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Biomedical subjects

W S Smellie

Publications and source records attributed to W S Smellie.

17 recordsLinked to original sources
PubMed2001

A laboratory based intervention to improve appropriateness of lipid tests and audit cholesterol lowering in primary care.

PROBLEM: A need exists to reduce inequalities in lipid testing, to provide relevant, individual, patient based interpretation for users, and to audit lipid lowering in primary care. DESIGN: Model to compare laboratory activity between different general practices; construction of computer based strategies to define the lipid tests to be done and to interpret results for primary and secondary coronary prevention patients; introduction of the strategies into routine use; monitoring of any change after the intervention; and investigation of the potential of the strategies to produce audit data for primary care groups. BACKGROUND AND SETTING: Hospital clinical laboratory serving 22 general practices covering 150 000 patients in Bishop Auckland area County Durham. Key measurements for improvement: Reduction in differences in testing for the different serum lipids in coronary prevention. Production of usable audit data for the primary care groups involved. STRATEGIES FOR CHANGE: Four different categories of coronary prevention patient, with, for each category, the defined lipid tests to be done and advice to be given (based on the results), using the computer based strategies. EFFECTS OF CHANGE: Standardised test activity and the qualitative profile of the tests performed changed significantly. The strategies were readily adopted (median use 78%) within six months of introduction. LESSONS LEARNT: Computer based strategies can correct qualitative and quantitative differences in test requesting, provide interpretative guidance in accordance with national guidelines, and offer a cost effective model to monitor results of cholesterol lowering in general practice.

Cholesterol, HDL↗
PubMed2000

Development of a competency based training programme to support multidisciplinary working in a combined biochemistry/haematology laboratory.

The aim of this study was to develop a competency based training programme to support multidisciplinary working in a combined biochemistry and haematology laboratory. The training programme was developed to document that staff were trained in the full range of laboratory tests that they were expected to perform. This programme subsequently formed the basis for the annual performance review of all staff. All staff successfully completed the first phase of the programme. This allowed laboratory staff to work unsupervised at night as part of a partial shift system. All staff are now working towards achieving a level of competence equivalent to the training level required for state registration by the Council for Professions Supplementary to Medicine. External evaluation of the training programme has included accreditation by the Council for Professions Supplementary to Medicine and reinspection by Clinical Pathology Accreditation (UK) Ltd. The development of a competency based training system has facilitated the introduction of multidisciplinary working in the laboratory. In addition, it enables the documentation of all staff to ensure that they are fully trained and are keeping up to date, because the continuing professional development programme in use in our laboratory has been linked to this training scheme. This approach to documentation of training facilitated a recent reinspection by Clinical Pathology Accreditation (UK) Ltd.

Biochemistry↗
PubMed2000

Benchmarking general practice use of pathology services: a model for monitoring change.

AIMS: To identify a model to assess general practitioner use of pathology services that could be applied to assess specific interventions designed to promote best practice. METHODS: A database containing standardised requesting data for 22 general practices was constructed. The database contained 28 tests covering 95% of general practitioner activity, distributed across pathology, and it was evaluated during two sequential six month periods. A comparison of ranks of requesting activity between different time periods was undertaken by calculating Pearson rank correlation coefficients. Requesting numbers were also adjusted for patients' age and sex distributions within the 22 practices for a sample of three high volume tests. The effects of distributing requesting guidelines and details of requesting activity were assessed during two sequential three month periods. RESULTS: Requesting activity was extremely stable during the two baseline periods for most test (r > 0.80 for 20 of the 28 tests). Several less discriminatory tests were identified. Age and sex adjustment had minimal impact on the ranks of requesting activity. Requesting activity during the two three month periods after distributing guidelines and comparative details of individual requesting activity showed little change (overall correlation coefficient, 0.844 between baseline and intervention periods). CONCLUSIONS: Ranking general practitioners requesting activity adjusted for practice list size provides a reproducible means of measuring requesting activity for most pathology tests performed in general practice. Activity was not influenced by age or sex of patients on the practice list. Distributing requesting guidelines and individual requesting activity on their own do not have any measurable impact on requesting activity. More innovative (possibly multiple) interventions might be required to influence general practitioner requesting practice.

