Results From a Randomized Trial of Intensive Glucose Management Using CGM Versus Usual Care in Hospitalized Adults With Type 2 Diabetes: The TIGHT Study.

Objective: To evaluate whether continuous glucose monitoring (CGM) could assist providers in intensifying glycemic management in hospitalized patients with type 2 diabetes.

Research Design And Methods: At six academic hospitals, adults with type 2 diabetes hospitalized in a non-intensive care setting were randomly assigned to either standard therapy with glucose target 140-180 mg/dL (standard group) or intensive therapy with glucose target 90-130 mg/dL guided by CGM (intensive group). The primary outcome was mean glucose measured with CGM (blinded in standard group), and the key secondary outcome was CGM glucose <54 mg/dL.

External quality assessment performance in ten countries: an IFCC global laboratory quality project.

Objectives: This study aimed to assess the validity of external quality assessment (EQA) laboratory results across various cultural and environmental contexts and to identify potential improvement areas.

Methods: The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on Global Laboratory Quality (TF-GLQ) conducted a 2-year study (2022 and 2023) in which EQA materials, related software and online training was provided by a commercial vendor to 100 laboratories in ten IFCC member society countries. The results were analysed on a monthly basis by the TF-GLQ, to show the number of submissions per country, tests per lab, acceptability rates, random failures and to get a measure of which analytes performed poorly.

External quality assessment practices in medical laboratories: an IFCC global survey of member societies.

Objectives: Clinical laboratory results are required for critical medical decisions, underscoring the importance of quality results. As part of total quality management, external quality assessment (EQA) is a vital component to ensure laboratory accuracy. The goal of this survey was to evaluate the current status of global laboratory quality systems and assess the need for implementation, expansion, or harmonization of EQA programs (EQAP) for Clinical Chemistry and Laboratory Medicine.

Defining acceptable limits for the metrological traceability of specific measurands.

Although manufacturers are compelled by the European IVD Directive, 98/79/EC, to have traceability of the values assigned to their calibrators if suitable higher order reference materials and/or procedures are available, there is still no equivalence of results for many measurands determined in clinical laboratories. The adoption of assays with metrological traceable results will have a significant impact on laboratory medicine in that results will be equivalent across different laboratories and different analytical platforms. The IFCC WG on Allowable Errors for Traceable Results has been formed to define acceptable limits for metrological traceability chains for specific measurands in order to promote the equivalence of patient results.

An Apple-core Lesion in the Colon: An Infectious Etiology.

Gastrointestinal involvement occurs in about 70% to 90% of histoplasmosis cases but is usually not the initial manifestation. We present the case of a 52-yearold HIV-positive woman who presented with gastrointestinal symptoms and an apple-core lesion on CT scan of the abdomen. The patient had been diagnosed with histoplasma colitis eight months earlier and was started on long-term itraconazole therapy.

Effect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure.

Background: Difficulty in distinguishing congestive heart failure (HF) from other causes of dyspnoea in the emergency department (ED) may result in delay in appropriate treatment and referral. Although the diagnostic value of serum amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is well documented, the impact on diagnostic certainty of providing these results to ED physicians is not well studied. We sought to determine the effect of providing NT-proBNP results on diagnostic certainty of physicians managing patients presenting to the ED with suspected HF.

Use of Capability Index to improve laboratory analytical performance.

* For detection of errors where the standard deviation is wide compared to clinical requirements, consider use of the Capability Index (Cps). * Cps is defined as 'Allowable Limit of Error divided by the standard deviation of between-batch QC measurement'. * 'Capable' assays have Cps >4 compared with 'incapable' ones with Cps <4.

The determination of the 99th centile level for troponin assays in an Australian reference population.

Background: Current guidelines for the diagnosis and risk assessment of patients presenting with myocardial infarction recommend a single decision cut-off point for cardiac troponin (cTn) based on the 99th centile of a reference population. The 99th centile level for eight troponin assays was determined in an apparently cardio-healthy Australian reference population.

Methods: Nine laboratories measured troponin in serum and plasma collected from 111 reference individuals.

EQA from an Australian perspective.

