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Almasoud NF, Aldosari MA, Mahmoud AS, Alendijani YA, Alkhenizan AH. Inappropriate laboratory test utilization in outpatient tertiary care: Implications for value-based healthcare. Saudi Med J 2024; 45:356-361. [PMID: 38657991 PMCID: PMC11147584 DOI: 10.15537/smj.2024.45.4.20230512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES To assess the rate of inappropriate repetition of laboratory testing and estimate the cost of such testing for thyroid stimulating hormone (TSH), total cholesterol, vitamin D, and vitamin B12 tests. METHODS A retrospective cohort study was carried out in the Family Medicine and Polyclinic Department at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. Clinical and laboratory data were collected between 2018-2021 for the 4 laboratory tests. The inappropriate repetition of tests was defined according to international guidelines and the costs were calculated using the hospital prices. RESULTS A total of 109,929 laboratory tests carried out on 23,280 patients were included in this study. The percentage of inappropriate tests, as per the study criteria, was estimated to be 6.1% of all repeated tests. Additionally, the estimated total cost wasted amounted to 2,364,410 Saudi Riyals. Age exhibited a weak positive correlation with the total number of inappropriate tests (r=0.196, p=0.001). Furthermore, significant differences were observed in the medians of the total number of inappropriate tests among genders and nationalities (p<0.001). CONCLUSION The study identified significantly high rates of inadequate repetitions of frequently requested laboratory tests. Urgent action is therefore crucial to overcoming such an issue.
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Affiliation(s)
- Nouf F. Almasoud
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Mohammed A. Aldosari
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed S. Mahmoud
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Yaser A. Alendijani
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Abdullah H. Alkhenizan
- From the Department of Family Medicine and Polyclinics, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia.
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Cadogan SL, Browne JP, Bradley CP, Fitzgerald AP, Cahill MR. Physician and practice characteristics associated with immunoglobulin test ordering. Fam Pract 2018; 35:41-46. [PMID: 28968810 DOI: 10.1093/fampra/cmx063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Primary care test requests for serum immunoglobulins are rising rapidly, with concerns that many requests may be unnecessary. Evidence suggests some characteristics of general practitioners (GPs) and practices are associated with higher test ordering. OBJECTIVE To identify the physician and practice characteristics associated with immunoglobulin test ordering. METHODS Retrospective, cross-sectional study using routine laboratory data on primary care serum immunoglobulin requests. Data were linked with GP patient list size data. The primary outcome measure was the count of test requests per GP. Predictor variables were physician gender, years experience, practice region and type (number of GPs), GP patient list size and composition. Mixed-effects multilevel regression models were used to calculate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for the associations between physician and practice characteristics and GP requesting. Sensitivity analysis was performed by limiting the model to the more than 70 years age category. RESULTS In total, 5990 immunoglobulin tests were ordered by 481 GPs in the South of Ireland during 2013. The number of tests ordered by individual GPs varied from one to 377. In the final fully adjusted Poisson regression analysis, female gender (IRR: 1.81; 95% CI: 1.45-2.26) and less experience (IRR: 2.27; 95% CI: 1.47-3.51) were associated with higher requesting (P < 0.001). None of the practice factors were associated with test ordering. Sensitivity analysis on the 70 years or more age category found similar results. CONCLUSION Further research is required to explore the potential reasons for higher requesting among GPs with fewer years of experience and also among female GPs.
