Quality of interpretative commenting on common clinical chemistry results in the Asia-Pacific region and Africa

Vasikaran, Samuel; Lai, Leslie C.; Sethi, Sunil; Lopez, Joseph; Sikaris, Ken

doi:10.1515/cclm.2009.225

Cited by 19 publications

(8 citation statements)

References 17 publications

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“…The disease may also be unrecognised due to the challenged health-care system, with some facilities having only 7% of the required number of doctors [18].Enhancing awareness of Addison’s disease may be achieved by providing annotations on chemical pathology reports alerting clinicians to the possibility that primary hypoadrenalism may coexist with compatible biochemistry. This should be tempered by the fact that recent interpretive commenting was diverse, incorrect in some cases and potentially misleading [19]. Awareness of Addison’s disease should be raised among medical students.…”

Section: Discussionmentioning

confidence: 99%

Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

Ross

Levitt

2013

PLoS ONE

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BackgroundAddison’s disease is a potentially life-threatening disorder, and prompt diagnosis, and introduction of steroid replacement has resulted in near normal life-expectancy. There are limited data describing the clinical presentation of Addison’s disease in South Africa. It is hypothesised that patients may present in advanced state of ill-health, compared to Western countries.PatientsA national database of patients was compiled from primary care, referral centres and private practices. 148 patients were enrolled (97 white, 34 mixed ancestry, 5 Asian and 12 black).MethodsDemographic and clinical data were elicited using questionnaires. Biochemical data were obtained from folder reviews and laboratory archived results.ResultsThe majority of the cohort was women (62%). The median and inter-quartile age range (IQR) of patients at enrolment was 46.0 (32.0–61.0) years, with a wide range from 2.8–88.0 years. The median and IQR age at initial diagnosis was 34.0 (20.0–45.0) years (range 0.02–77.0) years, indicating that at the time of enrolment, the patients, on average, were diagnosed with Addison’s disease 12 years previously. Hyperpigmentation was observed in 76%, nausea and vomiting occurred in more than 40%, and weight loss was noted in 25%. Loss of consciousness as a presenting feature was recorded in 20%. with a 95% confidence interval [CI] of (14–28%) and shock occurred in 5% CI (1.5–8.5%). Case-finding was recorded at 3.1 per million.ConclusionsThe usual constellation of hyperpigmentation, nausea, vomiting and weight loss suggests Addison’s disease, but a significant proportion present with an advanced state of ill-health and Addisonian crises. A lower prevalence rate, compared to Western countries is suggested.

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Section: Discussionmentioning

confidence: 99%

Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

Ross

Levitt

2013

PLoS ONE

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“…Since 1998, the Royal College of Pathologists in the UK has defined guidelines for interpretative comments in clinical biochemistry but further efforts are needed by professional organization and scientific societies to better define the mechanisms and responsibilities needed to assure quality and safety to this type of interpretation. EQA programs examining the interpretation of laboratory tests have been introduced in the past decade, particularly in the UK, Australasia, Italy, and Asia-Pacific [4,[20][21][22]. Analysis of proficiency data from EQA programs, together with professional initiatives to identify the appropriate expertise and ideal qualifications of laboratory scientists issuing interpretive reports, may ensure better quality of interpretative comments and reduce the risk of associated errors.…”

Section: Interpretative Comments Vary In Quality; Implicationsmentioning

confidence: 99%

Assuring the quality of interpretative comments in clinical chemistry

Vasikaran¹,

Sikaris

Kilpatrick

et al. 2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The provision of interpretative advice on laboratory results is a post-analytic activity and an integral part of clinical laboratory services. It is valued by healthcare workers and has the potential to prevent or reduce errors and improve patient outcomes. It is important to ensure that interpretative comments provided by laboratory personnel are of high quality: comments should be patientfocused and answer the implicit or explicit question raised by the requesting clinician. Comment providers need to be adequately trained and qualified and be able to demonstrate their proficiency to provide advice on laboratory reports. External quality assessment (EQA) schemes can play a part in assessing and demonstrating the competence of such laboratory staff and have an important role in their education and continuing professional development. A standard structure is proposed for EQA schemes for interpretative comments in clinical chemistry, which addresses the scope and method of assessment including nomenclature and marking scales. There is a need for evidence that participation in an EQA program for interpretative commenting facilitates improved quality of comments. It is proposed that standardizing goals and methods of assessment as well as nomenclature and marking scales may help accumulate evidence to demonstrate the impact of participation in EQA for interpretative commenting on patient outcome.

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“…Indicators in the analytical phase might include choice of the most appropriate methods, evaluation of their performance at critical decision-making values and protocols for evaluating analytical errors. The postanalytical phase might include interpretative advice, 7,8 reflective testing 9 and telephoned critical results. 10 In summary, we have surveyed clinical biochemists to determine whether quality indicators can be used as a measure of clinical quality.…”

Section: What Should We Do Nextmentioning

confidence: 99%

Clinical quality indicators in laboratory medicine: a survey of current practice in the UK

Barth

2011

Ann Clin Biochem

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Background: Clinical outcomes are the current paradigm for assessing the performance of health institutions. In contrast, clinical laboratories are assessed on largely operational criteria. Methods: An invitation to an online questionnaire was sent to all members of the Association for Clinical Biochemistry in the UK and Eire. All data were normalized to the total number of respondents irrespective of how many respondents answered each question. Results: A total of 335 individuals responded to the survey. A further six responses were discarded as the respondents worked outside clinical laboratories. Overall responses showed that of the selected quality indicators, responses ranged from 7% to 84%. In general, although most laboratories provided an advisory and interpretative service, there was little evaluation and audit of this component of the service. The majority of respondents reported a written critical (alert) list and a hospital point-of-care committee. Conclusion: This survey has explored clinical quality indicators in the preanalytical, analytical and postanalytical phases of laboratory practice. This should act as a template for laboratory assessment and clinical quality improvement.

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Quality of interpretative commenting on common clinical chemistry results in the Asia-Pacific region and Africa

Cited by 19 publications

References 17 publications

Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

Addison’s Disease Symptoms – A Cross Sectional Study in Urban South Africa

Assuring the quality of interpretative comments in clinical chemistry

Clinical quality indicators in laboratory medicine: a survey of current practice in the UK

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