REVIEW

Best practice in primary care pathology: review 1

W S A Smellie¹, D Wilson², C A M McNulty³, M J Galloway⁴, G A Spickett⁵, D I Finnigan², D A Bareford⁶, M A Greig⁷ and J Richards⁸

¹ Department of Pathology, Bishop Auckland Hospital, General Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK
² PRODIGY, Sowerby Centre for Health Informatics at Newcastle, Bede House, All Saints Business Centre, Newcastle upon Tyne NE1 2ES, UK
³ Health Protection Agency Primary Care Unit, Microbiology Department, Gloucester Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK
⁴ Department of Haematology, E Floor Haematology Office, Sunderland Royal Hospital, Kayll Road, Sunderland SR4 7TP, UK
⁵ Department of Immunology, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
⁶ Department of Haematology, City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK
⁷ Department of Microbiology, St Richard’s Hospital, Spitalfield Lane, Chichester, West Sussex PO19 4SE, UK
⁸ Microbiology Department, Norfolk and Norwich Hospital, Bowthorpe Road, Norwich NR2 3TX, UK

Correspondence to:
Correspondence to:
Dr W S A Smellie
Department of Pathology, Bishop Auckland Hospital, General Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK; info{at}smellie.com

This first best practice review examines four series of common primary care questions in laboratory medicine, namely: (i) measurement and monitoring of cholesterol and of liver and muscle enzymes in patients in the context of lipid lowering drugs, (ii) diagnosis and monitoring of vitamin B12/folate deficiency, (iii) investigation and monitoring of paraprotein bands in blood, and (iv) management of Helicobacter pylori infection. The review is presented in a question–answer format, referenced for each question series. The recommendations represent a précis of guidance found using a standardised literature search of national and international guidance notes, consensus statements, health policy documents, and evidence based medicine reviews, supplemented by MEDLINE EMBASE searches to identify relevant primary research documents. They are not standards but form a guide to be set in the clinical context. Most are consensus rather than evidence based. They will be updated periodically to take account of new information.

Abbreviations: CK, creatine kinase; DU, duodenal ulcer; GMS, General Medical Services; GU, gastric ulcer; LFT, liver function test; MCV, mean red cell volume; MGUS, monoclonal gammopathy of unknown significance; NICE, National Institute for Health and Clinical Excellence; PPI, proton pump inhibitor; ULN, upper limit of normal

Keywords: appropriateness; best practice; interdiscipline

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