Enrolment in external quality assurance programs is part of the accreditation process for medical laboratories in Australia, with the majority of Australian laboratories being enrolled in programs from RCPA Quality Assurance Programs Pty Limited, a company owned by the Royal College of Pathologists of Australasia. An important feature of these programs is that they have been developed with the involvement and contribution of the profession. For example, the Chemical Pathology programs are a joint venture between the company and the Australasian Association of Clinical Biochemists (AACB).

Effect of ultrasound beam angle on equine articular cartilage thickness measurement.

The purpose of this study was to determine if variation in the ultrasound beam angle would affect cartilage thickness measurement performed with B-mode ultrasonography. Transverse sections of six fresh equine middle phalanges were obtained from necropsy. Ultrasonographic images of the proximal articular cartilage were obtained in a water bath, in a plane parallel and adjacent to the section plane using a 5-10 MHz linear transducer.

Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement.

The systematic staging of chronic kidney disease (CKD) by glomerular filtration measurement and proteinuria has allowed the development of rational and appropriate management plans. One of the barriers to early detection of CKD is the lack of a precise, reliable and consistent measure of kidney function. The most common measure of kidney function is currently serum creatinine concentration.

Bilirubin measured on a blood gas analyser: a suitable alternative for near-patient assessment of neonatal jaundice?

The reliability of a recently released total bilirubin assay for a blood gas analyser was assessed in two Australian hospital laboratories. The instrument computes total bilirubin concentration from multi-wavelength absorbance measurements of undiluted whole blood or plasma. Performance of the Radiometer ABL 735 blood gas analyser bilirubin method (software version 3.

Evaluation of amylase and lipase in the diagnosis of acute pancreatitis.

Background: The diagnosis of acute pancreatitis relies heavily on a raised amylase.

Methods: In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls (n = 35), indeterminate as to pancreatitis (n = 189) or exclusions (non-pancreatitis diseases where amylase may be elevated; n = 53).

Results: Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%.

Amylase measurement with 2-chloro-4-nitrophenyl maltotrioside as substrate.

The use of 2-chloro-4-nitrophenyl maltotrioside (CNP-G3) as substrate to measure amylase (EC 3.2.1.

The effect of (L)-cysteine and (L)-2-oxothiazolidine-4-carboxylic acid (OTZ) on urinary oxalate excretion: studies using a hyperoxaluric rat model.

Purpose: To determine the efficacy of (L)-cysteine and (L)-2-oxothiazolidine-4-carboxylic acid (OTZ) in reducing urinary oxalate excretion under hyperoxaluric conditions and to determine whether by inclusion of glycolate in a standard diet, cysteine:glyoxylate adduct can be detected in hyperoxaluric rats given either compound.

Materials And Methods: Hyperoxaluria (200% above basal) was induced 2 days prior to commencement of the studies and maintained throughout. After a 3 days baseline, animals were randomly allocated to a control or treatment group.

The changing face of pathology--an Australian perspective.

Despite Government at various levels in Australia attempting to force restraint by limiting financial resources, modern medicine and community expectations will continue to place demands on health services. The principal illnesses confronting society are unlikely to change, with conditions such as cancer, cardiovascular disease and diabetes remaining at their current prevalence. Early and more sophisticated detection and monitoring of these diseases will be required, with concomitant increases in costs.

(D)-penicillamine increases hepatic oxalate production resulting in hyperoxaluria.

Purpose: To determine whether (D)-penicillamine is effective in reducing hepatic oxalate production and urinary oxalate excretion.

Materials And Methods: (D)-Penicillamine was administered orally to rats to determine its effect on urinary oxalate excretion and used in isolated rat hepatocytes to investigate the effect of (D)-penicillamine on oxalate production from glycolate. Studies involving hepatic aminotransferases and hepatocytes isolated from (D)-penicillamine treated rats were used to clarify the discrepancy between the in vitro and in vivo results.

Giant cell arteritis: diagnosis and management.

Giant cell arteritis should not be a diagnosis of exclusion, an afterthought, or a last thought. There is urgency to establishing this diagnosis and initiating therapy. All practitioners who treat adults will be confronted with these patients.