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Affiliation(s)
- Sharon L Cadogan
- Department of Epidemiology and Public Health, University College Cork, Ireland
| | - John P Browne
- Department of Epidemiology and Public Health, University College Cork, Ireland
| | - Colin P Bradley
- Department of General Practice, University College Cork, Ireland
| | - Anthony P Fitzgerald
- Department of Epidemiology and Public Health, University College Cork, Ireland.,Department of Statistics, University College Cork, Cork, Ireland
| | - Mary R Cahill
- Department of Haematology, Cork University Hospital, Cork, Ireland
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3
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Chami N, Simons JE, Sweetman A, Don-Wauchope AC. Rates of inappropriate laboratory test utilization in Ontario. Clin Biochem 2017; 50:822-827. [DOI: 10.1016/j.clinbiochem.2017.05.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 12/22/2022]
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Cadogan SL, McHugh SM, Bradley CP, Browne JP, Cahill MR. General practitioner views on the determinants of test ordering: a theory-based qualitative approach to the development of an intervention to improve immunoglobulin requests in primary care. Implement Sci 2016; 11:102. [PMID: 27435839 PMCID: PMC4952272 DOI: 10.1186/s13012-016-0465-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 07/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research suggests that variation in laboratory requesting patterns may indicate unnecessary test use. Requesting patterns for serum immunoglobulins vary significantly between general practitioners (GPs). This study aims to explore GP's views on testing to identify the determinants of behaviour and recommend feasible intervention strategies for improving immunoglobulin test use in primary care. METHODS Qualitative semi-structured interviews were conducted with GPs requesting laboratory tests at Cork University Hospital or University Hospital Kerry in the South of Ireland. GPs were identified using a Health Service Executive laboratory list of GPs in the Cork-Kerry region. A random sample of GPs (stratified by GP requesting patterns) was generated from this list. GPs were purposively sampled based on the criteria of location (urban/rural); length of time qualified; and practice size (single-handed/group). Interviews were carried out between December 2014 and February 2015. Interviews were transcribed verbatim using NVivo 10 software and analysed using the framework analysis method. Emerging themes were mapped to the theoretical domains framework (TDF), which outlines 12 domains that can enable or inhibit behaviour change. The behaviour change wheel and behaviour change technique (BCT) taxonomy were then used to identify potential intervention strategies. RESULTS Sixteen GPs were interviewed (ten males and six females). Findings suggest that intervention strategies should specifically target the key barriers to effective test ordering, while considering the context of primary care practice. Seven domains from the TDF were perceived to influence immunoglobulin test ordering behaviours and were identified as 'mechanisms for change' (knowledge, environmental context and resources, social/professional role and identity, beliefs about capabilities, beliefs about consequences, memory, attention and decision-making processes and behavioural regulation). Using these TDF domains, seven BCTs emerged as feasible 'intervention content' for targeting GPs' ordering behaviour. These included instructions on how to effectively request the test (how to perform behaviour), information on GPs' use of the test (feedback on behaviour), information about patient consequences resulting from not doing the test (information about health consequences), laboratory/consultant-based advice/education (credible source), altering the test ordering form (restructuring the physical environment), providing guidelines (prompts/cues) and adding interpretive comments to the results (adding objects to the environment). These BCTs aligned to four intervention functions: education, persuasion, environmental restructuring and enablement. CONCLUSIONS This study has effectively applied behaviour change theory to identify feasible strategies for improving immunoglobulin test use in primary care using the TDF, 'behaviour change wheel' and BCT taxonomy. The identified BCTs will form the basis of a theory-based intervention to improve the use of immunoglobulin tests among GPs. Future research will involve the development and evaluation of this intervention.
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Affiliation(s)
- S L Cadogan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland.
| | - S M McHugh
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - C P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - J P Browne
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - M R Cahill
- Department of Haematology, Cork University Hospital, Cork, Ireland
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Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study. BMC Musculoskelet Disord 2015; 16:345. [PMID: 26556589 PMCID: PMC4641391 DOI: 10.1186/s12891-015-0803-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/03/2015] [Indexed: 11/10/2022] Open
Abstract
Background Achilles tendon structure deteriorates 2-days after maximal loading in elite athletes. The load-response behaviour of tendons may be altered in type 1 diabetes mellitus (T1DM) as hyperglycaemia accelerates collagen cross-linking. This study compared Achilles tendon load-response in participants with T1DM and controls. Methods Achilles tendon structure was quantified at day-0, day-2 and day-4 after a 10 km run. Ultrasound tissue characterisation (UTC) measures tendon structural integrity by classifying pixels as echo-type I, II, III or IV. Echo-type I has the most aligned collagen fibrils and IV has the least. Results Participants were 7 individuals with T1DM and 10 controls. All regularly ran distances greater than 5 km and VISA-A scores indicated good tendon function (T1DM = 94 ± 11, control = 94 ± 10). There were no diabetic complications and HbA1c was 8.7 ± 2.6 mmol/mol for T1DM and 5.3 ± 0.4 mmol/mol for control groups. Baseline tendon structure was similar in T1DM and control groups – UTC echo-types (I-IV) and anterior-posterior thickness were all p > 0.05. No response to load was seen in either T1DM or control group over the 4-days post exercise. Conclusion Active individuals with T1DM do not have a heightened Achilles tendon response to load, which suggests no increased risk of tendon injury. We cannot extrapolate these findings to sedentary individuals with T1DM.
