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Biomedical subjects

D J Goldie

Publications and source records attributed to D J Goldie.

At least 19 recordsLinked to original sources
PubMed2004

Subclinical hypothyroidism: a comparison of strategies to achieve adherence to treatment guidelines.

BACKGROUND: Subclinical hypothyroidism is an entity based on the laboratory findings of a raised serum thyrotrophin (TSH) concentration and a normal free thyroxine (FT(4)) concentration. Patients with subclinical hypothyroidism who also have anti-thyroid peroxidase (TPO) antibodies have a higher conversion to overt hypothyroidism than those without, and treatment with thyroxine is recommended. METHOD: We audited anti-TPO assay requests within two NHS Trust hospitals, against consensus standards, to ascertain whether a cascade approach to anti-TPO testing and direct advice leads to more appropriate prescribing of thyroxine in general practice. RESULTS: Our data show that where anti-TPO status was automatically tested for and clear advice for treatment given, >85% of patients were treated according to the standard required by the consensus document, with >90% of those recommended to be commenced on thyroxine actually doing so. In contrast, where anti-TPO was not routinely assessed, treatment was started in 46% of patients, without clear evidence that this was appropriate. CONCLUSION: In order to better advise clinicians and in accordance with the agreed protocol, laboratory-generated cascade testing for anti-TPO antibodies should be an integral part of the investigation of subclinical hypothyroidism, and reports should contain appropriate interpretation and advice.

Antibodies↗
PubMed2001

Accreditation of external quality assessment schemes in the United Kingdom.

There are some 130 pathology external quality assessment schemes available in the United Kingdom. Most are provided from within the National Health Service, but a few from the private sector. At the invitation of the Department of Health, Clinical Pathology Accreditation (UK) Ltd. has developed an accreditation system for these schemes. Accreditation is based on scheme organisers declaring compliance with 62 standards and an on-site inspection. As of the end of 2000, 105 schemes have been accredited. Most of the schemes in the disciplines of Clinical Biochemistry, Haematology, Immunology and Microbiology have now been accredited, but progress has been slower in non-numerical schemes in the disciplines of Cellular Pathology and Genetics.

Accreditation↗
PubMed2001

Second trimester screening for Down's syndrome: 7 years experience.

OBJECTIVES: To evaluate the effectiveness of the first 7 years of a programme for second trimester antenatal screening for Down's syndrome, using alpha-fetoprotein (alphaFP) and total human chorionic gonadotropin (hCG) as maternal serum markers. METHODS: A clinical biochemistry laboratory providing a screening service for four obstetric units. Women attending for antenatal care who accepted an offer of serum screening for Down's syndrome were tested between 15 and 20 weeks gestation. Down's risk estimates were calculated using maternal serum alphaFP and total hCG results as modifiers of the maternal age related risk. Outcome was determined in collaboration with the regional cytogenetics unit. RESULTS: In 7 years 66,631 women were screened, in whom 108 Down's syndrome pregnancies were identified. Risks for Down's syndrome were reported without a specified cut off recommendation; however, at a cut off of 1 in 250, 72 (66.7%) of the affected pregnancies were screen positive, the false positive rate was 5.8%, and the uptake of amniocentesis 71.2%. The detection rate was higher in women screened before 17 weeks (70.5%) than in those screened at 17 weeks or later (56.7% overall and 20.0% in those under 30 years). The uptake of screening declined gradually from 84% in 1992 to 59.5% in 1998. CONCLUSIONS: Two marker screening using aFP and total hCG is an effective way of screening for Down's syndrome and is widely accepted in the local community. Detection rates were comparable with other second trimester studies using two markers including both total and free beta hCG.

Adult↗
PubMed1998

Methyl methacrylate levels in unwashed salvage blood following unilateral total knee arthroplasty.

