Education and communication is the key for the successful management of vitamin D test requesting

Introduction

Pre-preanalytical and post-postanalytical phases are steps where the laboratory professional may play a crucial role. Measuring the serum circulating 25 hydroxyvitamin D level (25(OH)D) is recommended to evaluate vitamin D status in patients at risk for vitamin D deficiency while 1,25 hydroxyvitamin D (1,25(OH)₂D) is only recommended to monitor several particular conditions (chronic kidney disease, hereditary phosphate-losing disorders, and some other) clearly defined by the current clinical guidelines of Endocrine Society.
Our research hypothesis was that through education and communication through comments in the Laboratory Information System (LIS), we could improve appropriateness in the request vitamin D tests.

Materials and methods

A retrospective observational cross-sectional study was conducted from January 2005 to December 2014. Each 1,25(OH)₂D request was reviewed individually by a member of the laboratory staff. Starting in November 2011, each inappropriate 1,25(OH)₂D request was registered in LIS and 25(OH)D was measured instead of 1,25(OH)₂D. We counted the overall number of 1,25(OH)₂D requests and the number of inappropriate requests which then were marked with a comment.

Results

The request of 25(OH)D increased along years. However, 1,25(OH)₂D requests increased until 2012 when demand began to diminish.

Conclusions

Education and communication through comments in the LIS, corrected the inappropriate request of 1,25(OH)₂D and promoted the use of 25(OH)D to study vitamin D deficiency.Key words: clinical laboratory services, utilization, vitamin D, communication, education     

Impact and structural features of meta-analytical studies,standard articles and reviews in psychology: Similarities and differences

Meta-analysis refers to the statistical methods used in research synthesis for combining and integrating results from individual studies. In this regard meta-analytical studies share with narrative reviews the goal of synthesizing the scientific literature on a particular topic, while as in the case of standard articles they present new results. This study aims to identify the potential similarities and differences between meta-analytical studies, reviews and standard articles as regards their impact and structural features in the field of psychology. To this end a random sample of 335 examples of each type of document were selected from the Thomson Reuters Web of Science database. The results showed that meta-analytical studies receive more citations than do both reviews and standard articles. All three types of documents showed a similar pattern in terms of institutional collaboration, while reviews and meta-analytical studies had a similar number of authors per document. However, reviews had a greater number of references and pages than did meta-analytical studies. The implications of these results for the scientific community are discussed.     

Automatic laboratory-based strategy to improve the diagnosis of type 2 diabetes in primary care

Introduction

To study the pre-design and success of a strategy based on the addition of hemoglobin A1c (HbA1c) in the blood samples of certain primary care patients to detect new cases of type 2 diabetes.

Materials and methods

In a first step, we retrospectively calculated the number of HbA1c that would have been measured in one year if HbA1c would have been processed, according to the guidelines of the American Diabetes Association (ADA). Based on those results we decided to prospectively measure HbA1c in every primary care patient above 45 years, with no HbA1c in the previous 3 years, and glucose concentration between 5.6-6.9 mmol/L, during an 18 months period. We calculated the number of HbA1c that were automatically added by the LIS based on our strategy, we evaluated the medical record of such subjects to confirm whether type 2 diabetes was finally confirmed, and we calculated the cost of our intervention.

Results

In a first stage, according to the guidelines, Hb1Ac should have been added to the blood samples of 13,085 patients, resulting in a cost of 14,973€. In the prospective study, the laboratory added Hb1Ac to 2092 patients, leading to an expense of 2393€. 314 patients had an HbA1c value ≥ 6.5% (48 mmol/mol). 82 were finally diagnosed as type 2 diabetes; 28 thanks to our strategy, with an individual cost of 85.4€; and 54 due to the request of HbA1c by the general practitioners (GPs), with a cost of 47.5€.

Conclusion

The automatic laboratory-based strategy detected patients with type 2 diabetes in primary care, at a cost of 85.4€ per new case.Key words: type 2 diabetes, HbA1c, diagnosis, preanalytical phase, test request appropriateness, costs, cost analysis     

Technology as ‘Applied Science’

The current consideration of technology as ‘applied science’, this is to say, as something that comes ‘after’ science, justifies the lack of attention paid to technology in science education. In our paper we question this simplistic view of the science-technology relationship, historically rooted in the unequal appreciation of intellectual and manual work, and we try to show how the absence of the technological dimension in science education contributes to a naïve and distorted view of science which deeply affects the necessary scientific and technological literacy of all citizens.     

The Process Of Developing a New Curriculum for Lower Secondary Education in Guatemala

The intention of this article is to present the way in which a proposal was put forward for a national basic curriculum for the lower level of secondary education in Guatemala, within a general curricular reform of the education system. In this process, the International Bureau of Education and UNESCO’s national office in the country provided technical advice. The article examines the socio-cultural and educational context, some conceptual foundations for the curricular reform, the construction of the curriculum for lower secondary education, some features of the proposed curriculum and the outlook for the future. The process of curriculum construction included a diagnosis, drawing up a strategy for reforming the first cycle of secondary education and preparation of the proposed curriculum. Likewise, the authors present the steps that must be taken in order for the national basic curriculum to be adopted, subject, amongst other factors, to the availability of funding. Original language: Spanish Linda Asturias de Barrios (Guatemala) Doctorate in Anthropology from the University at Albany, State University of New York. Postgraduate studies in Public Policies and Intercultural Affairs at the Universidad del Valle, Guatemala. She has taught at secondary school and university level. As a researcher, she has published books and articles on ethnology, development and education in Guatemala and Central America. At the Ministry of Education she has worked as Co-ordinator of the National and International Co-operation Unit (1997–1999), Co-ordinator of the Reform of Secondary Education (2004–2006) and Co-ordinator of the Reform of Lower Secondary Education (2007). E-mail: lindaasturias@yahoo.com Verónica Mérida Arellano (Guatemala) Teacher of secondary school language and literature and graduate in Literature and Philosophy at Rafael Landívar University. She completed a master’s degree in education and curriculum at the University del Valle, Guatemala. She has been a university lecturer. She has published books and articles on the teaching of Maya as a mother tongue and Spanish as a second language. She has worked as curriculum specialist at the Ministry of Education (1985–1991) and as Co-ordinator of Teacher-Training Programmes at Rafael Landívar University. From 2005 to 2007 she acted as Curriculum Consultant for Lower Secondary Education at the Ministry of Education. E-mail: vmeridaguate@yahoo.com.mx     

Education with ICT in South Korea and Chile

This article presents a linear-analytical case study on the development of ICT within the educational systems of Chile and South Korea. Through a comprehensive meta-data analysis and bibliographic review, we collected information on both educational systems and their ICT adoption policies. Key differences necessary to understand how both countries have developed their educational systems by integrating ICT were analyzed, including the educational system structure, the organization of state entities responsible for educational ICT, cultural characteristics, the creation of policies regarding ICT in education, and the effectiveness of such policies for the expansion of infrastructure and the ICT curriculum integration. We analyze these key differences in order to understand two cases of ICT integration initiatives on a national level, so that we might better understand the primary factors that influence successful ICT integration, as well as those that may hinder progress in this area.     

Critical Historical Thinking: When Official Narratives Collide With Other Narratives

In this article the authors examine The Student as Historian project in highlighting how critical historical thinking can provide other and more complex renditions of history. The authors note that teachers’ understandings of educational ends, purposes, values, and critical content knowledge are entwined and inextricable from ideological stances and historical positionality.