Age Factors↗
PubMed1995

Audit of an emergency biochemistry service.

AIM: To examine a model for the evaluation of appropriateness of testing in an emergency biochemistry laboratory. METHODS: A model was devised in which incoming emergency test requests were categorised as appropriate or inappropriate. Explicit criteria were used to define eight minor categories, which were chosen to reflect accurately current working practice within the hospital and laboratory. Five junior medical staff each undertook a prospective 24 hour assessment, during which time all incoming requests were monitored and categorised according to these criteria. Concordance between monitors was evaluated before and during assessments. RESULTS: Of 509 requests, 384 (75%) were appropriate and 125 (25%) were inappropriate according to the criteria used to define categories. Inappropriate requests fell into three main groups: preoperative samples (43.2% (54/125) of all inappropriate requests), missed routine samples (33.6% (42/125)) and accelerated (priority) analyses (16% (20/125)). Various other reasons accounted for the remaining 7.2% (9/125). CONCLUSION: This model may be used to obtain valid information about current clinical and laboratory practice. Strategies to reduce the number of inappropriate requests have been identified in order to reserve the emergency service for situations of true need.

Biochemistry↗
PubMed1995

Laboratory turnround time: closing the loop.

AIMS: To institute recommendations from a laboratory turnround time study; to evaluate audit methods; and to quantify improvements achieved. METHODS: Changes to result report distribution and specimen delivery were affected by posting results directly from the laboratory followed by the introduction of a twice daily courier service. Improvements were evaluated by repeating the turnround time audit described in an earlier report. Pre-, peri- and post-analytical turnround times were compared before and after changes had been instituted. RESULTS: Directly posting general practitioner (GP) results increased the percentage of reports which reached their destination within one and two days after they were generated from 13 to 29% and from 68 to 82%, respectively. Pre- and postanalytical times were superimposable before and after posting was started. Corresponding improvements to the satellite hospital service were from 25 to 78% and from 60 to 82%, respectively. The courier service shortened the median total turnround time from 50 to nine hours for GPs and from 69 to 18 hours for the satellite hospital. Fifty three per cent of GP reports and 21% of satellite hospital reports arrived on the same day as the sample was taken: 99% and 94%, respectively, had arrived by the next day. The number of analytically "old" samples which arrived the day after they had been taken, thus invalidating many results, fell from 25 to 3%. CONCLUSIONS: These audits of laboratory turnround time have been used to present a valid case for changes to laboratory transport and to quantify the improvements achieved. They produce consistent and repeatable results, which may also be used to monitor future performance, to assess further changes and to establish the cost-effectiveness of resources used.

Family Practice↗
PubMed1994

Evening primrose oil reduces urinary calcium excretion in both normal and hypercalciuric rats.

Hypercalciuria is an important risk factor in the aetiology of idiopathic urolithiasis and many treatment modalities in clinical practice are directed towards reducing urinary calcium excretion. There are no natural animal models of hypercalciuria, such as the spontaneous hypertensive rat; however, the streptozotocin-diabetic rat is accepted as a good model for studies of disordered renal function associated with diabetes mellitus. Hypercalciuria is a prominent feature of the streptozotocin-diabetic rat and the model was, therefore, used to study the influence of evening primrose oil on urinary calcium excretion. Twenty rats divided into two groups of ten rats each were maintained on either normal rat chow (group 1) or primrose oil enriched diet (group 2) for 10 weeks. At 4 weeks both groups of rats were made diabetic with streptozotocin. Urine calcium measurements were serially performed before commencement of the diet, during the pre-streptozotocin (pre-diabetic) phase and during the post streptozotocin (diabetic) phase. The urine calcium excretion was significantly less in the primrose oil fed animals during both the pre-diabetic phase and the diabetic phase compared with the rats on the normal rat chow. These results indicate that evening primrose oil, a rich source of gamma-linolenic acid, helps to reduce urine calcium excretion in normal animals as well as in the hypercalciuric streptozotocin-diabetic rat. Dietary modifications with long-chain omega-6 and omega-3 fatty acids might be a useful adjunct in the treatment of idiopathic hypercalciuric urolithiasis.

