Dennis Wright wrote:
>
> Northwick Park & St Mark’s hospitals receives, like most hospitals, a large
> number of requests for LFT’s. I have two questions relating to this
> workload.
>
> 1. What information is the profile meant to give us and what questions
> regarding the patient are being asked. I remember in my youth while
> studying for an MSc Vincent Marks describing LFT’s as not a test of liver
> function more a differential diagnosis of jaundice.
>
> 2. Having arrived at a clear idea of why we are doing LFT’s what evidence
> is there regarding the choice of transaminase (AST or ALT) and I stress
> evidence not folk law, history or custom and practice (is that another way
> of saying prejudice?).
>
> Clearly I have not been prompted to break cover and raise my head above the
> parapet without reason. The hospital we are likely to merge with measures
> the other transaminase in its profile, and don’t be silly we cannot afford
> to measure both and I start from the basis that in the 1990’s both assays
> are analytically as good as each other
>
> Dennis Wright
ANSWER:
In Sweden we have a prdject concerning cost-effective clinical chemistry
in primary care.After discussions with the clinicians we do not use the
package of "liver function tests" any more.In all clinical situations
only selective tests are ordered.The number of ASAT determinations have
decreased to about 1/4 of what was before.
For details please see my Web-site:
http://home1.swipnet.se/~w-12360/
The full report of the Spri prodject will be available in English in a
few months,but already now you can find about 150 literature references
concerning optimal use of clinical chemistry in primary care.
With best regards
Nils Tryding M.D. Ph.D.
Fax:+ 46 44 241260
Box 57,S-296 21 Åhus, Sweden
http://home1.swipnet.se/~w-12360/
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