In message <[log in to unmask]>, Marieke Jordaan
<[log in to unmask]> writes
> The DAWN anti-coagulation system used in our trust has been a prime
> example of how IT can be employed to manage certain patient groups
> effectively and consistently and focus clinical attention on those
> patients who really require it. At the same time it was
> demonstrated to have shortened the induction period of warfarin
> therapy (compared to prescription by doctors on the wards), thereby
> enabling earlier discharge.
>
> The Haematologists are ahead of us in this regard - anti-coagulant
> monitoring in this way is now commonplace. However, the use of such
> a system for the monitoring of patients on treatment for thyroid
> diseases and medications such as lithium seems to be much more
> limited. Would those who have such experience want to share it with
> us? Your experience with setting up the "rules" and involving the
> local clinicians would interest a wide audience. I would also
> appreciate information about software suppliers as our search has
> so far not been very fruitful.
> Kind regards
>
> Marieke Jordaan
Despite being a "just retired" Chemical Pathologist I have has for most
of my pathological life done and been responsible for Anticoagulant
Clinics. My experience suggests that there is some way to go before
there could be computer aided Thyroid &/or Lithium therapy systems that
worked as well as the rather crude DAWN system. Warfarin monitoring has
been evolving for even longer than I have been at it, this evolution has
also included the still rather crude PTI/INR assay. There also has been
considerable clinical agreement on the aims of the exercise.
This has to be balanced against the situation where a patient turns up
at her GP's surgery with the experience of having had TSH & FT4 done and
both found to be almost exactly in the centre of the Ref Range and was
then put on Thyroxine by an "Eminent Endocrinologist". One must remember
though that it was a private consultation!?
Despite this there would seem to be a possibility for Thyroid Disease,
but I wonder about Lithium with its narrow therapeutic range and the
tendency of the patients to self modify their therapeutic regimes.
--
Dr Henry Chandler
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