Search

OBJECTIVE--To examine whether serum 25-hydroxyvitamin D (25OHD) and dietary calcium predict incident type 2 diabetes and insulin sensitivity. RIESEARCN DESIGN AND METNODS--A total of 6,537 of the 11,247 adults evaluated [...]

OBJECTIVE--evaluate A1C for screening and diagnosis of undiagnosed type 2 diabetes defined by oral glucose tolerance testing in clinical and general populations. RESEARCH DESIGN AND METHODS--A1C cut offs (≤5.5% to [...]

This study aims to review current laboratory reporting strategies across Australia and New Zealand with a view to propose a more useful template for reporting serum testosterone in the context of prostate cancer.

Two cohorts of 11,855 and 150 participants were studied for biochemical or morphologic evidence of impending or existing bone disease. Evidence supporting a vitamin D–"insufficient" state was limited.

Low serum 25-hydroxyvitamin D (25[OH]D) levels have been associated with chronic kidney disease in cross-sectional studies. However, this association has not been studied prospectively in a large general population–based cohort.

Prostate cancer is a slowly progressing but potentially lethal disease. In order to cure it we must detect it while it remains organ confined. Because of the slow course of the disease, prostate cancer screening trials take a long time to show any benefit and in that time the measurement and interpretation of prostate specific antigen (PSA) concentrations have changed, and biopsy and treatment protocols have also developed. Nevertheless, measuring PSA in the blood remains the main tool we have at hand and improvements have been made but not fully utilised. Improvements in the specificity of PSA include age-related PSA reference limits, free to total PSA ratio and PSA dynamics such as doubling time. Improvements in sensitivity have progressed to defining that we should focus on the 50% of men with PSA concentrations above their population median, as men with PSA below the median are very unlikely to develop or suffer from prostate cancer. Like any medical procedure, men should be informed of the risks and benefits but this should ideally be done in a manner that encourages informed choice based on their own understanding and feelings, rather than informed compliance based on the views of others.

We present a descriptive analysis of the 10 case reports distributed in the Royal College of Pathologists of Australasia (RCPA) and the Australasian Association of Clinical Biochemists (AACB) Chemical Pathology Patient Report Comments Program to assess the quality of interpretative commenting in clinical biochemistry in 2001.

Vitamin B12 deficiency is usually due to dietary factors, however clinicians always consider the possibility of autoimmune pernicious anaemia. The Schillings test is no longer routinely available and therefore diagnosis often includes the specific intrinsic factor auto-antibodies (IFAb) +/– parietal cell auto-antibodies (PCAb). Holo-transcobalamin (HoloTC), also known as active B12, has proved to be a more reliable indicator of B12 deficiency than measuring total B12 (TB12). We therefore reviewed our experience with this test to see if HoloTC was more closely associated with pernicious anaemia testing.

Urine analysis for Bence-Jones protein (BJP) has been a test for detection of free light chains (FLC) in the urine for over a century. The method, however, is not standardised. Urine from the same patient is sometimes concentrated by 10–50 fold and sometimes not prior to analysis.

Vitamin B12 deficiency is an important cause of neurological and haematological disease. The clinical signs are non-specific and haematological changes may be masked by concurrent iron deficiency. Serum total vitamin B12 (TB12) measurement is the recommended first-line test but the result can be misleading because of method biases approaching 30% and the presence of different circulating forms of this vitamin. Approximately 80% of vitamin B12 in blood is bound in inert complexes with haptocorrin (Hapto-TC). The remainder is bound with transcobalamin (Holo-TC or ‘active B12’) which is the active fraction that enters cells for metabolic reactions involving homocysteine and methylmalonic acid.

The contemporary practice of pathology is heavily reliant upon information systems. These systems are becoming increasingly sophisticated and College Fellows are frequently required to have input on their design, selection, implementation and evaluation. Laboratories are adopting decision support technologies to support workflow management and clinical interpretation of pathology tests. The computationally intensive field of bioinformatics is growing rapidly especially in genomics laboratories while statistics, another informatics discipline, has always been an important part of Fellowship training. College Fellows have a professional duty of care, and also carry ethical and medico-legal responsibility, for the efficacy, reliability, safety and security of such systems. Significantly, the development of Health Informatics also proceeds apace in the wider medical community. Data mining tools, social media and decision support are expected to improve health resource utilisation, evidence-based practice, and clinical effectiveness. These tools will also become widely deployed as patients and health consumers have more control over health service delivery and expect an improved experience in their contact with the health system.

The main purpose of a reference interval is to have something to compare a patient’s initial result. Once we ask for a second test, it is probably more important to define whether that result is significantly different to the first result, as monitoring is a more sensitive way of assessing a patient’s health and uses that patient as their own baseline for comparison.

Any numerical result reported from the pathology laboratory should have a reference interval to assist clinicians with interpretation. Once called ‘normal ranges’, we have now agreed to avoid that term as it is difficult to confirm the ‘normality’ (or idealised health) of any individual, let alone a population. International guidelines (e.g., CLSI C28-A3) allow the use of indirect techniques (such as Bhattacharya) to derive reference intervals from laboratory databases when ‘most results, even in hospital and clinic patients, appear ‘normal’. Many pathologists are sceptical that ‘most’ of our results aren’t from healthy individuals and generally it is true that most patients having laboratory tests have a clinical complaint suggesting they aren’t healthy. We must therefore consider the clinician’s purpose in requesting any test. Does the clinician aim to (i) distinguish a diseased patient from a healthy individual or do they in fact (ii) aim to distinguish two types of patients, one with a particular disease versus one with the same complaint but without that disease? It could be that the ideal reference population is not those elusive ‘healthy individuals’ but those many patients that do have a clinical complaint, but do not have a disease that alters the pathology test requested.