Villefranche-de-Rouergue, France
Villefranche-de-Rouergue, France

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PubMed | Imperial College London, University of Bergen, Ghent University, Laboratoire Of Biologie Polyvalente and 2 more.
Type: Journal Article | Journal: EJIFCC | Year: 2016

Clinical practice guidelines (CPGs) relating to laboratory diagnostic testing are increasingly produced with the aim of standardizing practice and improving patient care based on the best available evidence. However, the production of a CPG is merely the first step in the process of getting evidence into practice, to be undertaken by laboratories and other stakeholders. This process should evaluate the information provided in the guidelines on laboratory tests, devise a strategy for implementing the CPG or the laboratory aspects of the CPG and finally, once implemented, assess the impact of the CPG on clinical practice, patient outcomes and costs of care. The purpose of CPG evaluation by the laboratory is to determine whether sufficient information is provided on the particular test recommended. CPGs may not always be written with the involvement of a laboratory specialist and this underlies the paucity of relevant information in some national guidelines. When laboratory specialists are involved, CPGs can provide practical information which supports local laboratories as well as clinicians in the implementation and appropriate use of recommendations. Implementation of CPGs is an often neglected area that needs attention and thought. There are many barriers to successful implementation, which may vary at local level. These need to be identified early if CPGs are to be successfully adhered to. The effectiveness of CPGs also needs to be audited using process and health outcome indicators. Clinical audit is an effective tool for assessing adherence to recommendations and for measuring the impact and success of the CPG.

Aakre K.M.,University of Bergen | Watine J.,Laboratoire Of Biologie Polyvalente | Bunting P.S.,Ottawa Hospital | Sandberg S.,University of Bergen | Oosterhuis W.P.,Atrium Medical
Diabetic Medicine | Year: 2012

Aims To evaluate if clinical practice guideline recommendations regarding self-monitoring of blood glucose in patients with diabetes not using insulin follow the principles of evidence-based medicine. Methods After a search from 1999 to 2011, 18 clinical practice guidelines were included. Recommendations regarding self-monitoring of blood glucose were graded on a scale from one (strongly against self-monitoring) to four (strongly in favour of self-monitoring) and compared with the similarly graded conclusions of systematic reviews that were cited by the clinical practice guidelines. We also investigated how clinical practice guideline characteristics, for example funding sources, and quality of references cited could be related to the guideline recommendations. Results The clinical practice guidelines cited in total 15 systematic reviews, 14 randomized controlled trials, 33 non-randomized controlled trials papers and 18 clinical practice guidelines or position statements. The clinical practice guideline recommendations had an average grade of 3.4 (range 2.0-4.0). Higher grades were seen for clinical practice guidelines that acknowledged industry funding (mean value 4.0) or were issued by organizations depending on private funding (mean value 3.6 vs. 3.0 for governmental funding). The conclusions of the 15 systematic reviews had a mean grade of 2.2 (range 1.0-3.8). Systematic reviews with low grades were less cited. In total, 21 randomized controlled trials were included in the systematic reviews. Approximately half of these evaluated an educational intervention where the effect of self-monitoring of blood glucose could not be clearly isolated. Conclusions Clinical practice guidelines were more in favour of self-monitoring use than the systematic reviews that were cited. The citation practice was non-systematic and industry funding seemingly led to a more positive attitude towards use of self-monitoring of blood glucose. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.

Watine J.,Laboratoire Of Biologie Polyvalente | Couaillac J.-P.,Hopital de Cahors | Augereau C.,Hopital europeen Georges Pompidou | Oosterhuis W.P.,Atrium Medical
Immuno-Analyse et Biologie Specialisee | Year: 2012

The proliferation and the success of Clinical practice guidelines (CPG) are accompanied by misconceptions about them. In this letter, the three ideas below are discussed with the help of examples. Many of the CPG available are formulated in a way that may lead the reader to believe that: 1) Opinions (including those of expert) have a lower value than the evidence; 2) Situations where we do not have any evidence are quite frequent in medicine; 3) It is acceptable that CPG do not apply to questions that are framed according to Patient, Intervention, Comparator, Outcome (PICOs), and without any indication about the medico-socio-economical setting where the recommendations are supposed to be implemented. These three ideas are mistaken and can lead to recommendations which can annihilate the very principles of CPG. © 2012 Elsevier Masson SAS.

