Browsing by Author "Omar, Fierdoz"
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- ItemOpen AccessAssessment of the effectiveness of electronic gatekeeping as a utilization management tool at Groote Schuur Hospital(2018) Bosman, Michelle; van der Watt, George; Omar, Fierdoz; Vreede, HelenaBACKGROUND: Utilization management ensures the appropriateness of laboratory testing by reducing the performance of tests which can be reasonably avoided with no adverse effects for the patient. Electronic gatekeeping, a utilization management tool, was introduced at Groote Schuur in 2010. Criteria were based on the minimum retesting interval, healthcare location, level of experience and discipline of the requesting clinician and specific ICD-10 codes. METHODS: A retrospective observational study assessing the effectiveness of electronic gatekeeping at Groote Schuur Hospital (Cape Town, South Africa), by comparing the test request volumes by using absolute test numbers and pre-defined ratios in the year prior to gatekeeping, to the two years following implementation. A secondary aim is to apply selected ratios to the other national academic hospitals to determine the potential for cost saving. RESULTS: At the medical wards of Groote Schuur Hospital there was an overall decrease in number and cost of tests of 24% per inpatient day for 2011. The most dramatic difference in cost is seen for chloride (91%) followed by HbA1c (90%), FT3 (89%) and CRP (82%). The application of ratios to Groote Schuur Hospital show a decrease in 2011 in all ratios apart from PCT: FBC+WCC (0.003 vs 0.002) and Mg: Ca (0.86 vs 0.84). AST: ALT remained the same at 0.55. This suggests overall effectiveness of the eGK rules although there is ongoing panel requesting. If the GSH eGK rules were to be applied at all other national academic hospitals, it could translate into a potential cost saving of $13 411 873.96 (R103 196 838.80) per annum. CONCLUSIONS: Electronic gatekeeping is an effective utilization management tool at Groote Schuur Hospital. It is relatively easy to implement and manage, and when combined with additional tools has the potential to result in larger reductions of unnecessary tests, cost savings and improved patient outcome.
- ItemOpen AccessDo Calcium and Vitamin D Levels in Blood Predict Clinical Features and/or Response to Treatment in People with Psoriasis?(2022) Waghid, Sihan; Jessop, Susan; Omar, FierdozContext: Psoriasis is an immune-mediated skin disease which is chronic and inflammatory, with multiple clinical types and variable severity. It is renowned for its significantly negative effect on quality of life and presents with recurrent relapses and remissions. The selection of treatment of psoriasis is dependent on the psoriasis type, impact on the individual and the severity of the disease. Variable factors that remain incompletely understood influence response to systemic treatment. It is of interest to establish whether calcium or vitamin D serum levels are linked with response to treatment in people with variable (moderate to severe) psoriasis in our population. Aims: This study aims to establish whether: 1. Clinical type or severity of psoriasis is correlated with serum calcium or vitamin D; 2. Calcium or vitamin D serum levels and response to treatment with systemic agents, including methotrexate, cyclosporine, acitretin and ultraviolet light, are associated in people with variable (moderate to severe) psoriasis; 3. Calcium and vitamin D serum levels differ in psoriatic patients compared with such levels in a control group. Materials and methods: As a case control (prospective) study, one hundred people (n = 100) were recruited, fifty having psoriasis and fifty control subjects. The psoriatic participants began a new systemic treatment and/or ultraviolet light for moderate to severe psoriasis. On the basis of a PASI score at both baseline and a three-month follow-up, response to treatment was assessed. The calcium and vitamin D serum levels were measured in psoriatic patients and controls. The collected blood samples were processed by the National Health Laboratory Services. Data collected from interviews, examination and laboratory results were recorded on a data capture sheet. The study was planned to be conducted for one year, but, due to the coronavirus pandemic, it was extended into a second year. For the psoriasis group, visits at one month and three months were recorded. Standard psoriasis treatment was provided by the dermatology health care professionals at Groote Schuur Hospital. ANOVA statistics and the Chi-squared test were applied to determine whether there is a correlation between variables. Results: No significant difference in calcium serum levels was found in psoriatic patients with different types of psoriasis (p = 0.63) or in those with varying severity of psoriasis (p = 0.48). A significant difference in the vitamin D serum levels in relation to different types of psoriasis (p = 0.62) or the severity of psoriasis (p = 0.31), was also absent. Psoriatic patients' response to treatment were less in those patients with low vitamin D serum levels. People with a higher vitamin D level had a significantly greater change in the PASI score (p = 0.01). No correlation was seen between calcium serum levels and changes in PASI score at follow-up. In other words no relationship between serum calcium level and response to treatment in psoriasis (p = 0.49) was found. This study exhibited no difference in calcium levels between the control group and psoriatic group (p = 0.79). However, there were significantly lower vitamin D levels in the psoriatic group compared to the controls (p = 0.01). The mean vitamin D level was 49,92 nmol/L in the control group (SD 20.69) and the mean vitamin D level in the psoriatic group equalled 39.82 nmol/L (SD 19.49). Conclusion: We established that psoriatic patients had lower vitamin D serum levels than controls and psoriatic patients with higher vitamin D serum levels responded better to systemic treatment. However, our findings are limited by small numbers and further studies need to be performed to corroborate this result. It is possible that treatment with Vitamin D could improve outcomes in our patients. This study demonstrated that calcium serum levels did not differ between the two groups and did not correlate with response to systemic treatment.