Animals↗
PubMed1994

Effects of changes in acid base and calcium concentration on fasting serum insulin, proinsulin, and glucose concentrations.

AIMS: To test the hypothesis that alterations in acid base or calcium concentration may affect proinsulin processing or the insulin secretion mechanism. METHODS: Changes in proinsulin secretion or cleavage were assessed by measuring serum intact proinsulin and immunoreactive insulin concentrations in three models of acid base and calcium disturbance: (1) subacute changes in acid base status in six volunteers who received oral placebo, ammonium chloride, or sodium bicarbonate for three five day periods; (2) acute changes in calcium concentration in eight subjects who received 25 mmol oral calcium; (3) chronic changes in calcium concentration in seven patients with primary hyperparathyroidism and five with pseudohypoparathyroidism. RESULTS: Acid base changes were confirmed by rises in serum bicarbonate concentrations (p < 0.01). No changes in serum insulin, intact proinsulin, or the proinsulin:insulin molar ratio were found. Serum calcium concentrations increased (2.49 v 2.38 mmol/l; p < 0.05) and parathyroid hormone concentrations decreased (1.1 v 1.9 pmol/l; p < 0.01) two hours after acute calcium loading. There were no significant differences in serum glucose, insulin, or intact proinsulin concentrations. Fasting proinsulin concentrations were significantly lower in the hyperparathyroid group (1.1 v 2.1 pmol/l; p < 0.05) and increased significantly after parathyroidectomy (2.1 v 1.1 pmol/l; p < 0.05). CONCLUSIONS: The results indicate that subacute acid base changes do not affect proinsulin cleavage. Although acute calcium loading has no demonstrable effect, chronic hypercalcaemia may influence the mechanism of insulin secretion.

Acid-Base Equilibrium↗
PubMed1994

Method for assessment of laboratory turnaround times: comparison before, during, and after analysis.

AIMS: To establish a mechanism to examine the components of turnaround time in a representative cross-section of laboratory users; and to identify potential areas for improvement. METHODS: Information was collected manually from result reports received by eight laboratory users: three wards in the main hospital, four GP practices, and one local psychiatric hospital. This was combined with data from the departmental computer files to create a spreadsheet detailing different time points in the processing of a specimen, from venepuncture to receipt of result report. RESULTS: At the main hospital, 80% of samples arrived within two hours of venesection and 95% by four hours; 75% of samples were analysed within two hours; 85% of results arrived in the wards within six hours of printing, although 12% took more than 18 hours to arrive; median overall time six hours. At the satellite (psychiatric) hospital, all samples arrived within seven hours of venesection; 45% were analysed within two hours--the rest the following morning; there were highly variable post-analytical times, minimum 18 hours, maximum 122 hours; the median overall time was 69 hours. Twenty five per cent of samples from GPs took more than 20 hours to arrive; 75% were analysed within two hours, the rest took over 18 hours--waiting overnight; the post-analytical times were highly variable, minimum 22 hours, maximum 122 hours; the median overall time was 50 hours. CONCLUSIONS: The method is easily repeatable and demonstrates the need for local improvement in the post-analytical period. Although specific to the individual data handling system for one laboratory, this method may be used as a basis for other laboratories in pathology disciplines to undertake a representative assessment of turnaround times for different groups of laboratory users.

Cross-Sectional Studies↗
PubMed1992

Probucol reduces plasma lipid peroxides in man.

Although primarily used as a lipid lowering drug, probucol also possesses anti-oxidant activity and has been shown in animal models to inhibit or delay the progression of atherosclerosis. It has been suggested that this anti-atherosclerotic effect may occur through inhibition of free radical oxidation of low density lipoprotein. The aim of this study was to investigate the effects of probucol on free radical activity in hyperlipidaemic patients. Plasma lipid peroxides were measured before probucol treatment, at 4 and 12 weeks treatment and then 4 weeks after stopping probucol. Lipid peroxide concentrations were significantly reduced during and 4 weeks after stopping treatment with probucol, when compared with baseline values. There were no changes in plasma vitamin E concentrations. The results of this study indicate that probucol reduces lipid peroxidation in patients, an effect which may occur through a free radical scavenging action.