Aakre K.M.,University of Bergen | Langlois M.R.,Az St Jan Hospital | Watine J.,Laboratoire Of Biologie Polyvalente | Barth J.H.,St Georges Hospital | And 4 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2013

Background: Correct information provided by guidelines may reduce laboratory test related errors during the preanalytical, analytical and post-analytical phase and increase the quality of laboratory results. Methods: Twelve clinical practice guidelines were reviewed regarding inclusion of important laboratory investigations. Based on the results and the authors' experience, two checklists were developed: one comprehensive list including topics that authors of guidelines may consider and one consisting of minimal standards that should be covered for all laboratory tests recommended in clinical practice guidelines. The number of topics addressed by the guidelines was related to involvement of laboratory medicine specialists in the guideline development process. Results: The comprehensive list suggests 33 preanalytical, 37 analytical and 10 post-analytical items. The mean percentage of topics dealt with by the guidelines was 33% (median 30%, range 17%-55%) and inclusion of a laboratory medicine specialist in the guideline committee significantly increased the number of topics addressed. Information about patient status, biological and analytical interferences and sample handling were scarce in most guidelines even if the inclusion of a laboratory medicine specialist in the development process seemingly led to increased focus on, e.g., sample type, sample handling and analytical variation. Examples underlining the importance of including laboratory items are given. Conclusions: Inclusion of laboratory medicine specialist in the guideline development process may increase the focus on important laboratory related items even if this information is usually limited. Two checklists are suggested to help guideline developers to cover all important topics related to laboratory testing.

Verboeket-Van De Venne W.P.H.G.,Atrium Medical | Aakre K.M.,Working Group on Guidelines | Aakre K.M.,University of Bergen | Watinea J.,Working Group on Guidelines | And 3 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2012

Reflective testing is a procedure in which the laboratory specialist adds additional tests and/or comments to an original request, after inspection (reflection) of the results. It can be considered as an extension of the authorization process where laboratory tests are inspected before reporting to the physician. The laboratory specialist will inevitably find inconclusive results, and additional testing can contribute to make the appropriate diagnosis. Several studies have been published on the effects of reflective testing. Some studies focus on the opinion of the general practitioners or other clinicians, whereas other studies were intended to determine the patient's perspective. Overall, reflective testing was judged as a useful way to improve the process of diagnosing (and treating) patients. There is to date scarce high quality scientific evidence of the effectiveness of this procedure in terms of patient management. A randomized clinical trial investigating this aspect is however ongoing. Cost effectiveness of reflective testing still needs to be determined in the future. In conclusion, reflective testing can be seen as a new dimension in the service of the clinical chemistry laboratory to primary health care. Additional research is needed to deliver the scientific proof of the effectiveness of reflective testing for patient management. © 2012 by Walter de Gruyter • Berlin • Boston.

Watine J.,Laboratoire Of Biologie Polyvalente | Watine J.,Paris Observatory | Wils J.,Paris Observatory | Wils J.,University of Rouen | And 2 more authors.
Journal of Clinical Epidemiology | Year: 2014

Objective To challenge the Grading of Recommendations Assessment, Development and Evaluation (GRADE) group to address the potential misconceptions about their approach to grading the strength of recommendations in clinical practice guidelines. Study Design and Setting Based on our own expertise of health care professionals trying to think in depth about, and using, guidelines, we have identified four such misconceptions. Results These potential misconceptions are: (1) evidence in medicine means factual or scientific evidence; (2) opinions are a subcategory of evidence; (3) the most important evidence is related to clinical benefits and harms; (4) being virtuous, and principled, does not particularly help in developing the best possible guidelines. Conclusion We call on the GRADE leadership to address all the above-mentioned misconceptions. These need explicit answers in their manuscript series. © 2014 Elsevier Inc. All rights reserved.

PubMed | Laboratoire Of Biochimie Medicale, Laboratoire Of Biologie Polyvalente and University of Rouen
Type: Journal Article | Journal: Annales de biologie clinique | Year: 2017

Two clinical practice guidelines published in 2012 and in 2013 by the Haute autorit de sant (HAS) respectively entitled Adult chronic kidney disease (clinical pathway guidelines) and Clinical utility of vitamin D measurements (Health technology assessment) contradict each other on a notable point: in 2012 the HAS recommend to measure blood concentrations of vitamin D once a year in all patients with chronic kidney disease whereas in 2013 the HAS recommend to use this test only for the ambulatory follow-up of patients three months after kidney transplantation. This contradiction encouraged us to evaluate the methodological quality of these two guidelines with the help of the AGREE (Appraisal of Guidelines for Research and Evaluation) instrument which is consensual at an international level, in particular at the WHO (World Health Organization) and at the European Union. At the end of this comparative evaluation this preliminary hypothesis might be proposed: a more rigorous development (AGREE domain n3) as well as a higher editorial independence (AGREE domain n6) in 2013 than in 2012 (scores respectively are 57% and 56% in 2013 versus 24% and 25% in 2012) ensure a higher validity to the 2013 recommendations than to the 2012 recommendations. However this hypothesis is weakened by the subjective intrinsic value of the AGREE tool, and by various methodological shortcomings in these two guidelines. Therefore we conclude, using the AGREE terminology, that the methods for developing those guidelines are too uncertain, above all in 2012, for recommending their use without modifications.