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Morgen EK, Naugler C. Inappropriate repeats of six common tests in a Canadian city: a population cohort study within a laboratory informatics framework. Am J Clin Pathol 2015; 144:704-12. [PMID: 26486733 DOI: 10.1309/ajcpyxdaus2f8xjy] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To identify inappropriate repeats of six common laboratory tests in a population sample of patients, using highly specific criteria based only on repeat time and test value. METHODS We used a laboratory informatics database to conduct a retrospective cohort study using a population sample of 103,000 patients in the city of Calgary with an index test in 2010 and uniform follow-up of 1 year. We examined six tests (cholesterol, hemoglobin A1c, thyroid-stimulating hormone, vitamin B12, vitamin D, and ferritin) with consensus-based or easily justified criteria for inappropriate repeats based solely on time to repeat and the index test value. RESULTS The percentages of tests repeated at 3, 6, and 12 months were 11%, 23%, and 41%, respectively. In total, 16% of these six tests were inappropriately repeated, representing an annual internal cost of $0.6 to $2.2 million Canadian dollars and corresponding to population-scaled national estimates for Canada and the United States of $160 million and $2.4 billion, respectively. CONCLUSIONS Objective definitions based on repeated testing identified 16% of six studied tests as inappropriate, delineating a subset of inappropriate testing that is well suited to automated identification and intervention and that provides a likely lower bound on the true burden of inappropriate testing.
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Breu AC, Theisen-Toupal J, Feldman LS. Serum and red blood cell folate testing on hospitalized patients. J Hosp Med 2015; 10:753-5. [PMID: 26463111 DOI: 10.1002/jhm.2385] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/29/2015] [Accepted: 03/03/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Anthony C Breu
- Medical Service, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jesse Theisen-Toupal
- Harvard Medical School, Boston, Massachusetts
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Leonard S Feldman
- Divisions of General Internal Medicine and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland
- Johns Hopkins School of Medicine, Baltimore, Maryland
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Planche V, Georgin-Lavialle S, Avillach P, Ranque B, Pavie J, Caruba T, Darnige L, Pouchot J. Etiologies and diagnostic work-up of extreme macrocytosis defined by an erythrocyte mean corpuscular volume over 130°fL: A study of 109 patients. Am J Hematol 2014; 89:665-6. [PMID: 24668797 DOI: 10.1002/ajh.23718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Virginie Planche
- Service d'Hématologie Biologique; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Sophie Georgin-Lavialle
- Service de Médecine Interne; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Paul Avillach
- Service de santé publique et Informatique médicale; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
- INSERM UMR S 872 eq22; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Brigitte Ranque
- Service de Médecine Interne; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Juliette Pavie
- Service d'Immunologie clinique et; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Thibaut Caruba
- Service de Pharmacie; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Luc Darnige
- Service d'Hématologie Biologique; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
| | - Jacques Pouchot
- Service de Médecine Interne; Université Paris Descartes, Paris Sorbonne Cité, Faculté de Médecine et AP-HP, Hôpital Européen Georges Pompidou; 20 rue Leblanc 75015 Paris France
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Vitamin B12 and cognitive function: an evidence-based analysis. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2013; 13:1-45. [PMID: 24379897 PMCID: PMC3874776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND More than 2.9 million serum vitamin B12 tests were performed in 2010 in Ontario at a cost of $40 million. Vitamin B12 deficiency has been associated with a few neurocognitive disorders. OBJECTIVE To determine the clinical utility of B12 testing in patients with suspected dementia or cognitive decline. METHODS Three questions were addressed: Is there an association between vitamin B12 deficiency and the onset of dementia or cognitive decline? Does treatment with vitamin B12 supplementation improve cognitive function in patients with dementia or cognitive decline and vitamin B12 deficiency? What is the effectiveness of oral versus parenteral vitamin B12 supplementation in those with confirmed vitamin B12 deficiency? A literature search was performed using MEDLINE, Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Cochrane Library, and the Centre for Reviews and Dissemination database, from January 2002 until August 2012. RESULTS Eighteen