2013-06-18T23:04:36Zhttp://www.ncbi.nlm.nih.gov/oai/oai.cgi

oai:pubmedcentral.nih.gov:12047632005-11-07clinbiorev

Managing Conflict of Interest: sense and sensibility Van Der Weyden, Martin B Chew, Mabel Editorial 2005-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1204763/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12047642005-11-07clinbiorev

Insulin and Insulin Resistance Wilcox, Gisela Review Article As obesity and diabetes reach epidemic proportions in the developed world, the role of insulin resistance and its consequences are gaining prominence. Understanding the role of insulin in wide-ranging physiological processes and the influences on its synthesis and secretion, alongside its actions from the molecular to the whole body level, has significant implications for much chronic disease seen in Westernised populations today. This review provides an overview of insulin, its history, structure, synthesis, secretion, actions and interactions followed by a discussion of insulin resistance and its associated clinical manifestations. Specific areas of focus include the actions of insulin and manifestations of insulin resistance in specific organs and tissues, physiological, environmental and pharmacological influences on insulin action and insulin resistance as well as clinical syndromes associated with insulin resistance. Clinical and functional measures of insulin resistance are also covered. Despite our incomplete understanding of the complex biological mechanisms of insulin action and insulin resistance, we need to consider the dramatic social changes of the past century with respect to physical activity, diet, work, socialisation and sleep patterns. Rapid globalisation, urbanisation and industrialisation have spawned epidemics of obesity, diabetes and their attendant co-morbidities, as physical inactivity and dietary imbalance unmask latent predisposing genetic traits. 2005-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1204764/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12047652005-11-07clinbiorev

Biochemical Assessment and Long-Term Monitoring in Patients with Acromegaly: Statement from a Joint Consensus Conference of The Growth Hormone Research Society and The Pituitary Society.1 Lim, Ee Mun Pullan, Peter Consensus Statement Review In April 2003, the Growth Hormone (GH) Research Society and The Pituitary Society developed a consensus statement to address the current status of both biochemical assessment and long-term monitoring in patients with acromegaly. They also highlighted the pitfalls of current GH and Insulin-like Growth Factor-1 (IGF-1) assay methodologies and the difficulties in defining target GH and IGF-1 levels in treated acromegaly. 2005-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1204765/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400242005-11-07clinbiorev

Standardised, Metabolite-Specific Assays with Validated Decision Limits: Utopian Ideal or Achievable Goal? Glendenning, Paul Editorial 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240024/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400252005-11-07clinbiorev

HbA1c Standardisation Destination – Global IFCC Standardisation How, Why, Where and When: A Tortuous Pathway From Kit Manufacturers, via Inter-laboratory Lyophilized and Whole Blood Comparisons to Designated National Comparison Schemes Goodall, Ian Review Articles Glycohaemoglobins were first used in routine clinical laboratories for diabetes monitoring around 1977 and at the time all methods had either no calibrators, or used material with assayed values derived from individual manufacturers’ assays. Over the next five to fifteen years, lyophilised and whole blood sample exchanges were shown to improve inter-laboratory variability markedly. The use of a precise HPLC method as the “standard method” in the Diabetes Control and Complications Trial (DCCT) led to significant further improvement. 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240025/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400262005-11-07clinbiorev

Vitamin D: A Hormone for All Seasons - How much is enough? Understanding the New Pressures Morris, Howard A Review Articles Further understanding of its endocrine mechanisms and increased evidence for autocrine/paracrine actions has recently enhanced our knowledge of the biological activities of the vitamin D metabolite 1,25-dihydroxyvitamin D (1,25(OH)2D). The recognition of the contribution of vitamin D depletion to increased risk of osteoporosis, and most importantly the risk of hip fracture in the elderly, has increased the clinical significance of clinical laboratory testing for vitamin D status. Research has revealed that at least three genes contribute to vitamin D activity within tissues. These are the vitamin D receptor as well as two major vitamin D metabolising enzymes, CYP27B1, responsible for synthesis of 1,25(OH)2D and CYP24, responsible for catabolism of vitamin D metabolites. Current research focuses on the contribution of vitamin D metabolism to increasing vitamin D activity. This is of particular interest in bone forming cells where increased 1,25(OH)2D activity has been proposed to contribute to strengthening the skeleton. As well, solid tumours such as prostate, breast and colon cancers are another increasing area of vitamin D research. The major issues for the clinical laboratory in vitamin D testing include defining clinical decision limits for the interpretation of serum 25-hydroxyvitamin D (25OHD) levels and improving the precision and accuracy of this assay. 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240026/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400272005-11-07clinbiorev

Improving the Measurement of 25-hydroxyvitamin D Wootton, Andrew M Analytical Commentary 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240027/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400282005-11-07clinbiorev

