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Hello David
can you expand on "Finlay's "Felix and Cyril" temperature analogy" - where would one find this?
Regards
Mark Lynch
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of David Bullock
Sent: 23 September 2011 22:29
To: [log in to unmask]
Subject: Team America World Police? [was IFCC vs DCCT HbA1c]
On 23 Sep 2011 at 17:19, Sharpe, Peter wrote:
> I attended the EASD (European Association for the Study of Diabetes)
> meeting last week. Not one mention was made of IFCC HbA1c. All of the oral
> and poster presentations gave DCCT% results only.
>
> So are we really all ready to move to IFCC reporting next week? Our Trust
> Diabetes electronic data-base cannot yet accept IFCC results. We are
> converting our DCCT results from the HbA1c analyser to IFCC using the
> standard formula.
>
> This whole process has worked out very badly indeed.
Firstly, I must state explicitly that I intend no offence whatsoever
to Peter, who has merely raised this as a very current issue [sorry,
but I have to do this upfront, having recently been flamed by several
of our US POCT chums for expressing honest and objective scientific
views regarding "waived testing" and related issues - I also
sincerely apologise in advance for any inadvertent typogrphical
errors], and conscious that I may be sticking my head somewhatabove
the parapet
If it is the right thing to do, let's stick to our guns and get it
over with, and if we do it together it demonstrates professional
solidarity - the original inconsistencies in implementation date were
unfortunate, potentially engendering 'divide and rule' objections
- IFCC units are undoubtedly scientifically the way to go, based on
reference measurement systems mandated by the EU IVD Directive as
traceable to a higher metrological order, and other countries
(especially those which never adopted the pragmatic but
scientifically unsound DCCT view of reality - useful in its day in
improving comparability of results, but that day is now past) have
converted already
- I'm old enough to recall the UK's national conversion to molar SI,
which went pretty well OK (though I was based at the time in a
'backslider' lab which deferred conversion in the belief that others
would change back!)
- I also seem to recall a US Presidential commitment to adopt molar
SI across the healthcare and possibly other sectors, which was later
reneged upon?
- during a social encounter with a community dietician last year
(having unfortuantely been told that she was a diabetologist, leading
to a distinctly bizarre initial dialogue), she confirmed (completely
unsolicited) that she was indeed aware that that HbA1c reporting
units were changing
- with regard to the media, why not tell them in October that the
change has been completed in the UK, with (hopefully!) no adverse
patient consequences, and that the UK we are now in international
consensus ["absent the US", to use their own terminology] - I'm told
that they do sometimes appreciate 'good news' stories!
My sole concern is that, for good mathematical reasons completely
outwith our control, CVs and performance scores do appear worse when
expressed in IFCC mmol/mol than DCCT % (search on Finlay's "Felix and
Cyril" temperature analogy for full details of the reasons for this)
which could be misinterpreted to imply worse patient care using IFCC
units
All constructive responses warmly welcomed, in the spirit of
delivering better scientific and clinical care for patients
Best wishes to all
David
Dr David Bullock
Director, UK NEQAS
Birmingham Quality
P O Box 3909
Birmingham B15 2UE
FAX 0121 414 1179 [+44 121 414 1179]
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