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Background: Minimising unnecessary tests is a global health economic priority with multiple initiatives in place to avoid inappropriate healthcare utilisation(1) and harm. Anti-nuclear antibody (ANA) testing is frequently performed as a diagnostic test for autoimmune conditions, such as systemic lupus erythematosus (SLE) or as a screening test in patients with inflammatory or musculoskeletal symptoms. The value of serial testing in the monitoring of such conditions is unclear and false positive tests can lead to unnecessary further investigation and increased patient anxiety(2) Objectives: To evaluate the frequency of repeated ANA testing as a prelude to Electronic Medical Record (EMR) test alert design in an Australian healthcare network. The primary endpoint was calculation of the total cost associated with repeated testing and whether a longitudinal change in ANA resulted in any new ANA associated rheumatological diagnoses. Our secondary endpoint was the examination of baseline ANA testing behaviours. Method(s): We retrospectively analysed data from a multi-centre tertiary health network in Melbourne, Australia across a 7-year period (19 March 2011 to 23 July 2018). ANA and other autoimmune test results were obtained from the hospital pathology system with a positive ANA cut off set at 1:160. Clinical information was sourced from clinical information systems on patients who had a change in ANA result from negative to positive on repeat testing. The associated cost of repeated ANA testing was calculated based on the baseline cost to the public system. Result(s): A total of 36,715 ANA tests (excluding 980 cancelled same-day requests) were performed in 28,840 patients. Of these, 14,058 (38.3%) were positive with females accounting for 9,265 (65.9%, p<0.001). The most frequent ANA patterns were homogenous (47.4%) and nucleolar (23.3%). ANA titres were as follows; 1:160 (41.4%), 1:320 (15.3%), 1:640 (13.1%) and 1:1280 (29.2%). 7,875 (21.4%) of tests were repeat tests.

Background: This study examined whether patellar tendon vascularity could be quantified accurately in the clinical setting using colour Doppler ultrasonography. Methods: A sonographer and two radiologists visually estimated tendon vascularity in millimetres in 74 tendons during ultrasound (US) examination and from hard copy films. These estimates were then compared to the length of vessels measured from the digital image in millimetres and the correlation between them was determined. A subset of 16 tendons was used to compare the estimates of vascularity by two examiners at US examination. Results: The estimation of vascular length at US examination correlated highly with the measured vascular length (r = 0.92; 95% confidence interval (CI) 0.87 to 0.94), as did the length estimated from the films (r = 0.94; 95% CI 0.9 to 0.96). The correlation between examiners was 0.84 (95% CI 0.51 to 0.94) for the estimates made during US examination and 0.85 (95% CI 0.59 to 0.95) for the vessel lengths measured from the digital images. Conclusions: These excellent correlations indicate that tendon vascularity can be reliably estimated using colour Doppler ultrasonography and tendon vascularity could therefore be used by clinicians to rate clinical change. This method of quantifying tendon vascularity could also be used in research to investigate the effects of tendon treatments on vascularity.