-
[show abstract]
[hide abstract]
ABSTRACT: Laboratory medicine practice guidelines (LMPGs) are an important part of clinical laboratory medicine. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument has been developed to evaluate the process of practice-guideline development and the quality of reporting. We assessed the applicability of AGREE II in assessing the National Academy of Clinical Biochemistry (NACB) LMPGs.
The NACB website was searched for all available LMPGs up to December 2011. Two independent appraisers used the AGREE II instrument to assess each LMPG identified by the search. Quality was assessed across 6 domains (scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence), comprising a total of 23 items and 2 overall assessments, each scored on a 7-point scale (1, strongly disagree, to 7, strongly agree). All scores were expressed as AGREE II calculated percentages (100% indicates that all items scored 7 by all appraisers).
Eleven LMPGs were identified. All of the LMPGs provided some information seen as applicable to clinical practice by the appraisers. Only 5 of the LMPGs had overall scores ≥50%, with a median score of 42% (range: 8%-92%). Individual domain scores varied considerably from 0% to 100%. One guideline achieved a very high score on the instrument.
The AGREE II instrument is applicable and useful to evaluate LMPGs. All domains were evaluated as being useful to assess LMPGs, some were addressed well (e.g., clarity of presentation), whereas others could be improved (e.g., applicability).
Clinical Chemistry 08/2012; 58(10):1426-37. · 7.91 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 1-step approach for gestational diabetes (GDM) screening using a 75 g-oral glucose tolerance test (75 g-OGTT) has been recommended. We undertook an audit (January 2007-June 2010) to assess adherence to an existing 2-step approach (50 g-glucose challenge test followed by a 75 g-OGTT). Adherence was sub-optimal. Overall follow-up was missed in 14.5% of those screened. Only 36% of those who met dysglycemia criteria for a follow-up 75 g-OGTT received the test as per step 2 of the protocol.
Diabetes research and clinical practice 02/2012; 96(2):e43-6. · 2.16 Impact Factor
-
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 02/2010; 100(2):74-5. · 2.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To review pediatric critical values after consultation with departmental pediatricians.
An electronic survey with the critical value list of 26 high or low abnormal chemistry laboratory values of 12 analytes was circulated to pediatricians. The survey results were presented to a focus group of 3 pediatricians for comments and review.
Thirty-one of 125 pediatricians affiliated with the Department of Pediatrics responded. Sixteen of 26 (61.5%) current values met the agreement criteria. The procedures for calling high glucose levels in neonates and children, and the low magnesium and low ionized calcium critical values were revised after discussion with the focus group.
This survey among the hospital's pediatricians resulted not only in a revised list of critical values, but also the procedure for calling the user. The use of unique critical values for different areas of clinical practice within the children's hospital was identified as an area for future development.
Clinical biochemistry 08/2009; 42(16-17):1658-61. · 2.02 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the argument for use of bone resorption markers in patients exposed to bisphosphonates and requiring dental surgery to prevent development of osteonecrosis of the jaw.
Review of literature.
5 primary reports and a number of reviews were considered.
There is insufficient evidence to recommend use of bone resorption markers in patients exposed to bisphosphonates prior to dental surgery as a routine test to assess risk of osteonecrosis of the jaw.
Clinical biochemistry 04/2009; 42(10-11):1194-6. · 2.02 Impact Factor
-
Clinical Chemistry and Laboratory Medicine 02/2009; 47(7):882-4. · 2.15 Impact Factor
-
Andrew C Don-Wauchope
BMJ (Clinical research ed.). 12/2005; 331(7526):1203.
-
Andrew C Don-Wauchope
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 09/2005; 95(8):542. · 2.04 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Macroprolactin is a complex of prolactin (PRL) and IgG and may account for a significant proportion of cases of 'idiopathic hyperprolactinaemia'. In this study, we sought to determine the prevalence and clinical features of macroprolactinaemia in patients diagnosed with hyperprolactinaemia in our region, with a view to determining how patients with macroprolactinaemia should be investigated and managed.
An Immuno-1 automated immunoassay system with polyethylene glycol (PEG) precipitation was used to identify macroprolactin, with a recovery of </= 50% taken as indicating significant macroprolactinaemia. Macroprolactin was found in 58 (21%) of 273 patients with a total PRL > 700 mU/l. The clinical records of 51 (44 female) were available for retrospective review.
The mean (range) age of patients was 39.5 (18-82) years. The median (range) concentrations for the various forms of PRL were: total PRL 1130 mU/l (728-5116), monomeric PRL 240 mU/l (50-656) and macroprolactin 895 mU/l (381-4854). Classical symptoms of hyperprolactinaemia were present in 39% of patients, although in many there were other possible explanations for their symptomatology. Pituitary adenomas were identified in six out of 36 people who underwent neuroimaging. Five of these patients had a microadenoma and one had a 10-mm macroadenoma (although, in this patient macroprolactin was identified after the discovery of the tumour). There was no relationship between macroprolactin concentrations and the presence of hyperprolactinaemic symptoms or neuroimaging abnormalities.
Macroprolactinaemia is a common occurrence in patients with hyperprolactinaemia, but associated symptomatology may not necessarily be linked. The neuroimaging abnormalities were also probably incidental findings and it is questionable whether neuroimaging is necessary when significant macroprolactinaemia is identified and the concentration of monomeric PRL is not elevated (using the Immuno-1 assay system, following PEG precipitation).
Clinical Endocrinology 09/2003; 59(3):339-46. · 3.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: ObjectivesTo evaluate the argument for use of bone resorption markers in patients exposed to bisphosphonates and requiring dental surgery to prevent development of osteonecrosis of the jaw.MethodsReview of literature.Results5 primary reports and a number of reviews were considered.ConclusionsThere is insufficient evidence to recommend use of bone resorption markers in patients exposed to bisphosphonates prior to dental surgery as a routine test to assess risk of osteonecrosis of the jaw.
Clinical Biochemistry.
-
[show abstract]
[hide abstract]
ABSTRACT: ObjectivesTo assess whether our critical values were viewed as appropriate by our physicians and to assess their understanding of critical values.MethodsA web-based survey was prepared. The critical value levels were taken from our current values and select values based on a review of the literature. One of the options in the response for each analyte probed the understanding of the concept of critical value.ResultsThere were 115 respondents from a range of disciplines. The results indicated that some (4/11) of our critical values were appropriate however, many required review (7/11). Most respondents (79%) did not fully appreciate the concept of critical value.ConclusionsThis survey specifically considers physician input for the establishment of critical values. The data enabled our laboratory to better identify critical values and has highlighted the need for physician education in the concept of critical values.
Clinical Biochemistry.
