Gastrointestinal tuberculosis:Diagnostic approaches for this uncommon pathology

A case report entitled“Primary gastroduodenal tuberculosis presenting as gastric outlet obstruction”recently published in the World Journal of Clinical Cases presented a rare cause of gastric outlet obstruction and highlighted the atypical manner in which gastrointestinal tuberculosis(TB)can present.The literature with regards to this rare pathology is limited to case reports and case series with the largest being published using data from between 2003 and 2013.However,since then the diagnostic tools available have significantly changed with more modern and increasingly accurate tests now available.This editorial reviews the current state of the art with regards to diagnosis in gastrointestinal TB.

Using clinical cases to guide healthcare

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their patients.The well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support EBP.Case-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare workers.Case series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming individuals.They are also vital in generating and disseminating early signals and encouraging further research.Whilst these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

Biobanks and biomarkers:Their current and future role in biomedical research

The importance and utility of biobanks has increased exponentially since their inception and creation.Initially used as part of translational research,they now contribute over 40%of data for all cancer research papers in the United States of America and play a crucial role in all aspects of healthcare.Multiple classification systems exist but a simplified approach is to either classify as population-based or disease-oriented entities.Whilst historically publicly funded institutions,there has been a significant increase in industry funded entities across the world which has changed the dynamic of biobanks offering new possibilities but also new challenges.Biobanks face legal questions over data sharing and intellectual property as well as ethical and sustainability questions particularly as the world attempts to move to a low-carbon economy.International collaboration is required to address some of these challenges but this in itself is fraught with complexity and difficulty.This review will examine the current utility of biobanks in the modern healthcare setting as well as the current and future challenges these vital institutions face.

Research surveys and their evolution:Past,current and future uses in healthcare

Research surveys are believed to have originated in antiquity with evidence of them being performed in ancient Egypt and Greece.In the past century,their use has grown significantly and they are now one of the most frequently employed research methods including in the field of healthcare.Modern validation techniques and processes have allowed researchers to broaden the scope of qualitative data they can gather through these surveys such as an individual’s views on service quality to nationwide surveys that are undertaken regularly to follow healthcare trends.This article focuses on the evolution and current utility of research surveys,different methodologies employed in their creation,the advantages and disadvantages of different forms and their future use in healthcare research.We also review the role artificial intelligence and the importance of increased patient participation in the development of these surveys in order to obtain more accurate and clinically relevant data.

Using national census data to facilitate healthcare research

National censuses are conducted at varying intervals across both the developed and developing world and collect detailed data on a wide range of societal,economic and health questions.This immense volume of data has many potential uses in the field of healthcare research and can be utilised either in isolation or in conjunction with other information sources such as hospital records.At a governmental level census data can be used for healthcare service planning by providing accurate population density information but also,through the use of more detailed data collection,by helping to identify high-risk populations that may require increased resource allocation.It can also be a key tool in addressing and improving healthcare inequality and deprivation by both identifying those populations with poorer healthcare outcomes and through helping researchers to better understand the causes of this inequality.Similarly,it has utility when studying the complex causes of disease and assessing the success of strategies designed to tackle these aetiologies.However,the maximum benefit from these various uses can only be realised if the data collection and analysis processes utilised are robust and this requires that census bureaus regularly review and modify their methods in a transparent and thorough way.