Aotea Pathology

Wellington, New Zealand

Aotea Pathology

Wellington, New Zealand

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Koerbin G.,ACT Pathology | Koerbin G.,University of Canberra | Sikaris K.A.,Sonic Healthcare | Jones G.R.D.,St Vincents Hospital | And 3 more authors.
Clinica Chimica Acta | Year: 2014

Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models.An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued. © 2013 Elsevier B.V.


Florkowski C.,Canterbury Health Laboratories | Crooke M.,Wellington Hospital | Reed M.,Aotea Pathology
Clinica Chimica Acta | Year: 2014

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. It reflects the close cooperation between the clinical and laboratory communities in New Zealand, particularly through the agency of the New Zealand Society for the Study of Diabetes (NZSSD), a key organisation in New Zealand open to all those involved in the care of people with diabetes and the national advisory body on scientific and clinical diabetes care and standards.There was a phased process of consultation designed to increase familiarity and comfort with the new units and the final step was coupled with the adoption of HbA1c as a diagnostic test with some evidence-based pragmatism around using the rounded cut-off.Genuine clinical engagement is vital in such a process. © 2013 Elsevier B.V.


PubMed | Aotea Pathology, St Vincents Hospital, Sonic Healthcare, Royal Brisbane and Womens Hospital and 2 more.
Type: | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2014

Although we are in the era of evidence-based medicine, there is still a substantial gap between theory and current practice with the application of reference intervals as decision making tools. Different laboratories may have different reference intervals for the same tests using the same analytical methods and platforms. These differences have the potential to confuse physicians making the assessment and monitoring of patients more difficult by providing discordant information. This paper attempts to demonstrate how to use evidence-based approach for harmonising reference intervals. In order to consider harmonisation we must first have an appreciation of the various factors that influence the determination of that reference interval such as the choice of individuals within the population studied, biological variability of the analyte studied, partitioning, sample collection, analytical aspects such as bias and statistical models. An a priori approach for determining reference intervals, whilst recommended, may be beyond the scope of most laboratories and consideration should be given to the use of a validated indirect a posteriori approach. Regardless of method used, the continuing application of an evidence-based approach in harmonised reference intervals to meet the quality expectations of physicians should be pursued.


PubMed | Aotea Pathology, St Vincents Hospital, Sonic Healthcare, Royal Brisbane and Womens Hospital and 8 more.
Type: Journal Article | Journal: The Clinical biochemist. Reviews | Year: 2015

Harmonisation of reference intervals for routine general chemistry analytes has been a goal for many years. Analytical bias may prevent this harmonisation. To determine if analytical bias is present when comparing methods, the use of commutable samples, or samples that have the same properties as the clinical samples routinely analysed, should be used as reference samples to eliminate the possibility of matrix effect. The use of commutable samples has improved the identification of unacceptable analytical performance in the Netherlands and Spain. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) has undertaken a pilot study using commutable samples in an attempt to determine not only country specific reference intervals but to make them comparable between countries. Australia and New Zealand, through the Australasian Association of Clinical Biochemists (AACB), have also undertaken an assessment of analytical bias using commutable samples and determined that of the 27 general chemistry analytes studied, 19 showed sufficiently small between method biases as to not prevent harmonisation of reference intervals. Application of evidence based approaches including the determination of analytical bias using commutable material is necessary when seeking to harmonise reference intervals.


PubMed | Roche Holding AG, Australasian Association of Clinical Biochemists, StVincents Hospital, Sonic Healthcare and 7 more.
Type: Journal Article | Journal: The Clinical biochemist. Reviews | Year: 2015

Scientific evidence supports the use of common reference intervals (RIs) for many general chemistry analytes, in particular those with sound calibration and traceability in place. Already the Nordic countries and United Kingdom have largely achieved harmonised RIs. Following a series of workshops organised by the Australasian Association of Clinical Biochemists (AACB) between 2012 and 2014 at which an evidence-based approach for determination of common intervals was developed, pathology organisations in Australia and New Zealand have reached a scientific consensus on what adult and paediatric intervals we should use across Australasia. The aim of this report is to describe the processes that the AACB and the Royal College of Pathologists of Australasia have taken towards recommending the implementation of a first panel of common RIs for use in Australasia.


Basu I.,Auckland City Hospital | Bromhead C.,Aotea Pathology | Balm M.,Aotea Pathology | Upton A.,Labtests | And 6 more authors.
New Zealand Medical Journal | Year: 2015

Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis. Five laboratory confirmed cases of LGV were detected in MSM (men who have sex with men) in the upper North Island; four in Auckland between September and December 2013 and a fifth case was detected in Waikato in June 2014. The absence of a recent travel history for four cases supports the likelihood of local transmission of this uncommon infection. © NZMA.