- ItemOpen AccessHigh Molecular Weight (HMW): total adiponectin ratio is low in hiv-infected women receiving protease inhibitors(2014-12-16) Omar, Fierdoz; Dave, Joel A; King, Judy A; Levitt, Naomi S; Pillay, Tahir SAbstract Background At the time of the study, the HIV-treatment policy in South Africa included highly active antiretroviral therapy (HAART) regimens 1 (nucleotide reverse transcriptase inhibitors (NRTIs) only), and 2 (protease inhibitors (PI) and NRTIs). HAART is associated with the lipodystrophy syndrome, insulin resistance and reduced total adiponectin (TA) levels. The high molecular weight (HMW):TA ratio is a superior marker of insulin resistance. The aim of this study was to establish whether HMW:TA ratios are low in patients on PIs and whether they correlate with insulin resistance. Methods This was a cross-sectional study undertaken in an antiretroviral clinic at a tertiary hospital. The participants were 66 HIV-infected females: 22 were on regimen 2 (PI group), 22 on regimen 1 (non-PI) and 22 treatment naïve (TN), matched for BMI and age. Patients with a history of diabetes or impaired glucose tolerance were excluded. Serum adiponectin multimers were analysed using the AlpcoTM Adiponectin (Multimeric) enzyme immunoassay. Waist hip ratios (WHR), glucose and insulin levels were assessed, and HOMA-IR and QUICKI calculated. Data were analysed non-parametrically and multivariate analysis was performed. Results TA and HMW levels were lower in the treatment groups than in the TN group. HMW:TA was lower in the PI than in the non-PI and TN groups, and in the non-PI than in the TN groups. HMW:TA correlated negatively with waist, insulin and HOMA-IR, independently of BMI and duration of therapy. HOMA-IR and QUICKI did not differ among the groups. Conclusion HMW:TA is significantly decreased with HAART (particularly with PIs, but also with non-PIs) and may be a more sensitive marker of insulin resistance in these patients than conventional markers or HMW and total adiponectin individually.
- ItemOpen AccessUsing urinary MCP-1 and TWEAK to assess disease activity in a cohort of South African patients with lupus nephritis(2020) Rusch, Jody Alan; Okpechi, Ikechi Gareth; Omar, FierdozBackground: Renal involvement is common in systemic lupus erythematosus (SLE) and can lead to chronic kidney disease (CKD). Diagnosis of lupus nephritis (LN) is dependent on renal biopsy. Due to its invasiveness, repeat renal biopsy for monitoring disease activity is not recommended, thus creating a need for noninvasive and accurate biomarkers. Monocyte chemoattractant protein-1 (MCP-1) and tumour necrosis factor-like weak inducer of apoptosis (TWEAK) have been implicated in the pathogenesis of LN and are thus potential biomarkers for disease activity monitoring. Methods: In this study urinary MCP-1 (uMCP-1) and TWEAK (uTWEAK), together with standard markers of disease activity, were analysed in a cohort of 50 biopsy-proven LN patients at baseline, after sixmonths of induction therapy, and at one-year. Results: Throughout the study there was correlation between uMCP-1 and uTWEAK (r=0.52, p< 0.001). Both biomarkers also correlated with standard of care tests and clinical scores. The median [interquartile range] of uMCP-1 and uTWEAK were significantly increased in the active group when compared to the quiescent group (1440 [683–2729] vs 256 [175–477] pg/mL, p< 0.0001, and 209 [117–312] vs 74 [11– 173] pg/mL, p=0.0008, respectively). After completion of induction therapy in the active group, there was no significant difference in biomarker results between the groups. The sensitivity and specificity for indicating disease activity was 95% and 73% for uMCP-1 (area under curve [AUC]=0.875), and 60% and 90% for uTWEAK (AUC=0.783), respectively. Conclusion: uMCP-1 and uTWEAK reflect LN disease activity, and correlate with standard of care biomarkers in a South African cohort. Further studies are needed to assess additional clinical benefit.