Androgen Insufficiency in Ageing Men: how is it defined and should it be treated? Coates, Penelope Clinical Commentary 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240028/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400292005-11-07clinbiorev

Are Routine Testosterone Assays Good Enough? Sacks, Sydney S Analytical Commentary 2005-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240029/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400302006-02-01clinbiorev

Hepcidin - the Iron Regulatory Hormone Rossi, Enrico Commentary 2005-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240030/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400312006-02-01clinbiorev

Metabolic Syndrome and Type 2 Diabetes: The Hong Kong Perspective Chan, Norman N Kong, Alice PS Chan, Juliana CN Mini Review The Metabolic syndrome (MetS), obesity and type 2 diabetes are growing global epidemics especially in Asian populations. In light of the differences in body build between people from the West and the East, definitions of obesity in Asians have been modified accordingly. Data from Hong Kong, an epitome of future China, may provide important insight into the potential interactions between nature and nurture in this global epidemic. Now supported by large scale studies, it is clear that Chinese type 2 diabetic patients exhibit marked phenotypic heterogeneity in terms of risk profiles and complications. Apart from genetic differences, age- and stress-related neurohormonal dysregulation may also contribute to the increasing prevalence of obesity, type 2 diabetes and MetS in Chinese living in modern societies. In this mini-review, we aim to summarise findings from our group collected during the last decade in our attempt to understand this epidemic and to develop evidence-based care models to reduce the impact of this health hazard. 2005-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240031/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400322006-02-01clinbiorev

Preparing the Biochemistry Laboratory for the Next Outbreak: Lessons from SARS in Singapore Hawkins, Robert Mini Review Severe acute respiratory syndrome (SARS) is an emerging disease characterised by fever and atypical pneumonia and caused by a novel coronavirus. Singapore was affected by the global pandemic in early 2003, with 238 cases and 33 deaths. Samples sent to the biochemistry laboratory made up the majority (69%) of all SARS samples, yet remained a minority (29%) of total biochemistry workload. This paper describes the problems encountered and solutions adopted by the biochemistry laboratory at the designated SARS hospital in coping with this epidemic. It provides practical advice for laboratories planning for the handling of samples from future outbreaks. 2005-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240032/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400332006-02-01clinbiorev

Recent Developments in the First Detection of Hepatocellular Carcinoma Lopez, Joseph B. Review Article Hepatocellular carcinoma (HCC) ranks fifth in frequency of cancers worldwide. The main aetiological factor is hepatitis B virus (HBV) although the importance of hepatitis C virus (HCV) is growing. The most important tumour marker for HCC is alpha-fetoprotein (AFP). The common method of screening high risk patients by AFP and ultrasonography has been shown to result in earlier detection and consequently more easily treatable tumours and longer survival. Proposed screening interval varies from once every 3 months to annually to “as indicated’ but, most commonly, is once every 6 months. 2005-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240033/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12400342006-02-01clinbiorev

Chronic Kidney Disease and Automatic Reporting of Estimated Glomerular Filtration Rate: A Position Statement Position Statement The systematic staging of chronic kidney disease (CKD) by glomerular filtration measurement and proteinuria has allowed the development of rational and appropriate management plans.One of the barriers to early detection of CKD is the lack of a precise, reliable and consistent measure of kidney function.The most common measure of kidney function is currently serum creatinine concentration. It varies with age, sex, muscle mass and diet, and interlaboratory variation between measurements is as high as 20%.The reference interval for serum creatinine concentration includes up to 25% of people (particularly thin, elderly women) who have an estimated glomerular filtration rate (eGFR) that is significantly reduced (< 60 mL/min/1.73m2).The recent publication of a validated formula (MDRD) to estimate GFR from age, sex, race and serum creatinine concentration, without any requirement for measures of body mass, allows pathology laboratories to “automatically” generate eGFR from data already acquired.Automatic laboratory reporting of eGFR calculated from serum creatinine measurements would help to identify asymptomatic kidney dysfunction at an earlier stage.eGFR correlates well with complications of CKD and an increased risk of adverse outcomes such as cardiovascular morbidity and mortality.We recommend that pathology laboratories automatically report eGFR each time a serum creatinine test is ordered in adults.As the accuracy of eGFR is suboptimal in patients with normal or near-normal renal function, we recommend that calculated eGFRs above 60 mL/min/1.73m2 be reported by laboratories as “> 60 mL/min/1.73m2 ”, rather than as a precise figure. 2005-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1240034/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:12528242005-11-07clinbiorev