studies (7 systematic reviews and 11 observational studies) were identified to address the question of the association between B12 and the onset of dementia. Four systematic reviews were identified to address the question of the treatment of B12 on cognitive function. Finally, 3 randomized controlled trials were identified that compared oral B12 to intramuscular B12. CONCLUSIONS Based on very low quality evidence, there does appear to be an association between elevated plasma homocysteine levels (a by-product of B vitamins) and the onset of dementia. Based on moderate quality evidence, but with less than optimal duration of follow-up, treatment with B12 supplementation does not appreciably change cognitive function. Based on low to moderate quality of evidence, treatment with vitamin B12 and folate in patients with mild cognitive impairment seems to slow the rate of brain atrophy. Based on moderate quality evidence, oral vitamin B12 is as effective as parenteral vitamin B12 in patients with confirmed B12 deficiency. PLAIN LANGUAGE SUMMARY Low levels of vitamin B12 have been associated with neurocognitive disorders. This evidence-based analysis assessed the usefulness of serum vitamin B12 testing as it relates to brain function. This review found very low quality evidence that suggests a connection between high plasma homocysteine levels (a by-product of B vitamin metabolism in the body) and the onset of dementia. Moderate quality of evidence indicates treatment with vitamin B12 does not improve brain function. Moderate quality of evidence also indicates treatment using oral vitamin B12 supplements is as effective as injections of vitamin B12.
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Wick MR, Marchevsky AM. Evidence-Based Principles in Pathology: Existing Problem Areas and the Development of “Quality” Practice Patterns. Arch Pathol Lab Med 2011; 135:1398-404. [DOI: 10.5858/arpa.2011-0181-sa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—Contrary to the intuitive impressions of many pathologists, several areas exist in laboratory medicine where evidence-based medicine (EBM) principles are not applied. These include aspects of both anatomic and clinical pathology. Some non-EBM practices are perpetuated by clinical “consumers” of laboratory services because of inadequate education, habit, or overreliance on empirical factors. Other faulty procedures are driven by pathologists themselves.
Objectives.—To consider (1) several selected problem areas representing non-EBM practices in laboratory medicine; such examples include ideas and techniques that concern metastatic malignancies, “targeted” oncologic therapy, general laboratory testing and data utilization, evaluation of selected coagulation defects, administration of blood products, and analysis of hepatic iron-overload syndromes; and (2) EBM principles as methods for remediation of deficiencies in hospital pathology, and implements for the construction of “quality” practices in our specialty.
Data Sources.—Current English literature relating to evidence-based principles in pathology and laboratory medicine, as well as the authors' experience.
Conclusions.—Evidence-based medicine holds the promise of optimizing laboratory services to produce “quality” practices in pathology. It will also be a key to restraining the overall cost of health care.
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Viljoen A, Wierzbicki AS. Towards companion diagnostics for the management of statin therapy. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2009; 3:659-671. [PMID: 23496050 DOI: 10.1517/17530050903222254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Statins are the most commonly prescribed drugs in the world and are established first-line therapy for cardiovascular disease. Statin toxicity is related to dose, age, gender, ethnicity, body mass, renal and endocrine function and also to concomitant medications - particularly those that inhibit cytochrome P450 3A4. OBJECTIVE/METHOD This review describes the tests used before initiation of statin therapy, to establish their efficacy and to monitor their principal side effects. Lipids and apolipoproteins are used to measure efficacy and compliance, whereas transaminases and creatine kinase are used to measure toxicity. Guidelines agree in general, but differ in the details of measurement of baseline levels, action limits and management strategies for statin toxicity. Genetic factors are relevant to both the efficacy and the toxicity of statin therapy, with efficacy being associated with polymorphisms in lipid-related genes, whereas a function-related polymorphism in the organic anion transporting polypeptide 1B1 (OATP1B1; SLCO1B1) is associated with 60% of the cases of myopathy with high-dose simvastatin. CONCLUSIONS Although basic efficacy and safety panels for the initiation and monitoring of statin therapy are well established, controversy remains about the need for ancillary diagnostics in patients and to which patient groups these should be applied.
