Harmonisation of specialist training and continuing professional development in laboratory medicine: a long but necessary journey

Beastall, G. H.

doi:10.1515/cclm-2014-1005

Cited by 9 publications

(7 citation statements)

References 14 publications

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“…One of the reasons for this discrepancy is the assay used for 25(OH)D measurements. Indeed, some assays, particularly the one used in that study (VIDAS, bioMérieux), are known to underrecover 25(OH)D in African subjects [23], whereas the Fujirebio Lumipulse assay that we used in our study is much less affected [18]. It is not entirely clear why African subjects behave differently in terms of their 25(OH)D profile, but this could be partly due to differences in the polymorphism of vitamin D–binding protein [24].…”

Section: Discussionmentioning

confidence: 99%

“…Third-generation assays for PTH (whole PTH) and 25(OH)D were conducted using the Fujirebio Lumipulse G 1200 analyser (Fujirebio, Tokyo, Japan). Performance of the 25(OH)D assay has been recently described [18]. The third-generation PTH assay does not cross-react with N-truncated PTH fragments that accumulate in CKD patients [19], since the antibody used only recognizes the first four amino acids of the peptide.…”

Section: Methodsmentioning

confidence: 99%

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Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines

Cavalier

Yayo

Attoungbre-Hauhouot

et al. 2018

Clinical Kidney Journal

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Background The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend targets based on multiples of the upper limit of normal (ULN) of parathyroid hormone (PTH) concentration. However, the ULN has not always been correctly established by manufacturers. While it is known that the ULN is supposed to be higher in African Americans than in Caucasians, it is largely unknown in Africans. Methods We established the ULN of PTH concentration in a population of 240 healthy Ivorians using second- and third-generation PTH assays before and after supplementation with 100 000 IU of cholecalferol. We measured the levels of PTH, bone alkaline phosphatase, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in 100 haemodialysed Ivorian patients. Results The prevalence of vitamin D deficiency in Ivory Coast is low. The ULN obtained using the third-generation PTH assay was similar to that obtained in Caucasians but was higher when PTH was measured using the second-generation PTH assay. According to the KDIGO guidelines, ∼20% of the haemodialysed patients were below twice the ULN and 30% were above nine times the ULN. Approximately 25% of the patients were even >12 times the ULN. We observed a discrepancy in the results between the two PTH assays (14%) that was relatively more important than what we observed from previous studies in Caucasians using the same strategy. Conclusions We found a low prevalence of vitamin D deficiency in a tropical country like Ivory Coast. We also established the PTH reference range, which could prove useful for the follow-up of haemodialysed patients, particularly for the large number of patients suffering from secondary hyperparathyroidism who are at high risk of adverse bone events.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines

Cavalier

Yayo

Attoungbre-Hauhouot

et al. 2018

Clinical Kidney Journal

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“…This experience emphasizes the importance of monitoring and controlling the many factors which are only apparently beyond the jurisdiction of the laboratory but are, on the contrary, the same problem of medical appropriateness and scientific method to the best approach to the sanitary system. [26][27][28][29][30] …”

Section: Discussionmentioning

confidence: 99%

Appropriate Umbilical Stem Cells Prescriptions and Tests in Italy: Not Conforming Behaviours

Parco¹,

Morgutti²,

Vascotto³

2016

International Journal of Advance in Medical Science

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The aim of this work is to study the impact of formal errors in obstetric-gynaecologic prescriptions and tests validation, especially related to cord blood collection, at a Children's Hospital of Trieste (cape town of FVG region). To this purpose had been performed a monitoring, during 2013-14s, to improve appropriateness of prescriptions related to stem cells collection and to make more suitable and safe transplants and related medical cares.Medical prescriptions were monitored for 24 months (from 2013 January to 2014 December), and studied with a χ 2 test before and after analysis not in compliance with the activities, and was introduced a management protocol to improve the external quality assessment (EQA) of the related tests.The comparison of prescriptions and related tests during 2014-15s has highlighted a significant decreasing of not appropriate requests, mistakes of prescriptions about obstetric exemptions (p<0.05), and an improvement of 2 tests out standard deviation (SD), with a good entry of EQA in the first or in the second SD.

