Audit of sweat testing: A first report from Italian Cystic Fibrosis Centres

Cirilli, Natalia; Padoan, Rita; Raia, Valeria

doi:10.1016/j.jcf.2008.03.005

Cited by 13 publications

(18 citation statements)

References 19 publications

(22 reference statements)

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“…Our study is in line with recently published studies that revealed several areas of concerns ranging from patients’ information, internal and external quality assessment to the use of appropriate reference ranges despite of internationally accepted guidelines that made a path to standardised performance of sweat test ( 13 , 14 , 25 ). …”

Section: Discussionsupporting

confidence: 88%

“…EQA, together with internal quality control (IQC) is an optimal tool for monitoring analytical phase of testing. Although all of them must be part of sweat test performance in clinical laboratories, our results reveal lack of internal quality assessment in some Croatian MBL and previously published Italian sweat test survey stressed low access of laboratories in external quality assessment ( 13 ). One of possible obstacles for Croatian MBL may be limited selection of methods for evaluation offered by providers of commercial quality controls nevertheless an “in-house” IQC is allowed by current guidelines.…”

Section: Discussionmentioning

confidence: 51%

“…In four centres (4/10) sweat stimulation and collection was performed in a clinic by clinical stuff exclusively. It seems a common practice across Europe that sweat stimulation and collection are settled in a clinic and a laboratory ( 13 , 14 ). Regarding patient information, current guidelines recommend that the centre should provide written or audio/visual material to patients and parents attending the test ( 8 , 9 ).…”

Section: Resultsmentioning

confidence: 99%

“…In era of published international sweat test performance guidelines it seems that inconsistencies in carrying out a sweat test are still present in everyday practice ( 13 , 14 ). Considering published reports about real-life sweat test challenges, a question about national sweat test practice emerged in light of related data lack.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia

Aralica¹,

Krleža²

2017

Biochem Med

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IntroductionSweat test has a diagnostic role in evaluation of cystic fibrosis. Its performance includes sweat stimulation, collection and analysis. All listed may be sources of inconsistencies in everyday practice. The aim of this study was an evaluation of external quality assessment (EQA) of sweat chloride measurement including sweat test performance in medical biochemistry laboratories in Croatia.Materials and methodsEQA for sweat chloride measurement was provided by Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM) in five consecutive exercises to medical biochemistry laboratories (MBL) that offered sweat testing. A questionnaire regarding all phases of testing was mailed to involved MBL (N = 10). Survey results were compared to current guidelines for sweat test performance.ResultsReported results of EQA in 2015 exercises showed coefficients of variation (CV) from 28.9%, 29.0% to 35.3%, respectively. An introduction of uniform sweat chloride measurement protocol resulted in CV of 15.5% and 14.7% reported in following two exercises in 2016. All MBL included in this study replied to the questionnaire. Results reported by MBL indicated: lack of patient information policy (7/10), use of unacceptable electrodes (6/9), misuse of minimum of acceptable sweat weight (6/9), lack of internal quality assessment (5/9) and recommended reference ranges (5/9 and 4/9). Agreements to guidelines were found in approach to unsuitable patients (9/10) and sweat collection (8/9).ConclusionPresented results indicate major weak points of current practice in sweat test performance in Croatian MBL and stress the need for its standardization on a national level.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 51%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia

Aralica¹,

Krleža²

2017

Biochem Med

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“…The Cystic Fibrosis Foundation summarized its guidelines in 23 topics in order to ensure the appropriate quality of STs 11 12 The topics are based on the classical GC method of pilocarpine stimulation, 9 use of filter paper or Macroduct (r) Sweat Collection System (MSCS; EliTechGroup, Paris, France) for sweat collection, and determination of Cl − by manual titration or by a coulometric quantitative test 9 10 , 12 - 15 The qualitative method is not accepted for confirming a definitive diagnosis of CF 10 …”

Section: Introductionmentioning

confidence: 99%

Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil

et al. 2017

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Objective:The sweat test (ST) measures chloride levels in sweat and is considered the gold standard for the diagnosis of cystic fibrosis (CF). However, the reliability of a ST depends on their being performed by experienced technicians and in accordance with strict guidelines. Our aim was to evaluate how sweat stimulation, sweat collection, and chloride measurement are performed at 14 centers (9 public centers and 5 private centers) that routinely perform STs in the state of São Paulo, which has the highest frequency of CF in Brazil. Methods: This was a cross-sectional cohort study, using a standardized questionnaire administered in loco to the staff responsible for conducting STs. Results: No uniformity regarding the procedures was found among the centers. Most centers were noncompliant with the international guidelines, especially regarding the collection of sweat (the samples were insufficient in 10-50% of the subjects tested); availability of stimulation equipment (which was limited at 2 centers); modernity and certification of stimulation equipment (most of the equipment having been used for 3-23 years); and written protocols (which were lacking at 12 centers). Knowledge of ST guidelines was evaluated at only 1 center. Conclusions: Our results show that STs largely deviate from internationally accepted guidelines at the participating centers. Therefore, there is an urgent need for standardization of STs, training of qualified personnel, and acquisition/ certification of suitable equipment. These are essential conditions for a reliable diagnosis of CF, especially with the increasing demand due to newborn screening nationwide, and for the assessment of a possible clinical benefit from the use of modulator drugs.

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Sixty-five years since the New York heat wave: Advances in sweat testing for cystic fibrosis

et al. 2013

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The sweat test remains important as a diagnostic test for cystic fibrosis (CF) and has contributed greatly to our understanding of CF as a disease of epithelial electrolyte transport. The standardization of the sweat test, by Gibson and Cooke [Gibson and Cooke (1959) Pediatrics 1959;23:5], followed observations of excessive dehydration amongst patients with CF and confirmed the utility as a diagnostic test. Quantitative pilocarpine iontophoresis remains the gold standard for sweat induction, but there are a number of collection and analytical methods. The pathophysiology of electrolyte transport in sweat was described by Quinton [Quinton (1983) Nature 1983;301:421-422], and this complemented the developments in genetics that discovered the cystic fibrosis transmembrane conductance regulator (CFTR), an epithelial-based electrolyte transport protein. Knowledge of CF has since increased rapidly and further developments in sweat testing include: new collection methods, further standardization of the technique with international recommendations and age related reference intervals. More recently, sweat chloride values have been used as proof of effect for the new drugs that activate CFTR. However, there remain issues with adherence to sweat test guidelines in many countries and there are gaps in our knowledge, including reference intervals for some age groups and stability of sweat samples in transport. Furthermore, modern methods of elemental quantification need to be explored as alternatives to the original analytical methods for sweat electrolyte measurement. The purpose of this review is therefore to describe the development of the sweat test and consider future directions.

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Audit of sweat testing: A first report from Italian Cystic Fibrosis Centres

Abstract: Our study showed areas of inconsistencies in sweat testing current practices in Italy and highlights the need for evidence based national guidelines to improve practice and management strategies.

Cited by 13 publications

References 19 publications

Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia

Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia

Sweat test and cystic fibrosis: overview of test performance at public and private centers in the state of São Paulo, Brazil

Sixty-five years since the New York heat wave: Advances in sweat testing for cystic fibrosis

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