Adult↗
PubMed1991

Primary hyperlipidaemia is not associated with increased urinary albumin excretion.

In a group of 141 otherwise healthy subjects attending a lipoprotein clinic, urinary albumin excretion was measured to determine whether primary hyperlipidaemia was associated with evidence of early renal dysfunction. There was no evidence of increased urinary albumin concentrations or albumin:creatinine ratios when compared with data for normal controls. There were no differences in these parameters when the values for the upper and lower quartiles of the cholesterol distribution were compared, and no relationship existed between plasma cholesterol and albuminuria. A weak association was shown between plasma triglyceride and urinary albumin concentration after log transformation of the data. We conclude that hyperlipidaemia per se is not associated with renal disease as measured by sensitive assays of albuminuria.

Albuminuria↗
PubMed1981

des-Asp-angiotensin I: its identification in rat blood and confirmation as a substrate for converting enzyme.

The observation that angiotensin III is present in the circulation of the rat in amounts similar to those of angiotensin II has led to the notion that it may, in part, be formed by the action of converting enzyme on des-Asp-angiotensin I without the prior formation of angiotensin II. This possibility was studied in conscious rats using a combination of RIA and chromatographic techniques which allowed the separate measurement of angiotensin I, des-Asp-angiotensin I, angiotensin II, and angiotensin III in rat blood. Infusion of des-Asp1-[Ile5]angiotensin I at 50, 150, and 450 ng/kg . min resulted in a progressive increase in the plasma concentration of angiotensin III up to 279 +/- 50 (SD) pg/ml compared to 9 +/- 9 (SD) pg/ml after dextrose infusion. Regardless of the infusion of des Asp-[Ile5]angiotensin I, plasma angiotensin III made up a constant 46 +/- 8% (+/- SD) of the total immunoactive material, the remainder being composed of smaller metabolic fragments, indicating a rapid rate of clearance of angiotensin III. Captopril completely inhibited the rise in angiotensin III after des-Asp1-[Ile5]angiotensin I infusion. A substance which chromatographed as des-Asp-[Ile5]angiotensin I was detected in rat blood and made up 19% of the angiotensin I immunoactive material, while angiotensin III made up 44% of the angiotensin II immunoactive material. These results confirm that des-Asp1-[Ile5]angiotensin I is a substrate for converting enzyme in the rat, and the presence of a chromatographically similar substance in the circulation suggests that at least part of the angiotensin III in rat blood may be formed by the action of converting enzyme on endogenous des-Asp-angiotensin I. (Endocrinology 108: 406, 1981)

Angiotensin I↗
PubMedDate not supplied

Screening and treatment for hyperlipidaemia in non-insulin-dependent diabetes: a prospective assessment of 350 patients.

This report presents experiences in screening 350 non-insulin-dependent diabetics for hypercholesterolaemia and results of 1 year's treatment. Mean serum total cholesterol was 6.4 mmol/l at screening; 46 patients whose initial total serum cholesterol was above 7.0 mmol/l attended for detailed assessment and treatment. Mean total cholesterol concentrations fell between screening and review (7.8 vs 7.1 mmol/l, P < 0.01). Levels fell below 7.0 mmol/l in 13 patients with diet alone. After excluding patients with secondary dyslipidaemia (including poor diabetic control), 10 patients received lipid-lowering drug treatment. Total cholesterol and triglyceride concentrations fell significantly and the HDL/non- HDL cholesterol ratio improved on treatment. Screening diabetic patients identifies a small group of hyperlipidaemic patients, whose lipoprotein profiles improve with drug treatment. Many of those screened, however, do not ultimately require drug treatment using a cut-off of 7.0 mmol/l.

Adult↗