Monthly Archives: September 2015

“Looking at the answer without knowing the question”

I remember as a junior doctor wading through piles (it was all paper in those days) of urine and wound swab results etc as part of my morning duties. Often the patient was not known to me, or due to the time taken for the result to come back I had forgotten what the reason was for ordering it in the first place. This makes interpretation very difficult. In essence you are to some extent managing the result, not the patient.

I am sure this still happens these days, and probably a lot more often than you would think.

The answer of course, is not only to make clinical details a pre-requisite on request forms (my mission to achieve this at my own labs is progressing slowly but surely) but also to present on the result whatever clinical details that were written on the original request form.

In this way the clinician can be reminded of the reason for requesting the test in the first place and can therefore interpret the result more accurately within the clinical context.

If clinical details are on a paper request form then it is time consuming to transcribe all these into the LIS, not to mention they may not always be legible. So I think there is an excuse for people/labs who currently use paper forms.

However once electronic requesting becomes established, there is no excuse….

CT scan results at my local hospital are reported in this fashion, always with the clinical details/reason for imaging at the start of the result report. Sadly, by looking at CT scan results, is often how I get some clinical details to help interpret microbiology results.

It is vital that the vision for microbiology follows along the same lines as CT reporting, presenting the clinical details as part of the result.



“Rotavirus vaccine: Getting immunity from the baby”

NZ introduced oral rotavirus vaccine onto its National Immunisation Schedule in July 2014. Already there has been a dramatic decline in cases of rotavirus and in some areas we have not seen a case for several months. The decline is in all age groups, not just the vaccinated cohort.

and it is not just herd immunity…..

My 9 month son received the vaccine last December. Because it is a live attenuated virus, it is likely, through nappy changing etc that the rest of the family has been exposed to the vaccine virus. There is a good chance that the whole family is now immune to Rotavirus. (7 vaccinations for the price of 1!)

The success story of the vaccine changes the landscape somewhat for laboratory testing for rotavirus. Traditionally rotavirus laboratory testing was very common. On occasion a positive result may have stopped a very sick infant getting further investigation, or be used to cohort patients with rotavirus together. But mostly it was just used to put a name to the illness.

Whilst the number of positive results has dropped dramatically, the test numbers have only decreased slightly.

Positivity rates have gone from approximately 1 in 10 tests to under 1 in 200.

We need to relay this information to the clinicians and ask them to think again about why they are testing for rotavirus. Rotavirus testing is still indicated in certain patient cohorts, but not in the wholesale manner of the past.


For a more detailed article on this topic, click here



“Keeping a Log”

It is so simple to do, but it is surprising how many people don’t do it.

I am talking here about keeping a log of interesting cases/isolates that you have come across in your day to day practice. 

Such a log is very useful if you want to do a case presentation at a journal club/grand round etc. Then it is simply a matter of looking at it and taking your pick. It is also very useful for teaching trainees.

My log is on a simple excel spreadsheet. I keep it ruthlessly brief, having columns only for date, lab no., patient ID no., and no more than a dozen words describing the case. The rest I can go back and get if necessary from the LIS or electronic clinical records.

It takes me approximately 1 minute to add a new case to the log and I probably add a new case on average every 2-3 weeks. I have been keeping it for a few years now.

My only regret is that it took me so long to get it started…….