Isn't part of the underlying problem the way we issue our reports?
Just imagine if:
1 You could link from and individual assay result to an unlimited volume
of support information, not simply the amount you can fit on a paper
slip, a computer screen, or the local paper-based laboratory handbook.
And you could do this without using expensive staff to annotate the
support information to the report.
2 The accumulated expertise in this mailgroup could feed that body of
support information.
Jonathan Kay
PS: Of course these are both available now... all you have to do is move
to using a clinical intranet to communicate with your clinicians!
Mohammad Al-Jubouri wrote:
> The way around this is to comment "Adequate luteal
> function" for day 21 progesterone of > 30 nmol/L and
> "Sub-optimal luteal function" for levels 20 - 29
> nmol/L and "Inadequate luteal function for levels < 20
> nmol/L. The inference from the latter is, that
> ovulation may occur but subsequent luteal function may
> not be sufficient to induce endometrial decidual
> changes to support a fertilised ovum.
>
> regards.
>
> --- Brian Senior <[log in to unmask]> wrote: > I
> recently had a convoluted dicussion with a
> > consultant gynaecologist about
> > the interpretation of progesterone results.
> >
> > The problem arose because of the comment on our
> > reports which reads
> > "Progesterone results between 30 and 80nmol/l on day
> > 21 of a 28 day cycly
> > are consistent with ovulation". The question arose
> > "What does a
> > progesterone result of 20nmol/l mean?".
> >
> > Clearly, any result of 20nmol/l in a patient
> > overwhelmingly suggests
> > luteinisation rather than other rare causes
> > (Granulomas etc). Also
> > luteinisation is predominantly associated with
> > ovulation; a quick Medline
> > search indicates that luteinisation without
> > ovulation occurs in no more
> > than 10% of cycles and that where this happens the
> > same patient is likely
> > to ovulate in the next cycle.
> >
> > Thus, a result of 20nmol/l is also "consistent with
> > ovulation" and in terms
> > of probability is best taken to indicate ovulation
> > rather than anything
> > else. So what is the lowest progesterone
> > concentration for which a report
> > could indicate that the probability of ovulation
> > outweighs the probability
> > of non-ovulation?
> >
> > The problem with our current comment is that while
> > it is true, the inverse
> > of the comment is not. This is leading some
> > clinicians to draw the wrong
> > conclusions (the gynaecologist says it is his GP
> > colleagues who are
> > confused!). How do others get round this problem?
> >
> >
> > Brian Senior
> > Department of Clinical Chemistry,
> > Royal Bolton Hospital,
> > BOLTON, Greater Manchester.
>
> =====
> Dr. M A Al-Jubouri
> Consultant Chemical Pathologist
> Whiston Hospital
> Prescot
> Merseyside L35 5DR
> UK
>
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