A discussion of cases in the 2001 RCPA-AQAP chemical pathology case report comments program

Aim: 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. Method: Participants were asked to comment on a given set of biochemistry results attached with brief clinical details. All responses received were translated into key phrases and graphically presented on a histogram. An expert panel was asked to evaluate the appropriateness of the key phrases and to propose a suggested composite comment. Results: While the majority of comments received were felt to be acceptable by the expert panel, some comments were felt to be inappropriate or misleading. As comments on laboratory reports may affect clinical management of patients, it is important that these comments reflect accepted practice and current guidelines. Conclusion: The Patient Report Comments Program may play an important role in continuing education and possibly in quality assurance of interpretative commenting.

Vitamin A is associated with the inflammatory marker CRP in cystic fibrosis

We have observed that vitamin A levels, deficient in patients with severe disease, returned to normal post lungtransplant independent of oral supplementation or pancreatic sufficiency. We hypothesised that vitamin A is associated with disease severity and the inflammatory marker C-related peptide (CRP). Data from RCH paediatric and TPCH adult CF clinic subjects (ns138 CF, 138 control, aged 5–56 yr), who had participated in a study of bone mineral density (BMD) in which vitamins A, E, D, and CRP, height, weight and lung function had been measured was used. Groups were compared using t- or Wilcoxon-tests, and predictors of vitamin A examined usingmultiple regression. Vitamin A was lower in CF subjects (1.23"0.5 vs. 1.80"0.6 mmolyl, P-0.0001), increasingwith age in paediatric subjects but to a lesser extent in the CF group (Ps0.0007). CRP was correlated with age (rs0.6, P-0.0001). FEV1% predicted (FEV) (57.93"23.0 vs. 70.63"21.8, Ps0.0014), weight z-score (WTZ) (y0.76"0.9 vs. y0.12"1.0, Ps0.0002), lumbar spine BMD z-score (y1.08"1.3 vs. y0.50"1.2, Ps0.009) were lower, and CRP higher (median 7.0, IQR 2–4 vs. median 1.0, IQR 1–3 mgy l, P-0.0001) in vitamin A insufficient CF subjects (61 insufficient vs. 71 sufficient). In all subjects, control status (P-0.0001), WTZ (Ps0.02), vitamin E (Ps 0.0003), CRP (Ps0.001), 1,25 dihydroxy vitamin D (1,25 vit. D) (Ps0.0007), and child, adolescent or adult grouping (all P-0.0001) were predictive of vitamin A. In the CF group, CRP (Ps0.01), Vitamin E (P-0.0001) and 1.25 vit. D (Ps 0.006), but not FEV, were predictive. The normal increase in vitamin A with age was not observed in CF subjects, who had lower levels at any age. This failure of normal increase in vitamin A had a consistent association with increasingCRP , supportingthe hypothesis that increased inflammation may result in increased vitamin A consumption.

Practical considerations for the measurement of free light chains in serum

Background: A new immunoassay for free light chain measurements has been reported to be useful for the diagnosis and monitoring of monoclonal light chain diseases and nonsecretory myeloma. We describe experience with and some potential pitfalls of the assay. Methods: The assay was assessed for precision, sample type and stability, recovery, and harmonization of results between two analyzers on which the reagents are used. Free-light-chain concentrations were measured in healthy individuals (to determine biological variation), patients with monoclonal gammopathy of undetermined significance, myeloma patients after autologous stem cell transplants, and patients with renal disease. Results: Analytical imprecision (CV) was 6-11% for kappa and A free-light-chain measurement and 16% for the calculated kappa/lambda ratio. Biological variation was generally insignificant compared with analytical variation. Despite the same reagent source, values were not completely harmonized between assay systems and may produce discordant free-light-chain ratios. In some patients with clinically stable myeloma, or post transplantation, or with monoclonal gammopathy of undetermined significance, free-light-chain concentration and ratio were within the population reference interval despite the presence of monoclonal intact immunoglobulin in serum. In other patients with monoclonal gammopathy of undetermined significance, values were abnormal although there was no clinical evidence of progression to multiple myeloma. Conclusions: The use of free-light-chain measurements alone cannot differentiate some groups of patients with monoclonal gammopathy from healthy individuals. As with the introduction of any new test, it is essential that more scientific data about use of this assay in different subject groups are available so that results can be interpreted with clinical certainty. (C) 2003 American Association for Clinical Chemistry.

The STARD statement for reporting studies of diagnostic accuracy: Explanation and elaboration

The quality of reporting of studies of diagnostic accuracy is less than optimal. Complete and accurate reporting is necessary to enable readers to assess the potential for bias in the study and to evaluate the generalisability of the results. A group of scientists and editors has developed the STARD (Standards for Reporting of Diagnostic Accuracy) statement to improve the reporting the quality of reporting of studies of diagnostic accuracy. The statement consists of a checklist of 25 items and flow diagram that authors can use to ensure that all relevant information is present. This explanatory document aims to facilitate the use, understanding and dissemination of the checklist. The document contains a clarification of the meaning, rationale and optimal use of each item on the checklist, as well as a short summary of the available evidence on bias and applicability. The STARD statement, checklist, flowchart and this explanation and elaboration document should be useful resources to improve reporting of diagnostic accuracy studies. Complete and informative reporting can only lead to better decisions in healthcare.

Reasons for cannabis use in men with and without psychosis

Psychoses are relatively low prevalence disorders that have a disproportionately negative impact on individuals and society. Cannabis use is one factor that can exacerbate the negative consequences associated with psychotic disorders. Relatively few studies have examined the effects or reasons for using cannabis self-reported by individuals with psychosis. The present study is the first known to compare directly such factors in individuals with and without psychosis, within a single study. At baseline and follow-up participants with psychosis most commonly reported using cannabis for positive mood alteration (36% and 42%), coping with negative affect (27% and 29%) and for social activity reasons (38% and 29%). The control group most commonly reported using cannabis for relaxation (34% and 43%) and social activity reasons (49% and 51%). Participants with psychosis were less likely to report relaxation as the most important effect after use ( 27%) or expect it at follow-up ( 49%) compared to the control group (53% and 70%). In both groups, addiction and positive affect enhancement were the composite variable scores correlated most consistently with concurrent amount and frequency of use.