The Evidence Based Medicine Approach to Diagnostic Testing: practicalities and limitations Hawkins, Robert C Review Article Evidence-Based Medicine (EBM) has become a popular approach to medical decision making and is increasingly part of undergraduate and postgraduate medical education. EBM follows four steps: 1. formulate a clear clinical question from a patient’s problem; 2. search the literature for relevant clinical articles; 3. evaluate (critically appraise) the evidence for its validity and usefulness; 4. implement useful findings into clinical practice. This review describes the concepts, terminology and skills taught to attendees at EBM courses, focusing specifically on the approach taken to diagnostic questions. It covers how to ask an answerable clinical question, search for evidence, construct diagnostic critically appraised topics (CATs), and use sensitivity, specificity, likelihood ratios, kappa and phi statistics. It familiarises readers with the lexicon and techniques of EBM and allows better understanding of the needs of EBM practitioners. 2005-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1252824/ Text en Copyright © 2005 The Australasian Association of Clinical Biochemists Inc.

oai:pubmedcentral.nih.gov:13201742006-05-01clinbiorev

Making the Most of a Patient’s Laboratory Data: Optimisation of Signal-to-Noise Ratio Petersen, Per Hyltoft Mini Review All results in laboratory medicine are compared to some reference for interpretation. This reference may be a previous result from the same patient, a reference population – either healthy or diseased, or both – or a decision limit recommended by an expert group. The aim for the medical laboratory is to improve the signal-to-noise ratio by increasing the signal or reducing the noise. This presentation deals with the more general tools for reduction of the noise component, and focuses on biological within-subject variation, reference intervals and decision models. The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320174/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13201752006-05-01clinbiorev

Biochemical Markers of Bone Turnover Part I: Biochemistry and Variability Seibel, Markus J Review Article With the ageing population in most countries, disorders of bone and mineral metabolism are becoming increasingly relevant to every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies has markedly grown. Together with clinical and imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease. The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320175/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13201762006-05-01clinbiorev

Below the Radar: Advanced Glycation End Products that Detour “around the side”: Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? Forbes, Josephine M Soldatos, Georgia Thomas, Merlin C. Review Article Advanced glycation is the irreversible attachment of reducing sugars onto the free amino groups of proteins. Its physiological roles are thought to include the identification of senescent proteins and hence there is a time dependent accumulation of advanced glycation end products (AGEs). AGE labelled proteins are catabolised by cells into low molecular weight peptides and amino acids and excreted primarily via the kidneys. This process appears to be tightly controlled by AGE clearance receptor complexes containing AGE-R1, AGE-R2 and AGE-R3 and scavenger receptors such as CD36, SR-AII and SR-BI. The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13201772006-05-01clinbiorev

The Relevance of Sweat Testing for the Diagnosis of Cystic Fibrosis in the Genomic Era Mishra, Avantika Greaves, Ronda Massie, John Position Statement Cystic fibrosis (CF) is the most common inherited disorder of childhood. The diagnosis of CF has traditionally been based on clinical features with confirmatory evidence by sweat electrolyte analysis. Since 1989 it has been possible to also use gene mutation analysis to aid the diagnosis. Cloning of the cystic fibrosis transmembrane conductance regulator (CFTR) gene has advanced our understanding of CF, in particular the molecular basis of an expanded CF phenotype. However, because there are over 1000 mutations and 200 polymorphisms, many without recognised effects on CFTR, the molecular diagnosis can be troublesome. This has necessitated measurement of CFTR function with renewed interest in the sweat test. This review provides an overview of the clinical features of CF, the diagnosis and complex genetics. We provide a detailed discussion of the structure and function of CFTR and the classification of CFTR mutations. Sweat electrolyte analysis is discussed, from the physiology of sweating to the rigours of a properly performed sweat test and its interpretation. With this information it is possible to understand the relevance of the sweat test in the genomic era. The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320177/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13201782006-05-01clinbiorev

Uncertainty of Measurement: What it is and What it Should Be Badrick, Tony Hawkins, Robert C. Wilson, Susan R. Hickman., Peter E. Correspondence The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320178/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13201792006-05-01clinbiorev

Uncertainty of Measurement is Exactly That: (or the hitch-hikers pocket guide to the uncertainties of laboratory results and their interpretation) White, Graham H. Correspondence The Australian Association of Clinical Biochemists 2005-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320179/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907892006-08-01clinbiorev

Normal Iron Metabolism and the Pathophysiology of Iron Overload Disorders Siah, Chiang W Ombiga, John Adams, Leon A Trinder, Debbie Olynyk, John K Review Article Iron overload disorders represent a heterogenous group of conditions resulting from inherited and acquired causes. If undiagnosed they can be progressive and fatal. Early detection and phlebotomy prior to the onset of cirrhosis can reduce morbidity and normalise life expectancy. We now have greater insight into the complex mechanisms of normal and disordered iron homeostasis following the discovery of new proteins and genetic defects. Here we review the normal mechanisms and regulation of gastrointestinal iron absorption and liver iron transport and their dysregulation in iron overload states. Advances in the understanding of the natural history of iron overload disorders and new methods for clinical detection and management of hereditary haemochromatosis are also reviewed. The current screening strategies target high-risk groups such as first-degree relatives of affected individuals and those with clinical features suggestive of iron loading. Potential ethical, legal and psychosocial issues arising through application of genetic screening programs need to be resolved prior to implementation of general population screening programs. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390789/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907902006-08-01clinbiorev

