Sharing reference intervals and monitoring patients across laboratories - findings from a likely commutable external quality assurance program.

Objectives: Laboratory results are increasingly interpreted against common reference intervals (CRIs), published clinical decision limits, or previous results for the same patient performed at different laboratories. However, there are no established systems to determine whether current analytical performance justifies these interpretations. We analysed data from a likely commutable external quality assurance program (EQA) to assess these interpretations.

What's to Be Done About Laboratory Quality? Process Indicators, Laboratory Stewardship, the Outcomes Problem, Risk Assessment, and Economic Value: Responding to Contemporary Global Challenges.

Objectives: For 50 years, structure, process, and outcomes measures have assessed health care quality. For clinical laboratories, structural quality has generally been assessed by inspection. For assessing process, quality indicators (QIs), statistical monitors of steps in the clinical laboratory total testing, have proliferated across the globe.

Enhancing the Clinical Value of Medical Laboratory Testing.

The value of medical laboratory testing is often directed to the cost of testing however the clinical benefits of these tests are at least as important. Laboratory testing has an acknowledged widespread role in clinical decision making, and therefore a role in determining clinical outcome. Consequently, the value of laboratory testing should be considered in its role in affecting beneficial actions and outcomes.

Uncertainty in measurement and total error - are they so incompatible?

There appears to be a growing debate with regard to the use of "Westgard style" total error and "GUM style" uncertainty in measurement. Some may argue that the two approaches are irreconcilable. The recent appearance of an article "Quality goals at the crossroads: growing, going, or gone" on the well-regarded Westgard Internet site requires some comment.

Patterns of type 2 diabetes monitoring in rural towns: How does frequency of HbA1c and lipid testing compare with existing guidelines?

Objective: To indicate levels of monitoring of type 2 diabetes in rural and regional Australia by examining patterns of glycated haemoglobin (HbA1c) and blood lipid testing.

Design And Setting: Retrospective analysis of pathology services data from twenty regional and rural towns in eastern Australia over 24 months.

Participants: Of 13 105 individuals who had either a single HbA1c result ≥7.

Comparison of IFCC-calibrated HbA(1c) from laboratory and point of care testing systems.

Objective: WHO, IDF and ADA recommend HbA(1c) ≥6.5% (48 mmol/mol) for diagnosis of diabetes with pre-diabetes 6.0% (42 mmol/mol) [WHO] or 5.

Physiology and its importance for reference intervals.

Reference intervals are ideally defined on apparently healthy individuals and should be distinguished from clinical decision limits that are derived from known diseased patients. Knowledge of physiological changes is a prerequisite for understanding and developing reference intervals. Reference intervals may differ for various subpopulations because of differences in their physiology, most obviously between men and women, but also in childhood, pregnancy and the elderly.

The de ritis ratio: the test of time.

De Ritis described the ratio between the serum levels of aspartate transaminase (AST) and alanine transaminase (ALT) almost 50 years ago. While initially described as a characteristic of acute viral hepatitis where ALT was usually higher than AST, other authors have subsequently found it useful in alcoholic hepatitis, where AST is usually higher than ALT. These interpretations are far too simplistic however as acute viral hepatitis can have AST greater than ALT, and this can be a sign of fulminant disease, while alcoholic hepatitis can have ALT greater than AST when several days have elapsed since alcohol exposure.

Automation in clinical biochemistry: core, peripheral, STAT, and specialist laboratories in Australia.

Pathology has developed substantially since the 1990s with the introduction of total laboratory automation (TLA), in response to workloads and the need to improve quality. TLA has enhanced core laboratories, which evolved from discipline-based laboratories. Work practices have changed, with central reception now loading samples onto the Inlet module of the TLA.

CA125--a test with a change of heart.

CA125 is well known as a tumour marker for ovarian cancer. Like all tumour markers it is not specific for a specific tumour and may be elevated in benign disease. Even in ovarian cancer it seems that CA125 is derived from mesothelial production rather than from the cancer cells.