Lawton B.A.,University of Otago | Rose S.B.,University of Otago | Raina Elley C.,University of Auckland | Bromhead C.,Aotea Pathology | And 2 more authors.
Journal of Primary Health Care | Year: 2010

Introduction: Genitourinary Chlamydia trachomatis infection is common and associated with considerable personal and public health cost. Effective detection strategies are needed. Aim: To assess feasibility of an opportunistic incentivised chlamydia screening programme in general practice over six months. Methods: This study was designed as a pilot for a randomised controlled trial in primary care. Three general practices were randomly allocated to intervention (two practices) and control groups. The intervention involved practice education, self-sample collection and practice incentives (funding and feedback) for a three-month 'active' intervention period. Feedback and education was discontinued during the second three-month period. Practice-specific nurse- or doctor-led strategies were developed for identifying, testing, treating and recalling male and female patients aged 16-24 years. The main outcome measure was the difference between the practices' chlamydia screening rates over the six months following introduction of the intervention, controlling for baseline rates from the previous year. Results: Chlamydia testing rates during the year prior to the intervention ranged from 2.9% to 7.0% of practice attendances by 16-24-year-olds. The intervention practices had higher rates of screening compared with the control practice (p<0.001) at three months, but both practices reverted to pre-intervention rates by six months. The nurse-led screening strategy was more effective (35% declining to 5.5% over six months) than the doctor-led strategy (15% declining to 1.6% over six months) (p=0.04). Discussion: Incentivised opportunistic chlamydia screening of 16-24-year-old patients attending their general practitioner with a programme involving practice education, feedback and self-sample collection can increase screening rates.


Rose S.B.,University of Otago | Lawton B.A.,University of Otago | Bromhead C.,Aotea Pathology | Jane Macdonald E.,Regional Public Health | Raina Elley C.,University of Auckland
Australian and New Zealand Journal of Public Health | Year: 2010

Objectives: New strategies are needed to reach at-risk populations for Chlamydia screening. Method: Self-sample collection kits containing instructions and all items required for testing were developed and piloted in a three-month trial in primary care. Practice staff offered kits to young people receiving opportunistic Chlamydia screening to pass on to their 'social contacts.' Results: The 'pass it on' approach failed to reach adequate numbers of youth for testing: of 67 kits distributed, three specimens were sent to the laboratory (4.5%). Conclusions: The method of kit distribution trialled here was not successful in reaching at-risk youth for testing outside the primary care setting. Implications: Use of self-sample collection for chlamydia testing outside healthcare settings is likely to be important for increased access to testing. The importance of chlamydia testing needs to be widely promoted and methods for kit distribution to reach at-risk youth identifed. © 2010 The Authors. Journal Compilation.


PubMed | Australian National University, Aotea Pathology, New South Wales Health Pathology, The Canberra Hospital and 2 more.
Type: Journal Article | Journal: Clinical endocrinology | Year: 2016

Thyroid disease can be subtle in its presentation, and TSH reference intervals may be artefactually increased by including persons with subclinical thyroid disease. We have therefore used a thyroid disease-free population to determine TSH and fT4 reference intervals.Apparently healthy subjects were assessed by health questionnaire, drug history, clinical assessment and measurement of thyroid antibodies.Healthy subjects in a community setting.TSH, free T4, antithyroglobulin and anti-TPO were measured on the Abbott Architect analyser. Subjects with clinical abnormalities, consumption of thyroid-active medications or with thyroid antibodies above the manufacturer-quoted reference intervals were excluded. TSH and fT4 data were log-transformed, and the central 95% was used to calculate reference intervals. We assessed whether these data were normally distributed. We compared samples spanning the reference intervals for both TSH and fT4 between different assays looking at biases.From a population of 1,606 subjects, 140 males (18%) and 284 females (34%) were excluded. The central population 95% for TSH was 043-328 mU/l and for fT4 108-168 pmol/l. There were no age- or sex-related differences. For both analytes, the distribution was not significantly different to a Gaussian distribution (P > 005). For 5 commonly used assays for TSH, the maximum difference in the upper limit of the TSH reference interval was 048 mU/l and for fT4 the maximum difference for the upper reference limit was 41 pmol/l.A substantial proportion of apparently healthy persons have subclinical thyroid disease. These subjects must be excluded for any thyroid hormone reference interval studies.


Nicol M.,Aotea Pathology | Nulsen M.,Massey University | Bromhead C.,Aotea Pathology
New Zealand Journal of Medical Laboratory Science | Year: 2015

Objectives: To share information and genetic characterization of the New Zealand culture collection Neisseria gonorrhoeae isolates. This information makes the isolates suitable as quality control material for diagnostic laboratories considering setting up molecular assays to predict susceptibility profiles of clinical N. gonorrhoeae where a culture isolate is not available. Methods: DNA was extracted from cultured isolates on the Cobas 4800 CT/NG platform. Taqman PCR assays with specific primers and probes were used to detect a sequence in penicillinase producing Neisseria gonorrhoeae (PPNG) or associated with reduced susceptibility to the cephalosporins (mosaic penA) and run on the LightCycler 480. The gyrA assay utilised a melt curve analysis to detect the Ser91®Phe mutation which occurs in ciprofloxacin resistant N. gonorrhoeae. Results: The three molecular assays used to predict resistance (or reduced susceptibility) produced valid results against each of the ESR culture collection strains examined, namely the WHO-K calibrator strain, the PPNG positive isolates (222, 3330 and 4543), the gyrA Ser®Phe positive isolates (4033 and 4543) and the mosaic penA positive isolate (4543). Conclusions: The N. gonorrhoeae isolates held by the New Zealand culture collection have been validated and characterised as positive or negative for three molecular markers associated with resistance to penicillin (PPNG), ciprofloxacin (gyrA) and ceftriaxone (mosaic penA). This goes some way to resolving the ever present issue of a lack of suitable control material when diagnostic laboratories are setting up bespoke and new molecular assays. © 2014 The authors.

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