Initiating an undiagnosed diseases program in the Western Australian public health system

Background

New approaches are required to address the needs of complex undiagnosed diseases patients. These approaches include clinical genomic diagnostic pipelines, utilizing intra- and multi-disciplinary platforms, as well as specialty-specific genomic clinics. Both are advancing diagnostic rates. However, complementary cross-disciplinary approaches are also critical to address those patients with multisystem disorders who traverse the bounds of multiple specialties and remain undiagnosed despite existing intra-specialty and genomic-focused approaches. The diagnostic possibilities of undiagnosed diseases include genetic and non-genetic conditions. The focus on genetic diseases addresses some of these disorders, however a cross-disciplinary approach is needed that also simultaneously addresses other disorder types. Herein, we describe the initiation and summary outcomes of a public health system approach for complex undiagnosed patients - the Undiagnosed Diseases Program-Western Australia (UDP-WA).

Results

Briefly the UDP-WA is: i) one of a complementary suite of approaches that is being delivered within health service, and with community engagement, to address the needs of those with severe undiagnosed diseases; ii) delivered within a public health system to support equitable access to health care, including for those from remote and regional areas; iii) providing diagnoses and improved patient care; iv) delivering a platform for in-service and real time genomic and phenomic education for clinicians that traverses a diverse range of specialties; v) retaining and recapturing clinical expertise; vi) supporting the education of junior and more senior medical staff; vii) designed to integrate with clinical translational research; and viii) is supporting greater connectedness for patients, families and medical staff.

Conclusion

The UDP-WA has been initiated in the public health system to complement existing clinical genomic approaches; it has been targeted to those with a specific diagnostic need, and initiated by redirecting existing clinical and financial resources. The UDP-WA supports the provision of equitable and sustainable diagnostics and simultaneously supports capacity building in clinical care and translational research, for those with undiagnosed, typically rare, conditions.

Electronic supplementary material

The online version of this article (doi:10.1186/s13023-017-0619-z) contains supplementary material, which is available to authorized users.

An investigation of criteria used to indicate cranial CT in males with schizophrenia

BACKGROUND

With the increased accessibility of the CT scanner, psychiatrists managing schizophrenia and first-episode psychosis have incorporated this imaging technique into their diagnostic work-up. This practice has been reinforced by published criteria for CT scanning in psychiatric patients suggesting that cranial CT should be used as a screening tool to exclude intracranial pathology in all patients with a first presentation of schizophrenia or first psychotic episode.

OBJECTIVES

This study reviews the performance of these criteria.

METHOD

This consisted of a 3-year retrospective case-note audit, using published criteria, of all male in-patients with an established diagnosis of schizophrenia who had a cranial CT during the review period.

RESULTS

The efficacy of the published criteria is not supported. In addition, non-specific abnormalities on cranial CT are related to duration of illness and not age in this sample.

CONCLUSIONS

There is a need to establish new and clinically meaningful approaches for the use of cranial CT and similar technologies in clinical psychiatry. Cranial CT performs poorly as a universal screening tool in this population. The decision to use such imaging techniques should be made on a case-by-case basis using all available clinical evidence.

Characterization of the bovine secondary in vitro antibody response

In the present report, the bovine secondary in vitro antibody response to keyhole limpet hemocyanin is described. The induction of anti-KLH antibody was not dependent upon the presence of mitogen but was antigen specific (KLH vs ovalbumin). Furthermore, this response was dependent upon cell density (10(6) per well), antigen dose (1 to 10(-5) ug/culture) and time in culture (5 days). The antibody produced was specific for KLH as measured in several binding assays. An unresponsive state was detected with high concentrations of KLH (more than 10 ug per culture) which was not due to the formation of immune complexes but to the inactivation of B and/or T cells. The induction of the antibody response was dependent on the presence of macrophages (syngeneic or allogeneic) and their presence could not be replaced with 2-mercaptoethanol.