From the Guidelines
I strongly recommend creating comprehensive and targeted test panels for different medical specialties, prioritizing those that address critical health concerns and have a significant impact on morbidity, mortality, and quality of life, as seen in the recent study on pharmacogenomics 1. When developing these panels, it's essential to consider the specific needs of each specialty and the most relevant tests that can aid in diagnosis, monitoring, and treatment. For example, in oncology, particularly for pediatric acute lymphoblastic leukemia, the initial workup should include a thorough medical history, physical examination, laboratory studies such as complete blood count, blood chemistry profile, and imaging studies as indicated 1. In cardiology, panels might include lipid profiles, high-sensitivity CRP, homocysteine levels, and cardiac markers like troponin and BNP, as suggested by appropriate use criteria for detecting stable ischemic heart disease 1. The panels should be designed to be accessible to both physicians and patients, with clear, non-technical language for the public and detailed information for healthcare providers about test methodologies, reference ranges, and clinical significance. Key considerations include:
- Preparation requirements (fasting vs. non-fasting)
- Sample collection methods
- Expected turnaround times
- The potential for reducing multiple appointments and improving patient compliance with necessary testing
- The integration of pharmacogenomic testing to personalize treatment plans, as discussed in the latest research on advancing pharmacogenomics 1. By focusing on the development of these targeted and comprehensive test panels, we can enhance patient care, improve outcomes, and make significant strides in managing various medical conditions effectively.
From the Research
Medical Specialities and Corresponding Tests
The following are some medical specialities and corresponding tests that can be included in panels:
- Cardiovascular diseases:
- Complete Blood Count (CBC) to assess cardiovascular and metabolic diseases 2
- White blood cell (WBC), neutrophil-to-lymphocyte ratio (NLR), hemoglobin (Hb), mean corpuscular volume (MCV), red cell distribution width (RDW), platelet count, mean platelet volume (MPV), and platelet-to-lymphocyte ratio (PLR) are useful markers to predict CVD and metabolic diseases 2
- Psychiatry:
- Panel diagnosis, also known as consensus or expert diagnosis, is frequently used as the reference standard in diagnostic studies 3
- Hematology:
- Complete Blood Count (CBC) is one of the most common blood tests requested by clinicians and evaluates the total numbers and characteristics of cell components in the blood 2, 4, 5
- Red blood cell test components of the CBC are introduced, followed by a discussion of the laboratory evaluation of anemia and polycythemia 5
- White blood cell (WBC) test components of the CBC are introduced, followed by a discussion of the laboratory evaluation of leukopenia and leukocytosis 4
Decision Making About Healthcare-Related Tests
Decision making about healthcare-related tests and diagnostic test strategies involves several challenges, including:
- Methodological challenges: study designs that are commonly used to assess tests' performance and the effects of tests on people's health, such as diagnostic randomized controlled trials and retrospective validation 6
- Practical challenges: the use of tests in decision-making in healthcare, provides clarifications, and informs the proposed solutions 6
Panel Diagnosis
Panel diagnosis, also known as consensus or expert diagnosis, is frequently used as the reference standard in diagnostic studies, particularly in psychiatry and cardiovascular diseases 3
- The use of panel diagnosis as the reference standard in diagnostic research has been systematically reviewed, and guidance on preferred methodology is lacking 3
- A checklist and flow chart for initial guidance for researchers conducting and reporting of studies involving panel diagnosis have been developed 3