Implementation of the HbA1c IFCC unit --from the laboratory to the consumer: The New Zealand experience.

In 2007, an international consensus statement recommended that HbA1c results should be reported world-wide in IFCC units (mmol/mol) and also the more familiar derived percentage units using a master equation. In New Zealand, the HbA1c IFCC units have been successfully implemented and used exclusively since 3rd October 2011 (following a 2 year period of reporting both units) for both patient monitoring and the diagnosis of diabetes, with a diagnostic cut-off of ≥50 mmol/mol. The consultation process in New Zealand dates back to 2003, well before the international recommendations were made.

Understanding the new HbA1c units for the diagnosis of Type 2 diabetes.

In New Zealand laboratories the measurement of glycated haemoglobin (HbA1c) for diagnosis of diabetes is now only reported in SI units of mmol/mol. HbA1c is now recommended as the preferred test to diagnose diabetes in most circumstances. The requirement for a second positive test in asymptomatic individuals is retained.

Plasma poltergeists: a negative cortisol interference leading to a false diagnosis of adrenal insufficiency.

Introduction: Adrenal insufficiency is a rare life threatening condition with non-specific clinical signs and symptoms. This necessitates a high level of reliance on laboratory results for making the diagnosis.

Methods: We report a case involving an interference in cortisol measurement leading to spuriously low-cortisol measurements and the incorrect diagnosis and treatment of adrenal insufficiency.

From evidence to practice: consensus in cardiovascular risk assessment and diabetes.

Rigorously developed evidence based practice guidelines are necessary to promote clinical interventions that are consistent and most effective. Recommendations for treatment should be linked clearly to proven reduction in absolute risk, expressed as number needed to treat, rather than being based on the more commonly quoted and potentially misleading reduction in relative risk. Data published since 2003 has been incorporated in a 2009 revision of the New Zealand guideline for assessment and management of cardiovascular risk.

Can support and education for smoking cessation and reduction be provided effectively by midwives within primary maternity care?

Objective: To test the hypothesis that appropriate interventions delivered by midwives within usual primary maternity care, can assist women to stop or reduce the amount they smoke and facilitate longer duration of breast feeding.

Design, Setting And Participants: In a cluster randomised trial of smoking education and breast-feeding interventions in the lower North Island, New Zealand, midwives were stratified by locality and randomly allocated into a control group and three intervention groups. The control group provided usual care.