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“…Un tema ancora irrisolto è l'armonizzazione delle conoscenze e delle competenze degli specialisti in Medicina di Laboratorio, almeno all'interno dell'Unione Europea, anche alla luce delle differenze nel nome, background culturale, organizzazione delle sub-specialità, lunghezza e contenuto della formazione, responsabilità professionali, requisiti per il riconoscimento professionale e conferma dello stesso in ambito UE [17]. In un recente editoriale [44] Graham Beastall riconosce che la strada dell'armonizzazione è piuttosto lunga e che le prospettive future credibili sono relative non tanto a un'irrealistica unificazione dei contenuti e delle pratiche della specialità e delle professioni mediche e non, ma alla messa a punto di standard e formazioni che costituiscono un quadro di insieme per ridurre la variabilità degli approcci delle diverse sub-specialità e dei diversi contesti socio-professionali. Altri punti da sviluppare in un'ottica di armonizzazione sono il ruolo della leadership delle equipe di laboratorio che deve essere orientata alla clinica e le caratteristiche del continuing professional development (CPD) tale da consentire non solo l'aggiornamento delle conoscenze, ma un'armonizzazione nello sviluppo delle competenze.…”

Section: La Trasformazione Delle Professioniunclassified

Il mutamento delle professioni della Medicina di Laboratorio

Cappelletti

2015

Riv Ital Med Lab

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Riassunto Lo sviluppo delle professioni in Medicina di Laboratorio è largamente determinato dall'evoluzione scientifica, disciplinare e organizzativa che il Laboratorio Clinico ha subito soprattutto negli ultimi venticinque anni. In conseguenza delle innovazioni tecnologiche, della pressione per la diminuzione dei costi, ma anche delle nuove necessità dei pazienti, il Laboratorio Clinico ha subito trasformazioni (contestuale centralizzazione e decentralizzazione) che hanno determinato la rottura spazio-temporale del rapporto medico-paziente e l'amplificazione geometrica dell'interfaccia clinica-laboratorio con le conseguenze della moltiplicazione e complessità dei temi della sicurezza/qualità delle analisi, dell'interpretazione clinicamente adeguata e fondata e delle abilità comunicative in favore di soggetti diversi dal tradizionale medico "curante". Lo scenario attuale è dominato dallo sviluppo dell'era elettronica, avvenuto nel decennio scorso con la comparsa del "paziente digitale", della Hyperlinked Society e di ciò che è definito Health 2.0 e Medicine 2.0 (doctor Google, doctor Smartphone e Wearable Health Technology). Dettato dai cambiamenti intervenuti, il mutamento professionale è stato imponente: crescita professionale e legislativa dei tecnici di laboratorio, prevalente lavoro all'interfaccia dei dirigenti con maggiori accenti per la specializzazione tecnica o il rapporto clinico, necessità di aumentare le competenze in particolare comunicative. In questo quadro la Società Scientifica ha prodotto un'elaborazione concettuale che prevede: (1) la necessità di una nuova alleanza tra le professioni per la creazione di un'equipe multi-disciplinare e multi-professionale articolata nelle sue autonomie e responsabilità con attività collaborativa e coordinata tenuta insie-B P. Cappelletti

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Harmonisation of specialist training and continuing professional development in laboratory medicine: a long but necessary journey

Cited by 9 publications

References 14 publications

Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines

Vitamin D, bone alkaline phosphatase and parathyroid hormone in healthy subjects and haemodialysed patients from West Africa: impact of reference ranges and parathyroid hormone generation assays on the KDIGO guidelines

Appropriate Umbilical Stem Cells Prescriptions and Tests in Italy: Not Conforming Behaviours

Il mutamento delle professioni della Medicina di Laboratorio

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