Limits...
Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Sweat test has a diagnostic role in evaluation of cystic fibrosis. Its performance includes sweat stimulation, collection and analysis. All listed may be sources of inconsistencies in everyday practice. The aim of this study was an evaluation of external quality assessment (EQA) of sweat chloride measurement including sweat test performance in medical biochemistry laboratories in Croatia.

Materials and methods: EQA for sweat chloride measurement was provided by Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM) in five consecutive exercises to medical biochemistry laboratories (MBL) that offered sweat testing. A questionnaire regarding all phases of testing was mailed to involved MBL (N = 10). Survey results were compared to current guidelines for sweat test performance.

Results: Reported results of EQA in 2015 exercises showed coefficients of variation (CV) from 28.9%, 29.0% to 35.3%, respectively. An introduction of uniform sweat chloride measurement protocol resulted in CV of 15.5% and 14.7% reported in following two exercises in 2016. All MBL included in this study replied to the questionnaire. Results reported by MBL indicated: lack of patient information policy (7/10), use of unacceptable electrodes (6/9), misuse of minimum of acceptable sweat weight (6/9), lack of internal quality assessment (5/9) and recommended reference ranges (5/9 and 4/9). Agreements to guidelines were found in approach to unsuitable patients (9/10) and sweat collection (8/9).

Conclusion: Presented results indicate major weak points of current practice in sweat test performance in Croatian MBL and stress the need for its standardization on a national level.

No MeSH data available.


Electrodes for pilocarpine iontophoresis (PI) produced by local manufacturer
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC5382848&req=5

f1: Electrodes for pilocarpine iontophoresis (PI) produced by local manufacturer

Mentions: Q9 – Current guidelines recommend use of stainless steel or copper electrodes for the PI. They should be suitable and fixed size with an extra device that allows stable and safe application on patient flexor surface of forearm (8, 9). Six out of nine MBL reported use of electrodes produced by local manufacturer (Figure 1). Those electrodes did not meet guidelines criteria for fixed size due to their design as bracelet of flexible length that is adjustable around patient forearm since size depends of his/her age. Such electrodes design excludes controlled sweat stimulation. It refers particularly to unfixed size of stimulated area and uncontrolled sweat secretion rate that compromises accurate minimum sweat weight acceptable for analysis and increases a possibility of false chloride concentration in report.


Evaluating performance in sweat testing in medical biochemistry laboratories in Croatia
Electrodes for pilocarpine iontophoresis (PI) produced by local manufacturer
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5382848&req=5

f1: Electrodes for pilocarpine iontophoresis (PI) produced by local manufacturer
Mentions: Q9 – Current guidelines recommend use of stainless steel or copper electrodes for the PI. They should be suitable and fixed size with an extra device that allows stable and safe application on patient flexor surface of forearm (8, 9). Six out of nine MBL reported use of electrodes produced by local manufacturer (Figure 1). Those electrodes did not meet guidelines criteria for fixed size due to their design as bracelet of flexible length that is adjustable around patient forearm since size depends of his/her age. Such electrodes design excludes controlled sweat stimulation. It refers particularly to unfixed size of stimulated area and uncontrolled sweat secretion rate that compromises accurate minimum sweat weight acceptable for analysis and increases a possibility of false chloride concentration in report.

View Article: PubMed Central - PubMed

ABSTRACT

Introduction: Sweat test has a diagnostic role in evaluation of cystic fibrosis. Its performance includes sweat stimulation, collection and analysis. All listed may be sources of inconsistencies in everyday practice. The aim of this study was an evaluation of external quality assessment (EQA) of sweat chloride measurement including sweat test performance in medical biochemistry laboratories in Croatia.

Materials and methods: EQA for sweat chloride measurement was provided by Croatian Centre for Quality Assessment in Laboratory Medicine (CROQALM) in five consecutive exercises to medical biochemistry laboratories (MBL) that offered sweat testing. A questionnaire regarding all phases of testing was mailed to involved MBL (N = 10). Survey results were compared to current guidelines for sweat test performance.

Results: Reported results of EQA in 2015 exercises showed coefficients of variation (CV) from 28.9%, 29.0% to 35.3%, respectively. An introduction of uniform sweat chloride measurement protocol resulted in CV of 15.5% and 14.7% reported in following two exercises in 2016. All MBL included in this study replied to the questionnaire. Results reported by MBL indicated: lack of patient information policy (7/10), use of unacceptable electrodes (6/9), misuse of minimum of acceptable sweat weight (6/9), lack of internal quality assessment (5/9) and recommended reference ranges (5/9 and 4/9). Agreements to guidelines were found in approach to unsuitable patients (9/10) and sweat collection (8/9).

Conclusion: Presented results indicate major weak points of current practice in sweat test performance in Croatian MBL and stress the need for its standardization on a national level.

No MeSH data available.