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Affiliation(s)
- Adie Viljoen
- Lister Hospital, Department of Clinical Biochemistry, Stevenage SG1 4AB, UK +44 1438 314 333 ext 5972 ; +44 1438 781 147 ;
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Aguilar-Shea AL, Sierra Santos L, Castro Toro J, Gallardo-Mayo C. [Topiramate and vitamin B(12) deficiency]. Aten Primaria 2009; 41:123-4. [PMID: 19231712 DOI: 10.1016/j.aprim.2008.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Accepted: 06/18/2008] [Indexed: 11/30/2022] Open
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Smellie WSA, Shaw N, Bowley R, Stewart MF, Kelly AM, Twomey PJ, Chadwick PR, Houghton JB, Ng JP, McCulloch AJ. Best practice in primary care pathology: review 10. J Clin Pathol 2007; 60:1195-204. [PMID: 17496187 PMCID: PMC2095485 DOI: 10.1136/jcp.2007.048512] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2007] [Indexed: 01/03/2023]
Abstract
This tenth best practice review examines four series of common primary care questions in laboratory medicine: (i) antenatal testing in pregnant women; (ii) estimated glomerular filtration rate calculation; (iii) safety testing for methotrexate; and (iv) blood glucose measurement in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Bishop Auckland, UK.
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Abstract
Low vitamin B-12 levels can occur without deficiency being present, and normal levels don't always rule out vitamin B-12 deficiency. A clinical assessment, together with blood count and blood film results, can ensure a correct interpretation of vitamin B-12 and folate levels
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Affiliation(s)
- Michael Galloway
- City Hospitals Sunderland NHS Foundation Trust, Sunderland Royal Hospital, Sunderland SR4 7TP.
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15
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Smellie WSA, Vanderpump MPJ, Fraser WD, Bowley R, Shaw N. Best practice in primary care pathology: review 11. J Clin Pathol 2007; 61:410-8. [PMID: 17965216 DOI: 10.1136/jcp.2007.052738] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This eleventh best practice review examines two series of common primary care questions in laboratory medicine: (i) thyroid testing, and (ii) hypercalcaemia and hypocalcaemia. The review is presented in the same question-answer format as in the previous reviews. These questions and answers deal with common situations in men and non-pregnant women. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. In the case of the thyroid series, the recommendations are drawn from the 2006 guidelines published by the Association for Clinical Biochemistry, the British Thyroid Association and the British Thyroid Foundation. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK
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Smellie WSA, Shaw N, Bowlees R, Taylor A, Howell-Jones R, McNulty CAM. Best practice in primary care pathology: review 9. J Clin Pathol 2007; 60:966-74. [PMID: 17259298 PMCID: PMC1972434 DOI: 10.1136/jcp.2006.044883] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2007] [Indexed: 11/03/2022]
Abstract
This ninth best-practice review examines two series of common primary care questions in laboratory medicine: (i) potassium abnormalities and (ii) venous leg ulcer microbiology. The review is presented in question-and-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK
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Smellie WSA, Hampton KK, Bowley R, Bowlees R, Martin SC, Shaw N, Hoffman J, Ng JP, Mackenzie SM, van Heyningen C. Best practice in primary care pathology: review 8. J Clin Pathol 2007; 60:740-8. [PMID: 17172476 PMCID: PMC1995784 DOI: 10.1136/jcp.2006.044719] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2006] [Indexed: 11/04/2022]
Abstract
This eighth best practice review examines four series of common primary care questions in laboratory medicine: (i) sodium abnormalities; (ii) faecal occult blood testing; (iii) warfarin management; and (iv) sputum cytology in diagnosis of bronchopulmonary malignancy. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence-based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Bishop Auckland, UK.
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Smellie WSA, Forth J, Smart SRS, Galloway MJ, Irving W, Bareford D, Collinson PO, Kerr KG, Summerfield G, Carey PJ, Minhas R. Best practice in primary care pathology: review 7. J Clin Pathol 2007; 60:458-65. [PMID: 17046843 PMCID: PMC1994553 DOI: 10.1136/jcp.2006.042994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2006] [Indexed: 11/04/2022]
Abstract
This seventh best-practice review examines four series of common primary care questions in laboratory medicine: (1) blood count abnormalities 2; (2) cardiac troponins; (3) high-density lipoprotein cholesterol; and (4) viral diseases 2. The review is presented in a question-answer format, with authorship attributed for each question series. The recommendations are a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. The recommendations are not standards, but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.