The Influence of Cytochrome P450 Pharmacogenetics on Disposition of Common Antidepressant and Antipsychotic Medications van der Weide, Jan Hinrichs, John WJ Review Article Since the identification of all the major drug-metabolising cytochrome P450 (CYP) enzymes and their major gene variants, pharmacogenetics has had a major impact on psychotherapeutic drug therapy. CYP enzymes are responsible for the metabolism of most clinically used drugs. Individual variability in CYP activity is an important reason for drug therapy failure. Variability in CYP activity may be caused by various factors, including endogenous factors such as age, gender and morbidity as well as exogenous factors such as co-medication, food components and smoking habit. However, polymorphisms, present in most CYP genes, are responsible for a substantial part of this variability. Although CYP genotyping has been shown to predict the majority of aberrant phenotypes, it is currently rarely performed in clinical practice. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390790/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907912006-08-01clinbiorev

Diagnosis of the Haemoglobinopathies Trent, Ronald J A Review Article Despite having been extensively studied at both the biochemical, haematological and molecular levels, the haemoglobinopathies continue to provide a diagnostic challenge particularly in the multiethnic communities seen in Australia. Early detection and characterisation of the haemoglobinopathies is essential so that appropriate counselling can be provided to couples and families who may be at risk of severe haematological consequences. Although DNA diagnostics have made a major impact on our understanding and detection of the haemoglobinopathies, DNA mutation testing should never be considered a short cut or the test of first choice in the workup of a haemoglobinopathy. A careful three tier approach involving: (1) Full blood count (2) Special haematological tests, followed by (3) DNA mutation analysis, provides the most effective way in which to detect primary gene mutations as well as gene-gene interactions that can influence the overall phenotype. Just as important as the laboratory investigations is the family work up. Often, the first and most helpful clue to gene gene interactions comes from the family study. In Australia, there are many different forms of α and β thalassaemia. Increasingly, different Hb Variants are being detected, and their effects per se, or in combination with the thalassaemias, provide additional diagnostic challenges. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390791/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907922006-08-01clinbiorev

Ethical Considerations in the Use of DNA for the Diagnosis of Diseases Barlow-Stewartand, Kristine Burnett, Leslie Review Article Scientific advances in genetics have recently provided new information and enabled new interventions that are challenging existing ethical conventions. ISO 15189:20031 obliges the laboratory to consider its ethical responsibilities and the AACB (through membership of the IFCC) has taken a leading role in the discussion of evolving new ethical frameworks. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390792/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907932006-08-01clinbiorev

Diagnostic Molecular Biology Beilby, John Editorial The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390793/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907942006-08-01clinbiorev

Clinical Applications of Molecular Biology for Infectious Diseases Speers, David J Review Article Molecular biological methods for the detection and characterisation of microorganisms have revolutionised diagnostic microbiology and are now part of routine specimen processing. Polymerase chain reaction (PCR) techniques have led the way into this new era by allowing rapid detection of microorganisms that were previously difficult or impossible to detect by traditional microbiological methods. In addition to detection of fastidious microorganisms, more rapid detection by molecular methods is now possible for pathogens of public health importance. Molecular methods have now progressed beyond identification to detect antimicrobial resistance genes and provide public health information such as strain characterisation by genotyping. Treatment of certain microorganisms has been improved by viral resistance detection and viral load testing for the monitoring of responses to antiviral therapies. With the advent of multiplex PCR, real-time PCR and improvements in efficiency through automation, the costs of molecular methods are decreasing such that the role of molecular methods will further increase. This review will focus on the clinical utility of molecular methods performed in the clinical microbiology laboratory, illustrated with the many examples of how they have changed laboratory diagnosis and therefore the management of infectious diseases. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390794/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:13907952006-08-01clinbiorev

Genotyping of Single Nucleotide Substitutions Mamotte, Cyril DS Review Article The description of the polymerase chain reaction in 1985 caused a revolution in genetics and today molecular diagnostics is one of the leading growth areas across all disciplines of laboratory medicine. This paper reviews the principles and limitations of a number of traditional and emerging techniques for typing of single nucleotide substitutions. The techniques discussed include traditional approaches such as restriction enzyme analysis, more recent homogenous methods, such as those utilising TaqMan®, fluorescence resonance energy transfer (FRET) and Scorpion® probes, and high resolution melting curve analysis. Non-homogenous but highly flexible approaches such as Pyrosequencing™ and mass-spectrometry are also discussed. While many techniques are available, it is clear that no one approach is clearly superior. However, in terms of their many advantages and continuing developments, homogenous approaches have much to recommend them. The Australian Association of Clinical Biochemists 2006-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1390795/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2006 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090.