Pantel A.,Nimes University Hospital Center | Pantel A.,Montpellier University | Boutet-Dubois A.,Montpellier University | Boutet-Dubois A.,Laboratoire Of Biologie Polyvalente | And 7 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2014

In February 2011, the CARB-LR group was created as a sentinel laboratory-based surveillance network to control the emergence of carbapenem-resistant Gram-negative bacilli (CR GNB) in a French Southern Region. We report the epidemiological results of a 2-year study. All the Gram-negative bacilli isolates detected in the different labs (hospital and community settings) of a French Southern Region and with reduced susceptibility to ertapenem and/or imipenem were characterised with regard to antibiotic resistance, bla genes content, repetitive sequence-based polymerase chain reaction (rep-PCR) profiles and multilocus sequence typing (MLST). A total of 221 strains were analysed. Acinetobacter baumannii was the most prevalent carbapenemase-producing bacteria, with a majority of OXA-23 producers (n = 37). One isolate co-produced OXA-23 and OXA-58 enzymes. Klebsiella pneumoniae was the most frequent carbapenemase-producing Enterobacteriaceae (CPE) (OXA-48 producer: n = 29, KPC producer: n = 1), followed by Escherichia coli (OXA-48 producer: n = 8, KPC producer: n = 1) and Enterobacter cloacae (OXA-48 producer, n = 1). One isolate of Pseudomonas aeruginosa produced a VIM-1 carbapenemase. A clonal diversity of carbapenemase-producing K. pneumoniae and E. coli was noted with different MLSTs. On the other hand, almost all OXA-23-producing A. baumannii strains belonged to the widespread ST2/international clone II. The link between the detection of CR GNB and a foreign country was less obvious, suggesting the beginning of a local cross-transmission. The number of CR GNB cases in our French Southern Region has sharply increased very recently due to the diffusion of OXA-48 producers. © 2014, Springer-Verlag Berlin Heidelberg.

Watine J.,Laboratoire Of Biologie Polyvalente
Journal of Medical Ethics | Year: 2011

The concept of evidence-based medicine (EBM) has been invented by physicians mostly from English Canada, mostly from McMaster University, Ontario, Canada. The term EBM first appeared in the biomedical literature in 1991 in an article written by a prominent member of this group-Gordon Guyatt from McMaster University. The inventors of EBM have also created the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group, which is a prominent international organisation whose main purpose is to develop evidence-based clinical practice guidelines (CPGs). CPGs that are based on the GRADE approach are becoming increasingly adopted worldwide, in particular by many professional or governmental organisations. This group of thinkers being thus identified, we have retrieved and read many of their publications in order to try and understand how they intend to incorporate bioethical values into their concept. The author of this little essay did also spend a few years on the internet as an active member of the GRADE group discussion list. The observations thus gathered suggest that although some of the inventors of EBM, at least Gordon Guyatt, wish to incorporate core principles of biomedical ethics into their concept (ie, non-malevolence, beneficence and maybe to a lesser extent respect for autonomy, and justice), some clarifications are still necessary in order to better understand how they intend to more explicitly incorporate bioethical values into their concept and, perhaps more importantly, into evidence-based CPGs.

Laudat A.,Laboratoire Of Biologie Polyvalente | Lecourbe K.,Laboratoire Of Biologie Polyvalente
Pathologie Biologie | Year: 2011

Further to the acquisition of a new material consisting in a microscope and its video equipment, we report the example of some drift with regards to written, updated and validated procedures. Indeed, once the new material was fully operating, depending on the operator, the (spermocytogrammes) morphology was realized either in oculars or by using the video screen. The statistical study performed on the results from 50 patients showed a significant difference in the results of the appreciation of the microcephalous and the macrocephalous according to the mode of observation that had been used. As an outcome of this study, we insisted that everyone within the team should work consistently and comply with the current procedures. © 2009 Elsevier Masson SAS.

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