In addition, some general questions about your approach to screening in relation to this paper:
Does anyone have specific differences in the sequence or diseases you screen for?
Do you screen all your patients with abnormal enzymes for celiac sprue?
Do you agree that ANA, smooth muscle and LKA are second line tests after SPEP?
With regards to the approach I would say that the patient characteristics and epidemiology have to be more closely linked to the approach they outline, for example if I had a person with past IDU with a single abnormal elevation I would screen them for at least HIV, HCV, HBV and not repeat the enzymes before doing so. The case has been made for screening all people regardless for HIV and HCV and CDC recommends screening all adults born between 1945 and 1965 for HCV.
Any comments?
Please consider the topic for the next session and recommend any papers you have. Also please comment if you would like to look at the issue of influenza vaccine and/or Tamiflu effectiveness for the next session. This would bring us to the dreaded metanalysis…..
Chester
Hi all,
Thanks for all your input and discussion. Hope we can get all participants to contribute this session.
We will address one of the areas you identified as important in this session, the approach to elevated liver enzymes in asymptomatic patients with a paper from the NEJM in 2000.
Although a bit dated it demonstrates a relevant approach with all major pathologies outlined and it is open access.
Learning Objectives:
ARTICLE:
Pratt D & Kaplan M. Evaluation of Abnormal Liver-Enzyme Results in Asymptomatic Patients. N Engl J Med. 2000. 342:1266-1271. (NEJM Free Full Text) or click the image of the article.
(Posted on behalf of Neil Gibson)
As a related but interesting side note, this discussion could also include the differences seen between single trials and metanalyses.