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Multiple myeloma is a malignant plasma cell dyscrasia that is becoming more prevalent in an increasingly ageing population. It is a complex disease with clinical phases ranging from the premalignant monoclonal gammopathy of undetermined significance to asymptomatic (smouldering) myeloma and then symptomatic myeloma; the latter occasionally terminating in the clonal proliferation of plasma cells outside the bone marrow. We present a patient whose clonally evolved disease from monoclonal gammopathy of undetermined significance to multiple myeloma demonstrated the presence of an unusual combination of monoclonal immunoproteins. Capillary electrophoresis demonstrated the presence of three paraproteins in the gamma region (γ-region), two of which were additional to the IgGk paraprotein which migrated in the slow γ-region at initial diagnosis. Subsequent isotypic identification of the new paraproteins was not possible by immunotyping and initial immunofixation studies failed to definitively characterize the monoclonal proteins. After reduction with beta-mercaptoethanol, two paraproteins were detected by both capillary and gel electrophoresis. However, only immunofixation was able to resolve three distinct monoclonal bands, confirming the presence of free monoclonal kappa light chains in the mid-gamma region and free monoclonal heavy chains in the fast gamma region. Triple gammopathies in themselves are uncommon; this case presents a very unusual combination of paraproteins which required various electrophoretical and immunochemical techniques to identify and characterize them. The change of electrophoretic signature from the monoclonal gammopathy of undetermined significance phase to the diagnosis of multiple myeloma suggested that a number of genetically distinct subclones were present in the pretreatment clonal evolution of the disease. [ABSTRACT FROM AUTHOR]

Aim: To describe differences in biochemistry test request rates (adjusted for practice size) between general practices and to investigate whether differences in HbA1C and thyroid function test request rates are related either to the practice prevalence of hypothyroidism and diabetes or to Quality and Outcome Framework (QOF) scores. Methods: Information on test request rates, prevalence of diabetes and hypothyroidism, and QOF data over a one-year period were obtained from 58 practices covering a population of 284,609 patients. Spearman's rank correlation tests were used to investigate relationships between adjusted test request rates. Results: There was wide variability in adjusted test request rates (lowest for HbA1C and highest for immunoglobulins). The ranking of practices for different tests was highly correlated. There was no relationship between adjusted test request rates for HbA1C and thyroid function and the reported prevalence of diabetes and hypothyroidism, respectively, nor was there any relationship with QOF scores in diabetes and hypothyroidism. Conclusions: There is wide variability in test request rates in general practice that do not appear to be related to disease prevalence or crude clinical outcome measures. [ABSTRACT FROM AUTHOR]

Self-monitoring of blood glucose (SMBG) is advocated as a valuable aid in the management of diabetes. The volume and cost of monitoring continues to increase. SMBG has a number of theoretical advantages/disadvantages which might impact on treatment, outcome and wellbeing. Investigating and quantifying the effect of self-monitoring in a condition where self-management plays a central role poses major methodological difficulties because of the need to minimize confounding factors. Despite the absence of definitive evidence, some situations where monitoring is generally accepted to be beneficial include patients on insulin, during pregnancy, in patients with hypoglycaemia unawareness and while driving. An area of controversy is the role of monitoring in non-insulin-requiring type-2 diabetes where observational and controlled studies give conflicting results. The available evidence does not support the general use of monitoring by all patients with type-2 diabetes, although further research is needed to identify specific subgroups of patients or specific situations where monitoring might be useful. The best use of SMBG in patients with type-2 diabetes might be for those receiving insulin and those on sulphonylurea drugs. The impact of monitoring on patient wellbeing must also be considered, with some studies suggesting adverse psychological effects. Given the large increase in the prevalence of type-2 diabetes, it will be important to define the role of SMBG so that resources can be used appropriately. Presently, the widespread use of SMBG (particularly in type-2 diabetes patients) is a good example of self-monitoring that was adopted in advance of robust evidence of its clinical efficacy. [ABSTRACT FROM AUTHOR]

Background: There is no agreed system for the reporting, classification and grading of the severity of quality failures in the clinical biochemistry laboratory. Methods: A 'Quality Query' reporting system was set up to log all quality failures identified by staff and service users. Quality failures were classified into three major groups of the preanalytical, analytical and postanalytical phases with appropriate subcategories in each group. The severity of each quality failure was graded using a five-point scoring system incorporating both actual ('A') and potential ('P') score elements. The 'A' score measured the actual adverse impact of the quality failure on patient care, while the 'P' score measured the 'worst case' potential outcome that might have resulted. The system was assessed over a 19-month period. Results: Three hundred and ninety-seven Quality Query reports were completed (0.085% of all requests). Breakdown by cause: pre-analytical phase – 88.9%, analytical phase – 9.6%, post-analytical phase – 1.5%. The quality failure severity 'A' scores were skewed towards a low adverse impact on patient care: 72.7% allocated an 'A' score of 1 (least severe grade). The 'P' scores were skewed towards a high potential impact on patient care: 65.9% allocated a 'P' score of 5 (most severe grade). Conclusions: The Quality Query reporting system proved easy to integrate into routine laboratory practice. Although the great majority of quality failures had minimal adverse impact on patient care, the potential for adverse outcomes was much higher. This system generates important information on laboratory performance and helps inform risk management priorities. [ABSTRACT FROM AUTHOR]

The article focuses on the evidence base for laboratory medicine. It states that laboratory medicine aims to provide information that will help people either to maintain their health or in the event of illness to regain their health. It further discusses various ways to use laboratory tests which includes screening of asymptomatic subjects, diagnosis of disease and monitoring disease progression.

The article presents the author's views on the implication of patient's direct access to test results on clinical and laboratory practice. Topics discussed includes cancer diagnosis, laws enforced by the U.S. Department of Health and Human Services regarding the availability of test results and online portal Renal Patient View.

An introduction to the journal is presented in which the editors discuss the importance of cerebrospinal fluid (CSF) spectrophotometry in the accurate diagnosis of subarachnoid haemorrhage (SAH).

The article discusses the evolution of point-of-care testing (POCT) as documented by a journal on clinical biochemistry. It mentions an article in 1981 which described the acquisition of comprehensive metabolic information by patients who undertook self-sampling. It notes a series of papers in the late 1980s and early 1990s which explained analytical assessment of POCT.

The article examines the effectiveness of accuracy of point-of-care (POC) devices in measuring glucose. It states that POC measuring device of glucose is an important component of tight glycemic control (TGC) regimens in maintaining timely insulin dose adjustment. It notes that POC glucose measurement can operate to a total allowable error of 15%, which was unlikely to produce large insulin dosing errors.