oai:pubmedcentral.nih.gov:15792862007-02-21clinbiorev

Steroid Analysis in Saliva: An overview Lewis, John G Review Article The first report of steroid analysis in saliva was more than thirty years ago. Since that time its popularity has increased due to the attractiveness of non-invasive, repeated and simple stress-free sampling. It has proved a popular sampling fluid for psychobiology, sports medicine, pharmacology and paediatric studies as well as in the area of complementary medicine. In the diagnostic laboratory, salivary progesterone and oestradiol have been used for assessing ovarian function and 17α-OH progesterone for the diagnosis of congenital adrenal hyperplasia (CAH). Salivary cortisol is used for investigating adrenal function and recently there has been considerable interest in the use of bedtime salivary cortisol levels as a screening test for Cushing’s disease. However, there are several caveats on the use of saliva including collection techniques, the variable matrix of saliva, sensitivity, steroid stability, the presence of binding proteins and reference range anomalies. This brief review will attempt to address these issues and provide a balanced approach to steroid analysis in saliva. The Australian Association of Clinical Biochemists 2006-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579286/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15792872007-02-21clinbiorev

Cultural and Clinical Effectiveness of the ‘QAAMS’ Point-of-Care Testing Model for Diabetes Management in Australian Aboriginal Medical Services. Shephard, Mark DS Report The national Quality Assurance for Aboriginal Medical Services (QAAMS) Program, in which point-of-care testing (POCT) for haemoglobin A1c (HbA1c) and urine albumin: creatinine ratio (ACR) is performed for diabetes management in 65 Australian Aboriginal medical services, is now embedded in the practice of diabetes care across Indigenous Australia. This paper documents the results of a detailed survey to assess levels of satisfaction with the QAAMS HbA1c Program among three key stakeholder groups–doctors, POCT operators and patients with diabetes. Both doctors and patients with diabetes agreed that the immediacy of POCT results contributed positively to patient care, improved the doctor-patient relationship, and made the patient more likely to be both compliant and self-motivated to improve their diabetes control. Both POCT operators and patients with diabetes reported improved satisfaction with their diabetes services after the introduction of POCT. The paper also provides evidence from two participating medical services that POCT has been an effective tool in improving the delivery of pathology services and clinical outcomes for both individuals and groups of patients with diabetes. A statistically significant reduction in HbA1c from 9.3% (± 2.0) to 8.6% (± 2.0) was observed in 74 diabetes patients 12 months after commencing POCT (p = 0.003, paired t-test). An improvement in the percentage of patients achieving glycaemic targets and a reduction in the percentage of patients with poor control was also observed in this group. These data provide evidence that the QAAMS POCT model delivers a culturally and clinically effective service for diabetes management in Aboriginal Australia. The Australian Association of Clinical Biochemists 2006-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579287/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15792882007-02-21clinbiorev

Drug Testing in Oral Fluid Drummer, Olaf H Review Article Over the last decade there have been considerable developments in the use of oral fluid (saliva) for drug testing. Oral fluid can provide a quick and non-invasive specimen for drug testing. However, its collection may be thwarted by lack of available fluid due to a range of physiological factors, including drug use itself. Food and techniques designed to stimulate production of oral fluid can also affect the concentration of drugs. Current applications are mainly focused on drugs of abuse testing in employees at workplaces where drug use has safety implications, in drivers of vehicles at the roadside and in other situations where drug impairment is suspected. Testing has included alcohol (ethanol) and a range of clinical tests eg antibodies to HIV, therapeutic drugs and steroids. Its main application has been for testing for drugs of abuse such as the amphetamines, cocaine and metabolites, opioids such as morphine, methadone and heroin, and for cannabis. Oral fluid concentrations of basic drugs such as the amphetamines, cocaine and some opioids are similar or higher than those in plasma. Tetrahydrocannabinol (THC), the major species present from cannabis use, displays similar concentrations in oral fluid compared to blood in the elimination phase. However, there is significant local absorption of the drug in the oral cavity which increases the concentrations for a period after use of drug. Depot effects occur for other drugs introduced into the body that allow local absorption, such as smoking of tobacco (nicotine), cocaine, amphetamines, or use of sub-lingual buprenorphine. Screening techniques are usually an adaptation of those used in other specimens, with an emphasis on the parent drug since this is usually the dominant species present in oral fluid. Confirmatory techniques are largely based on mass spectrometry (MS) with an emphasis on Liquid Chromatography-Mass Spectrometry (LC-MS), due to low sample volumes and the low detection limits required. Drug testing outside laboratory environments has become widespread and provides presumptive results within minutes of collection of specimens. This review focuses on the developments, particularly over the last 10 years, and outlines the roles and applications of testing for drugs in oral fluid, describes the difficulties associated with this form of testing and illustrates applications of oral fluid testing for specific drugs. The Australian Association of Clinical Biochemists 2006-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579288/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15792892007-02-21clinbiorev

