Gordon and colleagues ought to be congratulated for the hard work and
commitment to this educational exercise. Little in endocrinology is EBM and,
as Gordon rightly points out, a great deal in this field is either consensus
or expert based. Nothing wrong with that of course so long we accept the
shortfalls and continue to educate ourselves
rgds
A
Ahmed Waise FRCP FRCPath
Laboratory Medicine-Clinical Biochemistry &
Centre for Diabetes & Endocrinology
York Hospital, Wigginton Road,
YORK YO31 8HE
Tel 01904725855
[log in to unmask]
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of gordon.challand
Sent: 09 December 2005 17:36
To: [log in to unmask]
Subject: Re: CASE 199
Dear Colleagues
Apologies to the many members of the ACB General Mailbase who are not
participants in the UK NEQAS for Interpretative Comments.
1. I apologise for my obvious typo in the Summary for the units for serum
cortisol stated after dexamethasone suppression: should have been nmol/L
rather than umol/L.
2. As Organiser of the scheme, I report on what participants state rather
than what individual experts (who frequently disagree with each other) think
they ought to state. This is directly comparable with the 'consensus mean'
compared with the 'true value' in conventional analytical EQAS.
3. Particularly in Endocrine Cases, there has often been a clear difference
of opinion between the majority of participants, and those offering an
opinion from specialised centres. It may of course be true that the latter
are telling us what is best practice (except when they disagree with each
other). However I'm not sure that this is necessarily true, since apart from
any other considerations the likelihood of a clinical condition being
present in a given patient depends not only on the symptoms and the results
but also on the prevalence of the condition in the population being tested.
Prevalence of an endocrine condition is likely to be rather different in
patients seeing a Family Doctor than in patients referred to a specialised
endocrine centre (cf screening for prostate cancerwith PSA in Family Doctor
practice compared with patients referred to a hospital Urology Department).
I don't know whether any of you can give me any data on evidence-based best
practice in investigation rather than opinion-based best practice (and the
older I get the less dogmatic I become).
4. It's also obvious from the Scheme that there are dramatic differences of
opinion on interpretation and advice over much of our subject: even areas
considered to be relatively simple such as lipid abnormalities. Again, these
differences seem to be mainly opinion-based rather than evidence-based, and
if nothing else, that should lead us to challenge ourselves on what can
occasionally appear to be dogmatic personal opinion.
Best wishes from the Scheme Organiser (is anyone out there willing to take
on this job instead of me?)
Gordon Challand
----- Original Message -----
From: "mjdiver" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 09, 2005 1:44 PM
Subject: CASE 199
>
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