Using pathology-specific laboratory profiles in clinical pathology to reduce inappropriate test requesting: two completed audit cycles.

BACKGROUND: Systematic reviews have shown that, although well prepared, the Consensus Guidelines have failed to change clinical practice. In the healthcare district of Castelnovo né Monti (Reggio Emilia, Italy), it became necessary for the GPs and Clinical Pathologists to work together to jointly define laboratory profiles. METHODS: Observational study with two cycles of retrospective audit on test request forms, in a primary care setting. Objectives of the study were to develop pathology-specific laboratory profiles and to increase the number of provisional diagnoses on laboratory test request forms. A Multiprofessional Multidisciplinary Inter-hospital Work Team developed pathology-specific laboratory profiles for more effective test requesting. After 8 training sessions that used a combined strategy with multifaceted interventions, the 23 General Practitioners (GPs) in the trial district (Castelnovo nè Monti) tested the profiles; the 21 GPs in the Puianello district were the control group; all GPs in both districts participated in the trial. All laboratory tests for both healthcare districts are performed at the Laboratory located in the trial district. A baseline and a 1-year audit were performed in both districts on the GPs' request forms. RESULTS: Seven pathology-specific laboratory profiles for outpatients were developed. In the year after the first audit cycle: 1) the number of tests requested in the trial district was distinctly lower than that in the previous year, with a decrease of about 5% (p < 0.001); 2) the provisional diagnosis on the request forms was 52.8% in the trial district and 42% in the control district (P < 0.001); 3) the decrease of the number of tests on each request form was much more marked in the trial district (8.73 vs. 10.77; p < 0.001). CONCLUSIONS: The first audit cycle showed a significant decrease in the number of tests ordered only in the trial district. The combined strategy used in this study improved the prescriptive compliance of most of the GPs involved. The presence of the clinical pathologist is seen as an added value.

Pregnancy and delivery in a patient with aortic prosthesis for Leriche syndrome.

CONTEXT: Leriche syndrome is a thrombotic obliteration of the bifurcation of the aorta, a rare condition that usually affects older men as a result of atherosclerosis. Women of childbearing age rarely need a vascular prosthesis (as a result of Leriche syndrome or other conditions) and there is no literature on an association between Leriche syndrome/vascular prosthesis and pregnancy/labor/delivery. CASE REPORT: A case of pregnancy and delivery in a 38-year-old patient with Leriche syndrome and an aortoiliac prosthesis is presented. The patient had no complications during pregnancy, and was admitted to the maternity hospital when close to term, to begin heparin therapy. Labor ensued spontaneously and a normal vaginal delivery occurred, resulting in a healthy infant. The authors present their considerations regarding the delivery route and the rationale for deciding in favor of vaginal childbirth.

Pregnancy and delivery in a patient with aortic prosthesis for Leriche syndrome

CONTEXT: Leriche syndrome is a thrombotic obliteration of the bifurcation of the aorta, a rare condition that usually affects older men as a result of atherosclerosis. Women of childbearing age rarely need a vascular prosthesis (as a result of Leriche syndrome or other conditions) and there is no literature on an association between Leriche syndrome/vascular prosthesis and pregnancy/labor/delivery. CASE REPORT: A case of pregnancy and delivery in a 38-year-old patient with Leriche syndrome and an aortoiliac prosthesis is presented. The patient had no complications during pregnancy, and was admitted to the maternity hospital when close to term, to begin heparin therapy. Labor ensued spontaneously and a normal vaginal delivery occurred, resulting in a healthy infant. The authors present their considerations regarding the delivery route and the rationale for deciding in favor of vaginal childbirth