CONFIDENTIALITY, PRIVACY AND FREEDOM-OF-INFORMATION

As noted previously in this newsletter (Volume 3, Number 2 - April 1999), MDS Metro has updated its policies regarding confidentiality, privacy and freedom-of-information. The revised policy assures that we are in compliance with a variety of new codes in this area (including the CMA Guidelines). Of interest to medical practitioners is the requirement that we must provide a patient with a copy of his or her laboratory results if requested by the patient. Our usual approach to such requests will be to send copies of reports to the patient by mail (or have them available for pickup). Suitable precautions will be taken to ensure the individual's identity. Questions regarding any aspect of confidentiality and privacy may be referred to Dr. Michael McNeely at 250-881-3109 .

WEBSITE OF INTEREST

We wish to bring to your attention a new website: www.bcdoctors.com, that has an online directory listing of BC doctors. You are able to enter the searchable database to inform patients of your special interests and specifics about your office practice. If you don't have Internet access, the information can be added by phone. Contact information: 604-736-5312 or email: bcdoctors@bcdoctors.com.

ANTIMICROBIAL SUSCEPTIBILITY PROFILE

Enclosed is a profile of antimicrobial susceptibility testing results of commonly reported urine organisms submitted to MDS Metro Laboratory Services from January 1 to June 30, 1999.

CHANGE IN CHLAMYDIA TRACHOMATIS TESTING METHOD AT MDS METRO

MDS Metro will be replacing the Chlamydia EIA (enzyme immunoassay) method with a PCR (polymerase chain reaction) method for all Chlamydia testing. PCR, which is a genetic amplification method, has been shown to be a much more sensitive method than the older EIA technology for detecting Chlamydia infections. PCR testing for Chlamydia of urine and genital swabs has an excellent sensitivity and specificity of 92–96% and 98–99% respectively.

Chlamydia testing by PCR of male and female first void urine specimens has been performed at MDS Metro for a year now. Commencing October 1, 1999 on the Mainland and November 1, 1999 on Vancouver Island, we will also test all male and female genital swabs (urethra, cervix) using the PCR method.

This will entail a gradual switch over of physician supplies, as the Chlamydia PCR test requires a different specimen collection kit than is used for EIA swabs. During this transition period, specimens submitted using EIA swabs will be accepted and tested by EIA until December 15, 1999. After December 15, 1999, no Chlamydia EIA testing will be available at MDS Metro. We will be contacting physicians and clinics to arrange collection of the old Chlamydia EIA kits and supply the new Chlamydia PCR swab collection kits.

For our Mainland clients, if you have not heard from us by October 15, 1999, please call 604-412-4481. For our Island clients, if you have not heard from us by November 15, 1999, please call 250-881-3111 ext. 124.

Please refer to the attached CHLAMYDIA PCR TEST INFORMATION LETTER for further information and collection instructions.

INFECTION CONTROL REMINDER REGARDING LABORATORY TESTING OF PATIENTS WITH POSSIBLE MEASLES, RUBELLA OR CHICKEN POX

We would like to remind physicians that if they have a patient requiring laboratory testing whom they suspect may have infectious measles, rubella or chicken pox (varicella), they should inform the patient of the need to call the Patient Service Centre before they go to the Patient Service Centre. This is to ensure the safety of other patients and staff, who may otherwise potentially be exposed. When you call ahead, we can institute precautions to help prevent exposure of non-immune patients/staff at the Patient Service Centre. For example, we may schedule to see the patient at a time/place where potential exposure of others can be minimized and respiratory precautions followed.

DIABETES PROTOCOL

In September, MDS Metro will implement the 2-hour post-75g glucose load test as described in the March 1999 BCMA/MSC Protocol for Diagnosis and Monitoring of Diabetes Mellitus. The 2-hour post-75g test is an abridged version of the 2-hour, 5-specimen glucose tolerance test (GTT), which it will replace. Patient preparation and the procedure are unchanged from previous GTT recommendations except that serum glucose is measured only at baseline and at two hours. The 1997 American Diabetes Association recommendations simplified the GTT when diabetes mellitus (DM) and other categories of glucose regulation were classified on the basis of these two results.

The 2-sample-2 hour GTT is requested by checking the 2H Post 75g (Non-preg) box on the requisition: fasting and 2h specimens will be collected. The test is primarily indicated to identify impaired glucose tolerance and is not recommended for routine diagnosis of DM. The Protocol limits the test to situations where a patient's fasting glucose is 6.1-6.9 mmol/L on two occasions and 2 or more of 11 clinical, physical, and laboratory criteria are met. Impaired glucose tolerance and/or impaired fasting glucose (see enclosed chart) are the criteria for impaired glucose regulation, which is associated with increased risk for the development of DM and cardiovascular disease. Appropriate care includes yearly measurement of fasting glucose to detect progression to DM, and attention to other risk factors and lifestyle modification.

The only exceptions to the 2-sample-2 hour GTT are GTT testing for hypoglycemia or during pregnancy. For unqualified GTT or 2H GTT requests, the 2-sample-2 hour test will be performed unless additional specimens are specifically indicated on the requisition. (For tolerances ³ three hours, specimens are drawn hourly unless otherwise instructed.)

MDS Metro will not require an appointment when only baseline and 2h post-glucose specimens are required. Please ensure optimal utilization by discussing the procedure and these important preanalytical requirements with your patient:

• An overnight fast for 10 hours but not more than 16 hours: other than drinking water, patients must not eat.
  
• A regular diet of >150g (600 calories) carbohydrate daily for three days before the test. (A list of sample foods and carbohydrate content is available from MDS Metro on request (604-431-5005 or 1-800-431-7206, ask for Client Information).
  
• Unrestricted activity for three days before the test.
  
• The test must begin in the morning and the patient remains in the lab until the second specimen is collected.

Acute illness or hospitalization within the previous six to eight weeks are relative contraindications to testing because severe acute illness can cause transient hyperglycemia. (Please note that appointments are still required for GTT ³ 3h, for gestational GTTs, and for any 2h GTT requiring more than two specimens.)

Although testing criteria for DM in presumably healthy adults is not discussed in the Protocol, the CDA and ADA recommend testing in adults aged 45 years and above and, if normal, retesting every three years. Earlier or more frequent testing should be considered for those with additional risk factors.

Note that measurement of HbA1c is not recommended to diagnose DM, but is the preferred laboratory test to monitor glucose control. Yearly measurement is recommended for patients with stable glucose control, while quarterly testing may be indicated for patients in poor control or whose therapy is being adjusted.

Please direct comments or concerns to the following:

Mainland: Dr. Margaret Kelly
604-412-4426 or 1-800-431-7206

Dr. David Aitken
604-412-4412 or 1-800-431-7206

Island: Dr. Michael McNeely
250-881-3109 or 1-800-304-4011

References:

1. "Protocol for Use of Glucose and HbA1c Tests in Diagnosis and Monitoring of Diabetes Mellitus." BCMA/MSC, March 1999.
2. American Diabetes Association "Report of the Expert Committee on The Diagnosis and Classification of Diabetes Mellitus", Diabetes Care, 20 (7), July 1997, 1183-96.
3. Canadian Diabetes Association "1998 Clinical Practice Guidelines for the Management of Diabetes in Canada.", CMAJ, 159 (8 Suppl), October 1998, S1-S29.