Biochemical Markers of Bone Turnover Part II: Clinical Applications in the Management of Osteoporosis Seibel, Markus J Review Article With the ageing population in most countries, disorders of bone and mineral metabolism are becoming increasingly relevant to every day clinical practice. Consequently, the interest in, and the need for effective measures to be used in the screening, diagnosis and follow-up of such pathologies have markedly grown. Together with clinical and imaging techniques, biochemical tests play an important role in the assessment and differential diagnosis of metabolic bone disease. These biochemical indices are non-invasive, comparatively inexpensive and, when applied and interpreted correctly, helpful tools in the diagnostic and therapeutic assessment of metabolic bone disease. The Australian Association of Clinical Biochemists 2006-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579289/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15792902007-02-21clinbiorev

The Role of Biochemical Markers of Bone Turnover in Osteoporosis Management in Clinical Practice Vasikaran, Samuel D Glendenning, Paul Morris, Howard A Editorial The Australian Association of Clinical Biochemists 2006-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579290/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15794112006-11-01clinbiorev

Communication Systems in Healthcare Coiera, Enrico Review Article The care of patients now almost inevitably seems to involve many different individuals, all needing to share patient information and discuss their management. As a consequence there is increasing interest in, and use of, information and communication technologies to support health services. Yet, while there is significant discussion of, and investment in, information technologies, communication systems receive much less attention and the clinical adoption of even simpler services like voice-mail or electronic mail is still not commonplace in many health services. There remain enormous gaps in our broad understanding of the role of communication services in health care delivery. Laboratory medicine is perhaps even more poorly studied than many other areas, such as the interface between primary care and hospital services. Given this lack of specific information about laboratory communication services, this paper will step back and generally review the components of a communication system, including the basic concepts of a communication channel, service, device and interaction mode. The review will then try and summarise some of what is known about specific communication problems that arise across health services in the main, including the community and hospital service delivery. The Australian Association of Clinical Biochemists 2006-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579411/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15794122006-11-01clinbiorev

Computerised Order Entry Systems and Pathology Services - A Synthesis of the Evidence Georgiou, Andrew Westbrook, Johanna I Review Article Computerised Physician Order Entry (CPOE) systems have been promoted in Australia and internationally for their potential to improve the quality of care. The existing research of the effect of CPOE on pathology laboratories has been variable, pointing to the potential to increase efficiency and effectiveness and contribute to enhancing the quality of patient care on the one hand, while leading to significant disruptions in work organisation with a negative impact on departmental relations on the other hand. In this paper we provide an overview of the research evidence about the impact of CPOE on four areas associated with pathology services; a) efficiency of the ordering process, e.g. test turnaround times, b) effectiveness as measured by test ordering volumes and test order appropriateness, c) quality of care, particularly its effects on patient care and d) work organisation patterns, which can be severely disrupted by CPOE. We discuss the possible ramifications of CPOE and offer three broad, but important recommendations for pathology laboratories, based on our own research experience investigating CPOE implementations over three years. Firstly, pathology laboratories need to be active participants in planning the implementation of CPOE. Secondly, the importance of building a firm organisational foundation for the introduction of the new system that includes openness and responsiveness to feedback. And thirdly, the implementation process needs to be underpinned by a strong commitment to a multi-method evaluation at every stage of the process to be able to measure the impact of the system on work practices and outcomes. The Australian Association of Clinical Biochemists 2006-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579412/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15794132006-11-01clinbiorev

Australian Guidelines for the Performance of the Sweat Test for the Diagnosis of Cystic Fibrosis: Report from the AACB Sweat Testing Working Party Supplement The Australian Association of Clinical Biochemists 2006-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579413/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:15794142006-11-01clinbiorev

