[EXTERNAL] Re: [IMPROVEDX] Support Tests.

Sherri Loeb sherriloeb at GMAIL.COM
Mon Jan 25 20:20:36 UTC 2016


I understand it is the same, but interpretation is vitally important!

On Mon, Jan 25, 2016 at 2:10 PM, Samuel, Rana <Rana.Samuel at va.gov> wrote:

> The test *is* the same – just may be reported with a different reference
> range or with an interpretive comment as in Lucy’s example below.
>
>
>
> *From:* Sherri Loeb [mailto:sherriloeb at GMAIL.COM]
> *Sent:* Monday, January 25, 2016 2:41 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [EXTERNAL] Re: [IMPROVEDX] Support Tests.
>
>
>
> I find this comment particularly interesting considering my husband passed
> away from metastatic prostate cancer. One he was diagnosed. We noticed that
> occasionally his psa was ordered as psa screening to check response to
> chemo and hormone therapy and other times as psa diagnostic. We were told
> it is exactly the same. From reading this email, it is obviously not the
> same.
>
>
>
> Thanks for the clear explanation.
>
>
>
> Sherri Loeb RN, BSN
>
>
>
> On Mon, Jan 25, 2016 at 1:01 PM, Knapp, Lucy <LKnapp at peacehealthlabs.org>
> wrote:
>
> In a word – speaking for the laboratory world – Communicate those needs to
> your laboratories. As an example, here we have two tests, “PSA, Screening”
> which has a reference range up to 4 and “PSA, Diagnostic” which also has a
> reference range of up to 4 but also includes an interpretative comment: “According
> to the American Urological Association (AUA), serum PSA should decrease and
> remain at undetectable levels after radical prostatectomy. The AUA defines
> biochemical recurrence as an initial PSA value of greater than or equal to
> 0.20 ng/mL followed by a subsequent confirmatory PSA value of greater than
> or equal to 0.20 ng/mL.”
>
>
>
> In a prior life – we had 2 tests with different reference ranges, plus a
> comment on the PSA, Diagnostic. Both options are easily done in an LIS (lab
> information system).
>
>
>
> We in the laboratory would love to have better communication from
> physicians – we want to make your lives easier. So my advice to all the
> physicians out there is to build relationships with the pathologists and
> laboratory personnel where you practice. Let us know where improvement is
> needed to the LIS, you need a new test, you need better sensitivity on a
> current test – whatever.
>
>
>
> I’m copying the to our medical director, we are trying to establish better
> communication with our physicians throughout our system.
>
>
>
> Lucy
>
>
>
> *Lucy Knapp, MT(ASCP) *  |  Technical Specialist, Chemistry  |  Laboratory
>
> *PeaceHealth* <http://www.peacehealth.org>  |  400 NE Mother Joseph Place
> |  Vancouver, WA 98664
>
> *office* 360-514-2732  |  *fax* 360-514-1646
>
>
>
> *From:* robert bell [mailto:
> 0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
> *Sent:* Sunday, January 24, 2016 1:56 PM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] Support Tests.
>
>
>
> I have suggested that at the same time, or even before we tackle Errors in
> Diagnosis, we see that all our support diagnostic tests (Lab, X-ray, etc.)
> are in good order so as to help make the correct diagnoses more often.
>
>
>
> I have been made aware that it is easy to miss a low but rising PSA in
> someone who has had a past radical prostatectomy.
>
>
>
> The Lab reports results as ng/mL with a reference range of (0.000 -
> 4.000). The range for someone with a prostate present.
>
>
>
> I asked myself with all the technology is there anything that could be
> done to prevent such happenings?
>
>
>
> And then I thought there must be 100s of similar situations when time,
> disease, surgery, treatments, etc effect lab interpretations - the PSA lab
> reports on the ones I have seen do not mention that the ranges are for
> someone with a prostate. Should they?
>
>
>
> Yes, good clinical skills would help but could the lab with or without
> technology do anything to help avoid such problems?  Could training or
> anything else help prevent?
>
>
>
> I wondered how often this happens - and if you decided to do something
> about it, could you triage it - presumably not without good error data!?
>
>
>
> Robert Bell
>
>
>
>
>
>
>
>
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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