IntroductionRequest forms are important means of communication between physicians and diagnostic service providers. Pre-analytical errors account for over two thirds of errors encountered in diagnostic service provision. The importance of adequate completion of request forms is usually underestimated by physicians which may result in medical errors or delay in instituting appropriate treatment. The aim of this study was to audit the level of completion of request forms presented at a multidisciplinary diagnostic center.MethodsA review of all requests forms for investigations which included radiologic, laboratory and cardiac investigations received between July and December 2011 was performed to assess their level of completeness. The data was entered into a spreadsheet and analyzed.ResultsOnly 1.3% of the 7,841 request forms reviewed were fully completed. Patient's names, the referring physician's name and gender were the most completed information on the forms evaluated with 99.0%, 99.0% and 90.3% completion respectively. Patient's age was provided in 68.0%, request date in 88.2%, and clinical notes/ diagnosis in 65.9% of the requests. Patient's full address was provided in only 5.6% of requests evaluated.ConclusionThis study shows that investigation request forms are inadequately filled by physicians in our environment. Continuous medical education of physicians on the need for adequate completion of request forms is needed.

IntroductionCardiovascular risk factors are prevalent in HIV-positive patients which places them at increased risk for cardiovascular disease (CVD). We aimed to determine the risk factors and risk assessment for CVD in HIV-positive patients with and without antiretroviral therapy.MethodsThis was a cross-sectional study of HIV-positive patients attending the Lagos University Teaching Hospital, Nigeria. Anthropometric and blood pressure measurements were performed; fasting lipid profile, plasma glucose, homocysteine and hsCRP were determined, as well as prevalences and risk assessments. Statistical tests were used to compare the groups and p-value <0.05 was considered to be significant.Results283 subjects were recruited for this study (100 HIV-positive treatment-naive, 100 HIV-positive treated and 83 HIV negative controls). Compared to the controls, mean (sd) values were significantly higher among HIV-treated subjects: waist circumference = 88.7 (10.4), p = 0.035; systolic bp= 124.9 (20.7), p = 0.014; glucose= 5.54 (1.7), p = 0.015; triglyceride= 2.0 (1.2), p < 0.001; homocysteine= 10.9 (8.9-16.2), p = 0.0003; while hsCRP= 2.9 (1.4-11.6), p = 0.002 and HDL-C = 0.9 (0.4), p = < 0.0001 were higher among the HIV-naïve subjects. Likewise, higher prevalences of the risk factors were noted among the HIV-treated subjects except low HDL-C (p < 0.001) and hsCRP (p = 0.03) which were higher in the HIV-naïve group. Risk assessment using ratios showed high risk for CVD especially in the HIV-naïve group. The median range for Framingham risk assessment was 1.0 - 7.5%.ConclusionRisk factors and risk assessment for CVD are increased in HIV-positive patients with and without antiretroviral therapy. Routine evaluation and risk assessment for CVD irrespective of therapy status is necessary to prevent future cardiovascular events.

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The quality of the clinical laboratory, defined as accurate, reliable and timely reporting of test results, has a direct impact on patient care. As much as 70% of all medical diagnosis relies on laboratory testing. 1,2 The impact of errors in laboratory testing may be immense including delayed diagnosis, misdiagnosis, wrong and inappropriate treatments, treatment complications, fatalities and financial waste. 2,3 The clinical laboratory plays a major role in detection of diseases (screening and confirmatory testing), staging and subclassification of diseases, monitoring of response to therapy, prognosis as well as guiding choice of therapeutic options for best outcomes. The issue of laboratory quality is therefore crucial and requires prompt and continual assessments of its current state and service gaps, followed by appropriate responses for quality improvement.Laboratory quality addresses meeting standards and benchmarks expected in a laboratory practice setting. Laboratory quality centres on reliable testing with negligible or no errors for users and patients. The laboratory quality management system, a management model, looks at the entire system that affects quality of laboratory performance. Its building blocks, otherwise termed quality system essentials, include 12 modules according to the International Organization for Standardization, ISO (organization, personnel, equipment, purchasing and inventory, process control, information management, documents and records, occurrence management, assessment, process improvement, customer service, facilities and safety). 4 Quality cannot be improved without being measured. In a 2013 survey by Schroeder et al, 5 most sub-Saharan African (SSA) countries did not have an internationally accredited laboratory. In Kampala, Uganda, only 0.3% of medical laboratories met international standards. In Nigeria, only two laboratories were internationally accredited to ISO 15189:2012 by May 2013. 5 Lagos (the former capital city) is the most populous state in the Nigerian federation with an estimated population of at least 20 million persons. 6 Anecdotal evidence reveals that private practice delivers over 60% of health care (including laboratory services) in Lagos state. The objective of this project was to test and characterize the state of laboratory quality systems in private clinical laboratory practice in Lagos, Nigeria, identify quality failures and proffer models for improvements. A pilot, cross-sectional survey of private laboratories in Lagos State was conducted. Statutorily, HEFAMAA (Health Facility Accreditation and Monitoring Agency), a parastatal of the Ministry of Health, Lagos State, is responsible for registering and monitoring all health facilities in Lagos State, including medical laboratories. On examining the HEFAMAA directory in October 2017, Lagos had over 2500 registered health facilities including 262 private medical laboratories. There were 158 public health institutions (including research laboratories, tertiary, secondary and comprehensive primary centr...