Annals of clinical biochemistry
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True and precise routine measurements of quantities of clinical interest are essential if results are to be optimally interpreted for patient care. Additionally, results produced by different measurement procedures for the same measurand must be comparable if common diagnostic decision values and clinical research findings are to be broadly applied. Metrology, the science of measurement, provides laboratory medicine with a structured approach to the development and terminology of reference measurement systems which, when implemented, improve the accuracy and comparability of patients' results. ⋯ Where traceability to the International System of Units (SI units) is not yet realized for a measurand, result comparability may be achievable by other, less ideal, approaches. Measurements are the core activity of clinical laboratories, and clinical biochemists should ensure that patients' results are traceable to the highest available reference. This review introduces and illustrates the principles of metrological traceability, describes its critical importance to improving the quality of patients' results and highlights the need to actively promote traceability in clinical laboratories.
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Ann. Clin. Biochem. · Jul 2011
Role of certain trace minerals in oxidative stress, inflammation, CD4/CD8 lymphocyte ratios and lung function in asthmatic patients.
Asthma is associated with increased inflammation, oxidative stress and abnormal immune system function. We determined the distributions of several essential trace minerals and assessed their relationships to factors that are associated with the pathophysiological status of patients with mild/moderate asthma. ⋯ Abnormal distributions of these trace minerals may aggravate oxidative damage and inflammation, increased CD4/CD8 lymphocyte ratios and decreased lung function in asthma.
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Ann. Clin. Biochem. · May 2011
Comparative StudyHigh sensitivity troponin outperforms contemporary assays in predicting major adverse cardiac events up to two years in patients with chest pain.
Previous studies have shown a risk of subsequent major adverse cardiovascular events (MACEs) in patients with suspected acute coronary syndromes (ACSs) and elevated cardiac troponin. The aim of this study was to compare prognostic utility of high-sensitivity troponin with contemporary troponin assays in such patients. ⋯ hsTnT outperformed contemporary TnI and TnT assays for the prediction of MACE at two years. Those with levels below the LOD for hsTnT identified a group of patients at very low risk for adverse events.
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Ann. Clin. Biochem. · May 2011
Comparative StudyComparison of high sensitivity and contemporary troponin assays for the early detection of acute myocardial infarction in the emergency department.
Current guidelines define acute myocardial infarction (AMI) by the rise and/or fall of cardiac troponin with ≥1 value above the 99th percentile. Past troponin assays have been unreliable at the lower end of the range. Highly sensitive assays have therefore been developed to increase the clinical sensitivity for detection of myocardial injury. ⋯ hsTnT was superior to TnT but equivalent to TnI 3 for the diagnosis of AMI. Serial troponin measurement increased test performance. hsTnT was the most likely to be raised at baseline in those with AMI. A delta troponin increases specificity but reduces sensitivity.
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Ann. Clin. Biochem. · May 2011
Randomized Controlled TrialEffect of NT-proBNP testing on diagnostic certainty in patients admitted to the emergency department with possible heart failure.
Difficulty in distinguishing congestive heart failure (HF) from other causes of dyspnoea in the emergency department (ED) may result in delay in appropriate treatment and referral. Although the diagnostic value of serum amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is well documented, the impact on diagnostic certainty of providing these results to ED physicians is not well studied. We sought to determine the effect of providing NT-proBNP results on diagnostic certainty of physicians managing patients presenting to the ED with suspected HF. ⋯ Measurement of NT-proBNP concentrations reduces diagnostic uncertainty and improves diagnostic accuracy in patients presenting to the ED with dyspnoea and possible HF.