To evaluate the safety of autologous reinfusion of drain blood in total knee arthroplasty (TKA), eight patients were prospectively evaluated to quantify levels of methyl methacrylate (MMA) monomer in systemic blood, and in their drain blood after unilateral cemented TKA. The systemic blood was analyzed before and after reinfusion of the drain blood. The drain blood was analyzed before reinfusion, and both before and after filtration through a 40-microm filter. A separate study was performed on 10 patients to assess the effect of blood, time, and filtration on MMA levels. Levels of MMA monomer in salvage blood were low enough to allow safe reinfusion. Systemic blood showed no evidence of MMA monomer either before reinfusion of salvage blood or at 5 minutes after reinfusion. Elimination of MMA is dependent on the time that MMA is exposed to blood and is independent of filtration.

Aged↗
PubMed1996

Down's syndrome screening using free beta hCG: instability can significantly increase the Down's risk estimate.

The stability of free beta hCG (human chorionic gonadotrophin) was assessed using a dual alpha-fetoprotein and free beta hCG assay. A significant increase in free beta hCG concentration was observed in heparinized samples left unseparated for 24 h or more, the mean increase in 21 samples being 10.2% after 24 h (P = < 0.001), increasing to 45.7% after 96 h. Similar results were also obtained in clotted samples. The effect of the increase in free beta hCG on the Down's risk estimate was calculated to assess the impact of delayed sample transport and separation. The Down's risk increased in all samples with increasing separation time, but this was most significant in two samples where, using a cut off of one in 250, the risk classification changed from low risk to high risk. These results suggest that delayed sample separation can have a significant effect on screening programmes using free beta hCG, particularly with respect to those patients whose risk classification is changed.

Blood Specimen Collection↗
PubMed1995

Screening for Down's syndrome: the first two years experience in Bristol.

OBJECTIVES: To evaluate the effectiveness of a programme for antenatal screening for Down's syndrome using alpha fetoprotein and total human chorionic gonadotrophin as maternal serum markers. SETTING: A district general hospital providing a screening service to a local purchasing authority and (under contract) to another purchasing authority in the same region. METHODS: Patients were counselled and screened between 15 and 20 weeks gestation and Down's risk estimates calculated using the maternal serum marker results as modifiers of the age related risk. Outcome was determined in collaboration with the Regional Cytogenetics Unit. OUTCOME MEASURES: Detection rate for Down's syndrome, false positive rate, uptake of screening, and uptake of amniocentesis. RESULTS: In two years 22816 women were screened (approximately 84% of population); 32 Down's pregnancies were identified, 19 (59.4%) had a reported risk of > or = 1:250 and 20 (62.5%) a reported risk of > or = 1:300. Of those screened before 17 weeks, 16/20 (80%) had a reported risk of > or = 1: 300 compared with 4/12 (33%) of those screened later (P = 0.008); 4.64% of patients screened had reported risks > or = 1: 250 and 5.87% reported risks of > or = 1:300. Amniocentesis uptake was 70% in patients with reported risks of > or = 1:300. CONCLUSIONS: Overall the screening programme was effective but screening before 17 weeks was very much more effective than screening later.

Adolescent↗
PubMed1990

Serum alanine transaminase (ALT) reference ranges estimated from blood donors.

It has been suggested that an increase in serum alanine transaminase (ALT) activity in blood donors may identify infection with non-A, non-B hepatitis. To facilitate identification of such donors, the reference range for ALT was measured on a Technicon SMAC 1 Analyser, using serum from 364 blood donors and 567 plasmapheresis donors. The distribution of ALT activities displayed a positive skewness, and so both logarithmic transformation and subsequent calculation of mean and standard deviation as well as non-parametric analysis were used to obtain best estimates of reference ranges for men and women, 5-65 IU/1 and 5-35 IU/1, respectively. ALT activities were found to be higher in plasmapheresis donors than in normal blood donors of both sexes, and it is postulated that this difference may be related to the increased frequency of donation in the former group.

Alanine Transaminase↗