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Smellie WSA, Forth J, Coleman JJ, Irvine W, Dore PC, Handley G, Williams DG, Galloway PJ, Kerr KG, Herriot R, Spickett GP, Reynolds TM. Best practice in primary care pathology: review 6. J Clin Pathol 2007; 60:225-34. [PMID: 16822875 PMCID: PMC1860559 DOI: 10.1136/jcp.2006.040014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2006] [Indexed: 12/22/2022]
Abstract
This sixth best practice review examines four series of common primary care questions in laboratory medicine: (1) laboratory monitoring in hypertension and heart failure abnormalities; (2) markers of inflammatory joint disease; (3) laboratory investigation of chronic diarrhoea; and (4) mumps and chickenpox. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.
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20
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Smellie WSA, Forth J, Ryder S, Galloway MJ, Wood AC, Watson ID. Best practice in primary care pathology: review 5. J Clin Pathol 2006; 59:1229-37. [PMID: 16644875 PMCID: PMC1860526 DOI: 10.1136/jcp.2006.037754] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2006] [Indexed: 12/31/2022]
Abstract
This fifth best practice review examines three series of common primary care questions in laboratory medicine: (1) minor liver function test abnormalities; (2) laboratory monitoring of patients receiving lithium; and (3) investigation of possible venous thromboembolism. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus-based rather than evidence-based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Durham, UK.
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21
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Smellie WSA, Forth J, Sundar S, Kalu E, McNulty CAM, Sherriff E, Watson ID, Croucher C, Reynolds TM, Carey PJ. Best practice in primary care pathology: review 4. J Clin Pathol 2006; 59:893-902. [PMID: 16714397 PMCID: PMC1860479 DOI: 10.1136/jcp.2005.035212] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2006] [Indexed: 11/04/2022]
Abstract
This fourth best practice review examines four series of common primary care questions in laboratory medicine are examined in this review: (1) safety monitoring for three common drugs; (2) use of prostate-specific antigen; (3) investigation of vaginal discharge; and (4) investigation of subfertility. The review is presented in question-answer format, referenced for each question series. The recommendations represent a precis of the guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most of them are consensus based rather than evidence based. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham, UK.
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22
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Aslinia F, Mazza JJ, Yale SH. Megaloblastic anemia and other causes of macrocytosis. Clin Med Res 2006; 4:236-41. [PMID: 16988104 PMCID: PMC1570488 DOI: 10.3121/cmr.4.3.236] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Revised: 05/11/2006] [Accepted: 06/19/2006] [Indexed: 12/22/2022]
Affiliation(s)
- Florence Aslinia
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA
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Smellie WSA, Forth J, Bareford D, Twomey P, Galloway MJ, Logan ECM, Smart SRS, Reynolds TM, Waine C. Best practice in primary care pathology: review 3. J Clin Pathol 2006; 59:781-9. [PMID: 16873560 PMCID: PMC1860461 DOI: 10.1136/jcp.200x.033944] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2005] [Indexed: 01/13/2023]
Abstract
This best practice review examines four series of common primary care questions in laboratory medicine: (i) "minor" blood platelet count and haemoglobin abnormalities; (ii) diagnosis and monitoring of anaemia caused by iron deficiency; (iii) secondary hyperlipidaemia and hypertriglyceridaemia; and (iv) glycated haemoglobin and microalbumin use in diabetes. The review is presented in question-answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents and evidence-based medicine reviews, supplemented by Medline Embase searches to identify relevant primary research documents. They are not standards, but form a guide to be set in the clinical context. Most of the recommendations are based on consensus rather than evidence. They will be updated periodically to take account of new information.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Bishop Auckland County, Durham, UK.
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Smellie WSA, Spickett GP. Paraprotein management. BMJ 2006; 333:185-7. [PMID: 16858048 PMCID: PMC1513487 DOI: 10.1136/bmj.333.7560.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This article explores best practice in the investigation and monitoring of paraprotein bands in blood or urine. It looks at the pitfalls and provides a summary of guidance
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