Clinical Proteomics: Present and Future Prospects Verrills, Nicole M Review Article Advances in proteomics technology offer great promise in the understanding and treatment of the molecular basis of disease. The past decade of proteomics research, the study of dynamic protein expression, post-translational modifications, cellular and sub-cellular protein distribution, and protein-protein interactions, has culminated in the identification of many disease-related biomarkers and potential new drug targets. While proteomics remains the tool of choice for discovery research, new innovations in proteomic technology now offer the potential for proteomic profiling to become standard practice in the clinical laboratory. Indeed, protein profiles can serve as powerful diagnostic markers, and can predict treatment outcome in many diseases, in particular cancer. A number of technical obstacles remain before routine proteomic analysis can be achieved in the clinic; however the standardisation of methodologies and dissemination of proteomic data into publicly available databases is starting to overcome these hurdles. At present the most promising application for proteomics is in the screening of specific subsets of protein biomarkers for certain diseases, rather than large scale full protein profiling. Armed with these technologies the impending era of individualised patient-tailored therapy is imminent. This review summarises the advances in proteomics that has propelled us to this exciting age of clinical proteomics, and highlights the future work that is required for this to become a reality. The Australian Association of Clinical Biochemists 2006-05 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579414/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:17840072007-06-20clinbiorev

Erratum Erratum The Australian Association of Clinical Biochemists 2006-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784007/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:17840082007-06-20clinbiorev

Measurement of Serum Creatinine – Current Status and Future Goals Peake, *Michael Whiting, Malcolm Review Article The first methods for the measurement of creatinine in serum and plasma were published over a century ago. Today, the Jaffe reaction using alkaline picrate remains the cornerstone of most current routine methods, after continuous refinements attempting to overcome inherent analytical interferences and limitations. With the recent introduction of the reporting of estimated glomerular filtration rate (eGFR), inter-laboratory agreement of serum creatinine results has become an important international priority. Expert professional bodies have recommended that all creatinine methods should become traceable to a reference method based on isotope dilution-mass spectrometry (IDMS). The Australian Association of Clinical Biochemists 2006-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784008/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:17840092007-06-20clinbiorev

The Analytical Quality of Point-of-Care Testing in the ‘QAAMS’ Model for Diabetes Management in Australian Aboriginal Medical Services Shephard, Mark DS Gill, Janice P Review Article Type 2 diabetes mellitus and its major complication, renal disease, represent one of the most significant contemporary health problems facing Australia’s Indigenous Aboriginal People. The Australian Government-funded Quality Assurance for Aboriginal Medical Services Program (QAAMS) provides a framework by which on-site point-of-care testing (POCT) for haemoglobin A1c (HbA1c) and now urine albumin:creatinine ratio (ACR) can be performed to facilitate better diabetes management in Aboriginal medical services. This paper provides updated evidence for the analytical quality of POCT in the QAAMS Program. The median imprecision for point-of-care (POC) HbA1c and urine ACR quality assurance (QA) testing has continually improved over the past six and half years, stabilising at approximately 3% for both analytes and proving analytically sound in Aboriginal hands. For HbA1c, there was no statistical difference between the imprecision achieved by QAAMS and laboratory users of the Bayer DCA 2000 since the QAAMS program commenced (QAAMS CV 3.6% ± 0.52, laboratory CV 3.4% ± 0.42; p = 0.21, paired t-test). The Western Pacific Island of Tonga recently joined the QAAMS HbA1c Program indicating that the QAAMS model can also be applied internationally in other settings where the prevalence of diabetes is high. The Australian Association of Clinical Biochemists 2006-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784009/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:17840102007-06-20clinbiorev

Proceedings of the Australasian Association of Clinical Biochemists’ 44th Annual Scientific Conference Supplement The Australian Association of Clinical Biochemists 2006-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784010/ Text en

oai:pubmedcentral.nih.gov:17840112007-06-20clinbiorev

Fundamental Toxicology Ilett, Kenneth F Book Review The Australian Association of Clinical Biochemists 2006-11 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1784011/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533302008-07-23clinbiorev

Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century Glendenning, P Guidelines Review The Australian Association of Clinical Biochemists 2003-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853330/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533312008-06-20clinbiorev

Electrospray Ionisation Mass Spectrometry: Principles and Clinical Applications Ho, CS Lam, CWK Chan, MHM Cheung, RCK Law, LK Lit, LCW Ng, KF Suen, MWM Tai, HL Mini-Review This mini-review provides a general understanding of electrospray ionisation mass spectrometry (ESI-MS) which has become an increasingly important technique in the clinical laboratory for structural study or quantitative measurement of metabolites in a complex biological sample. The first part of the review explains the electrospray ionisation process, design of mass spectrometers with separation capability, characteristics of the mass spectrum, and practical considerations in quantitative analysis. The second part then focuses on some clinical applications. The capability of ESI-tandem-MS in measuring bio-molecules sharing similar molecular structures makes it particularly useful in screening for inborn errors of amino acid, fatty acid, purine, pyrimidine metabolism and diagnosis of galactosaemia and peroxisomal disorders. Electrospray ionisation is also efficient in generating cluster ions for structural elucidation of macromolecules. This has fostered a new and improved approach (vs electrophoresis) for identification and quantification of haemoglobin variants. With the understanding of glycohaemoglobin structure, an IFCC reference method for glycohaemoglobin assay has been established using ESI-MS. It represents a significant advancement for the standardisation of HbA1c in diabetic monitoring. With its other applications such as in therapeutic drug monitoring, ESI-MS will continue to exert an important influence in the future development and organisation of the clinical laboratory service. The Australian Association of Clinical Biochemists 2003-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853331/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533322008-07-23clinbiorev

