needed stitches.”

That was just the beginning of a 12-month nightmare for Rachel who ended up needing a nine-and-a-half-hour operation to remove a cancerous tumour from her cheek and replace the skin with tissue and veins from her forearm.

“The thought of putting a lollipop round your mouth instead of having a biopsy in the first instance is amazing,” said Rachel who has spent years as a patient ambassador, campaigning for more awareness of mouth cancer. “I wish something like that had existed when I was diagnosed.”

Dr Ruchi Gupta, Associate Professor of Biosensors at the University of Birmingham, said she was thrilled to receive funding to begin the next phase of the project: “Smart hydrogels have really exciting potential for diagnosing mouth cancer,” she said. “They can be easily moulded into shapes as a solid to ‘catch’ proteins in saliva.

“We’re really excited to start the next phase of this project. We’re hoping that we can be the first to make a device which is much kinder for diagnosing mouth cancer for patients and easier for GPs to use.”

Rachel, who still has numbness around her face and can’t open her mouth wide enough to eat a burger, added: “I’m so grateful for the research and treatment that saved my life. Things have improved immensely since then but what’s happening now could be absolutely brilliant for people diagnosed in future.”

Executive Director of Research and Innovation at Cancer Research UK, Dr Iain Foulkes, said: “Biopsies and nasoendoscopy are the gold standard for diagnosing mouth cancer, but it requires great skill to carry out and can feel unpleasant for patients. We want an accurate, faster and kinder alternative test which can help us diagnose cases of mouth cancer sooner.

“This project is an exciting first step towards an entirely new way to identify mouth cancers earlier. Research like this is guiding us towards a future where people can live longer, better lives, free from the fear of cancer.”

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Revolutionising diagnosis and management of cartilage tumours

Written by Louise Stanley on 15/03/2024. Posted in Cancer outcomes, Early diagnosis and detection.

The musculoskeletal radiology department at BHP member the Royal Orthopaedic Hospital (ROH) has developed a new website designed to enhance the diagnosis and management of cartilage tumours.

bactip.co.uk is a platform that equips healthcare professionals with the tools and knowledge to navigate the complexities of central cartilage tumours. By offering drawings and real case examples, it serves as a valuable resource for interpreting musculoskeletal radiology imaging findings related to these tumours, ensuring their accurate and consistent reporting. Developed collaboratively by experts in the field, bactip.co.uk offers an approach for assessing, diagnosing and monitoring these lesions.

A standout feature of bactip.co.uk is its integrated calculator, which streamlines the grading process based on tumour characteristics, like size and aggressiveness. This innovative tool aims to simplify decision making processes for healthcare professionals dealing with cartilage tumours. This advanced tool also standardises the reporting of central cartilage tumours, reducing subjective differences and improving patient care.

bactip.co.uk enables radiologists and clinicians to make informed decisions by offering an imaging follow up plan. Whether it involves suggesting a referral to an oncology specialist or safely discharging a patient from surveillance monitoring, the protocol provides a detailed framework customised for each unique case.

As a leading authority in orthopaedic excellence, the ROH musculoskeletal radiology department is proud to share its expertise through bactip.co.uk, an open-source free resource.

Dr A. Mark Davies, consultant radiologist at the ROH commented: “This initiative reflects our commitment to openness making sure that healthcare professionals worldwide can access our cutting-edge knowledge and best practices without any barriers. Our dedication to spreading knowledge and best practices aligns with our shared goal of enhancing patient outcomes on a global scale.”

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Major contract awarded for a concussion research programme from the US Department of Defense

Written by Louise Stanley on 11/03/2024. Posted in Birmingham Health Partners, Clinical trials, Early diagnosis and detection.

Birmingham experts in neurology have been awarded a seven-year contract by the U.S. Department of Defense – which could be worth up to $15.5m – to undertake a major research programme aiming to transform the way concussion is identified and managed.

Some 890 people across the UK, aged 18 to 60, will take part in the study which will measure the ability of a range of biomarkers – such as blood and saliva, mental health, vision, balance and sleep – to predict long-term complications from mild Traumatic Brain Injury (mTBI), also known as concussion. The mTBI-Predict study will see researchers measure effectiveness of various methods to predict outcomes of mTBI after six, 12 and 24 months.

mTBI can be caused by physical impact to the head through accident, injury, sport, or even from shockwaves following explosions. Led by the Royal Centre for Defence Medicine (RCDM) and the University of Birmingham, researchers will use the UK TBI Research Network to recruit both civilian and military participants to the programme.

mTBI Predict will be supported by Birmingham Health Partners and University Hospital Birmingham, as well as a range of research institutions across the UK.

Professor Alex Sinclair, from the University of Birmingham, who will lead the study said: “Concern around the long-term effects of concussion is mounting. Even a minor injury to the head can cause concussion, which leads to brain injury with potentially serious effects on both immediate and long-term health.

“We have no precise way to tell who will have a serious consequence after a concussion. This means we can’t tell which patients will need more intensive treatment and which will recover spontaneously. The mTBI Predict research program will identify new ways to accurately predict whether concussion patients will develop long-term complications.”

Concussion has been declared a major global public health problem, with 1.4 million hospital visits due to head injury annually in England and Wales. Some 85% of these are classified as concussion and it is also estimated that up to 9.5% of UK military personnel in a combat role are diagnosed with concussion every year.

Major General Timothy Hodgetts CB CBE KHS, Surgeon General of the UK Armed Forces, commented:

“UK Defence has funded the initiation of this research, but it would not be possible to complete without the support from US DoD. This is a prime example of our longstanding bilateral research collaboration where we have a common purpose to address a significant and shared clinical problem. This study will be definitive in helping us identify those who need the most help and resources following a very common injury.”

The research programme brings together a team of experts including neuroscientists, psychologists, sport and exercise scientists, software developers and statisticians – coordinated by Birmingham Clinical Trials Unit.

The study will recruit patients with concussion related to sports injuries, road accidents, cycling accidents, falls and accidents at work, and military personnel experiencing concussion during training or active duty. It will involve military patients and expertise from the Defence Medical Rehabilitation Centre Stanford Hall and Royal Centre for Defence Medicine.

Dr. David J. Smith, from the US Department of Defense, commented: “The US Department of Defense is excited to support this study and continue to identify threats to the brain, such as blast overpressure, head impact, directed energy, and environmental hazards.

“These threats may have a direct impact on brain health. Our aim is to reduce risks to the brain, monitor exposures, and document them for long-term review. The goal is to look for multiple protection strategies to decrease exposures and protect brains better. This research will play a pivotal role in continuing our research investments partnering with the UK to better understand mTBI and concussion to prevent and reduce their effects.”

Although classed as mild brain injury, concussion leads to a disproportionate impact on future health, with three in 10 patients unable to work 12 months after their injury. The consequences of mTBI are profound, with many patients suffering long-term disability due to persistent headaches, imbalance, memory disturbance and poor mental health.

mTBI-Predict will look at biomarkers to enable faster diagnosis and assessment of a concussion, leading to improvements in treatment and long-term management, enabling a quicker return to play, work or duty.