Provision of laboratory services for lipid analysis in the United Kingdom

Hutchesson, A. C. J.; O’Kane, Maurice; Neely, R. D. G.; Oleesky, D A

doi:10.1258/000456307780480891

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…Are clinical decision limits more useful than traditional reference intervals? Reference intervals were more commonly used 20 years ago [30,31], but increasingly, laboratories no longer quote 'healthy' reference intervals for analytes such as cholesterol [32] because they each have clinical decision limits; it seems that the latter have priority. The principle that clinical decision limits -associated with risk and clinical outcome -are superior to reference intervals has a similarity to the Stockholm Consensus for defining analytical quality [33].…”

Section: Reference Limits and Flagging Abnormal Resultsmentioning

confidence: 99%

Performance criteria of the post-analytical phase

Sikaris¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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Quality in healthcare is ideally at an optimal benchmark, but must be at least above the minimal standards for care. While laboratory quality is ideally judged in clinical terms, laboratory medicine has also used biological variations and state-of-the-art criteria when, as is often the case, clinical outcome studies or clinical consensus are not available. The post-analytical phase involves taking quality technical results and providing the means for clinical interpretation in the report. Reference intervals are commonly used as a basis for data interpretation; however, laboratories vary in the reference intervals they use, even when analysis is similar. Reference intervals may have greater clinical value if they are both optimised to account for physiological individuality, as well as if they are harmonised through professional consensus. Clinical decision limits are generally superior to reference intervals as a basis for interpretation because they address the specific clinical concern in any patient. As well as providing quality data and interpretation, the knowledge of laboratory experts can be used to provide targeted procedural knowledge in a patient report. Most profoundly critically abnormal results should to be acted upon to minimise the risk of mortality. The three steps in quality report interpretation, (i) describing the abnormal data, (ii) interpreting the clinical information within that data and (iii) providing knowledge for clinical follow-up, highlight that the quality of all laboratory testing is reflected in its impact on clinical management and improving patient outcomes.

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Section: Reference Limits and Flagging Abnormal Resultsmentioning

confidence: 99%

Performance criteria of the post-analytical phase

Sikaris¹

2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Audit data on the efficacy of lipid management are commonly available for cardiology and primary care services but rarer for other specialties. Specialist lipid clinic services exist in a number of countries, but their distribution is patchy and laboratory support is variable . Historically referral to a lipid clinic has been advised for patients with possible genetic hyperlipidaemias and for advice on additional management .…”

Section: Discussionmentioning

confidence: 99%

“…Specialist lipid clinic services exist in a number of countries, but their distribution is patchy and laboratory support is variable. 13,14 Historically referral to a lipid clinic has been advised for patients with possible genetic hyperlipidaemias and for advice on additional management. 15 Specific guidelines advise referral to a lipid clinic for diagnosis and further investigation of familial hypercholesterolaemia and for management of severe hypertriglyceridaemia (TG > 20 mmol/L).…”

Section: Discussionmentioning

confidence: 99%

Review of referral criteria to lipid clinics and outcomes of treatment in four UK centres

Wierzbicki

Viljoen

et al. 2018

Int J Clin Pract

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Summary Background Little data exist on the referral patterns and effectiveness of lipid clinics. Methods An audit was conducted in four clinics of 100 consecutive referrals each. Data were recorded on referral criteria, cardiovascular disease (CVD) risk factors, drug history, investigations, diagnoses, therapies, results and referrals. Results Patients were aged 56 ± 14 years, 47% were male and 87% were primary prevention. Risk factors included smoking (16%), type 2 diabetes (13%) and hypertension (13%). Referrals were made for hypercholesterolaemia (68%), diagnosis of FH (31%), statin intolerance (23%) and hypertriglyceridaemia (23%). Initial total cholesterol (TC) was 7.65 ± 2.64 mmol/L, triglycerides (TG) 2.17 (0.41‐76.9 mmol/L) mmol/L, HDL‐C 1.53 ± 0.71 mmol/L, LDL‐C 4.57 ± 1.66 mmol/L with non‐HDL‐C 5.90 ± 2.09 mmol/L. Criteria for FH were met in 21% with genetic testing in 13% and lipid cascade testing in 30% of index cases. Triglycerides >20 mmol/L were present in 4%. The diagnosis was changed in 21%: hypercholesterolaemia (7%), mixed hyperlipidaemia (7%) and hypertriglyceridaemia (7%). Hepatic steatosis was identified in 14.5%. Lipoprotein(a) levels >125 nmol/L occurred in 41% in one clinic. Therapy changes included altered statins (40%), addition of a fibrate (11%) or ezetimibe (8%). These reduced TC by 1.92 mmol/L (19%; P = 0.0001), LDL‐C 1.07 mmol/L (15%; P = 0.02), non‐HDL‐C 1.50 mmol/L (16%; P < 0.001), and TG 2.3 (−4 to 38) mmol/L (16%; P < 0.001) with 11% extra achieving TG <5 mmol/L while HDL‐C increased by 7% (P = 0.37). Conclusions Lipid clinics have diverse functions including diagnosis of FH, managing severe hypercholesterolaemia, mixed hyperlipidaemia and statin intolerance. Effectiveness criteria of average reductions of 1.5 mmol/L in TC or non‐HDL‐C, 1 mmol/L in LDL‐C and 2 mmol/L in TG would be reasonable for newly referred patients.

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“…Some indication of the effectiveness of clinical guidelines in improving patient care and outcomes can be obtained by carefully designed audits that systematically review the performance against explicit criteria. 1–3…”

Section: Introductionmentioning

confidence: 99%

Clinical biochemistry guidelines in Wales: their impact on laboratory services

2008

Self Cite

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Background: Evidence of significant variations in clinical biochemistry practice in Wales led to the formation of the All Wales Clinical Biochemistry Audit Group (AWCBAG) in 1993, with the aim of auditing laboratory services to ensure that they are optimally used. As part of this process, clinical guidelines are produced and circulated to all clinical biochemistry departments in Wales. The current aim of the AWCBAG is to assess the extent and impact of adoption of these guidelines across Wales. Methods: Three surveys were despatched at intervals over a decade to all clinical biochemistry departments in Wales to investigate practice in: (1) urine albumin testing to screen for diabetic nephropathy; (2) biochemical investigation of menopausal status and the monitoring of hormone replacement therapy; (3) screening for Cushing's syndrome. Results: The results show that laboratories across Wales are generally following guideline criteria and are adapting their practice in-line with changing recommendations. Conclusion: The introduction of AWCBAG guidelines has been widely accepted by clinical biochemistry departments in Wales. These guidelines have led to a more efficient and effective use of laboratory services.

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Provision of laboratory services for lipid analysis in the United Kingdom

Abstract: Addresses

Cited by 3 publications

References 17 publications

Performance criteria of the post-analytical phase

Performance criteria of the post-analytical phase

Review of referral criteria to lipid clinics and outcomes of treatment in four UK centres

Clinical biochemistry guidelines in Wales: their impact on laboratory services

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