Vitamin D Metabolism: New Concepts and Clinical Implications Anderson, PH May, BK Morris, HA Review Article The vitamin D endocrine system plays a primary role in the maintenance of calcium homeostasis as well as exerting a wider range of biological activities including the regulation of cellular differentiation and proliferation, immunity, and reproduction. Most of these latter activities have been demonstrated using in vitro techniques. A major issue is to place such in vitro findings into their physiological context. Vitamin D exerts its genomic effects through a nuclear gene transcription factor, the vitamin D receptor (VDR), while metabolism of vitamin D both to its biologically active form, as well as to its excretory product, plays a major role in determining biological activity at the tissue level. Considerable information has become available recently concerning the metabolism of vitamin D both in the kidney and in non-renal tissues. These data confirm the endocrine action of vitamin D through renal metabolism which provides 1,25 dihydroxyvitamin D (1,25D) to the circulation. The major organ responding to the endocrine action of 1,25D is the intestine where it controls absorption of calcium and phosphate. Preliminary information regarding the contribution of tissue-specific production of 1,25D to its paracrine/autocrine activity is now becoming available. In bone cells, these data provide evidence for the modulation of cell proliferation and stimulation of bone cell maturation. The relevance of these concepts to the clinical laboratory is discussed in the context of vitamin D insufficiency and the increased risk of hip fracture amongst the elderly. The Australian Association of Clinical Biochemists 2003-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853332/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533332008-06-20clinbiorev

The Clinical Biochemist Reviews: Seeking International Impact and Influence Vasikaran, SD Editorial The Australian Association of Clinical Biochemists 2003-02 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853333/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533392008-06-20clinbiorev

Quality Leadership and Quality Control Badrick, Tony Review Article Different quality control rules detect different analytical errors with varying levels of efficiency depending on the type of error present, its prevalence and the number of observations. The efficiency of a rule can be gauged by inspection of a power function graph. Control rules are only part of a process and not an end in itself; just as important are the trouble-shooting systems employed when a failure occurs. 'Average of patient normals' may develop as a usual adjunct to conventional quality control serum based programmes. Acceptable error can be based on various criteria; biological variation is probably the most sensible. Once determined, acceptable error can be used as limits in quality control rule systems. The Australian Association of Clinical Biochemists 2003-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853339/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533402008-06-20clinbiorev

Guidelines for the Detection of Diabetes Mellitus - Diagnostic Criteria and Rationale for Screening Schneider, Hans Shaw, Jonathan Zimmet, Paul Commentary The Australian Association of Clinical Biochemists 2003-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853340/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533412008-07-23clinbiorev

The National Kidney Foundation Guideline on Estimation of the Glomerular Filtration Rate Jones, Graham RD Lim., Ee-Mun Guidelines Review The Kidney Disease Outcomes Quality Initiative (K/DOQI) is a set of evidence-based clinical practice guidelines from the National Kidney Foundation in the USA. All K/DOQI guidelines are published in the American Journal of Kidney Diseases and can also be accessed without restriction on the internet at: http://www.kdoqi.org. Our aim in this article is to critically review one section of the recently released guideline "K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification". Part 5 of this document, "Evaluation of laboratory measurements for clinical assessment of kidney disease" includes Guideline 4: "Estimation of GFR".1 The summary section of the guideline is reproduced in the box and is presented in the original with 16 pages of explanation and supporting material. In this review we will critically assess the various components of this guideline under headings based on the statements in the summary. The Australian Association of Clinical Biochemists 2003-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853341/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090

oai:pubmedcentral.nih.gov:18533422008-06-20clinbiorev

Proceedings of the Australasian Association of Clinical Biochemists’ 41st Annual Scientific Conference Supplement The Australian Association of Clinical Biochemists 2003-08 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853342/ Text en The contents of articles or advertisements in The Clinical Biochemist – Reviews are not to be construed as official statements, evaluations or endorsements by the AACB, its official bodies or its agents. Statements of opinion in AACB publications are those of the contributors. Print Post Approved - PP255003/01665. Copyright © 2005 The Australasian Association of Clinical Biochemists Inc. No literary matter in The Clinical Biochemist – Reviews is to be reproduced, stored in a retrieval system or transmitted in any form by electronic or mechanical means, photocopying or recording, without permission. Requests to do so should be addressed to the Editor. ISSN 0159 – 8090 oai%3Apubmedcentral.nih.gov%3A1853349!!!oai_dc!clinbiorev