- ItemOpen AccessUtility of chloride and adenosine deaminase measurement in cerebrosphinal fluid for the early presumptive diagnosis of tuberculous meningitis(2017) Swanepoel, Hendré; Wojno, Justyna Maria; Omar, FierdozBackground: Chloride and adenosine deaminase measurements in cerebrospinal fluid are still sporadically requested as part of tuberculous meningitis work-up. In the literature, evidence is contradictory and opinion is divided on their utility in clinical practice. The accuracy of both for the early presumptive diagnosis of tuberculous meningitis was investigated in patients in a region with high prevalence of tuberculosis and HIV infection in order to inform a decision on whether to continue offering these tests to clinicians. Methods: A retrospective descriptive study of diagnostic accuracy was conducted at the National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa. Data were collected on all cerebrospinal fluid specimens submitted for tuberculosis culture between 1 January 2012 and 31 December 2014. Chloride and adenosine deaminase concentrations were compared with automated liquid culture for Mycobacterium tuberculosis as the reference standard. Findings: There were 2531 cerebrospinal fluid specimens submitted for tuberculosis culture during the study period; exclusion of duplicates yielded 2081 specimens. Chloride was requested on 711 (34·2%) specimens; 44 (6·2%) were tuberculosis culture-positive. Adenosine deaminase was requested on 152 (7·3%) specimens; 20 (13·2%) were culture-positive. Chloride sensitivity (<120 mmol/L) for the detection of tuberculous meningitis was 93·2% (95% confidence interval 81·3-98·6), with specificity 62·4% (58·6-66·1), positive predictive value 14% (10·3-18·6), negative predictive value 99·3% (97·9-99·9), positive likelihood ratio 2·48 (2·18-2·81), and negative likelihood ratio 0·109 (0·037-0·326). Adenosine deaminase sensitivity (>6 U/L) was 70% (45·7-88·1), specificity 89·4% (82·8-94·1), positive predictive value 50% (30·6-69·4), negative predictive value 95·2% (89·8-98·2), positive likelihood ratio 6·6 (3·72-11·7), and negative likelihood ratio 0·336 (0·171-0·657). Interpretation: In this patient population chloride and adenosine deaminase showed at best only modest performance as markers of tuberculous meningitis. However, very good negative predictive values could serve to identify patients highly unlikely to have the disease.
- ItemOpen AccessValidation of an adjusted calcium formula using the Roche calcium (NMBATPA) and albumin (BCG) methods at Groote Schuur Hospital(2017) Ndlovu, Mbali; Omar, Fierdoz; Vreede, HelenaABSTRACT: Validation of an adjusted calcium formula using the Roche calcium (NMBATPA) and albumin (BCG) methods at Groote Schuur Hospital Introduction: Most laboratories continue to adjust serum total calcium (tCa) concentration for serum albumin as a surrogate marker of calcium status, despite the availability of ionised calcium (iCa) measurement. Current recommendations by the Association for Clinical Biochemistry and Laboratory Medicine (ACB) advocate that laboratories should use formulae specific for their tCa and albumin methods and analytical platforms. The National Health Laboratory Service at Groote Schuur Hospital (GSH) undertook to investigate this recommendation. An adjusted calcium (aCa) formula specific for the Roche serum tCa and albumin methods was derived from 3131 patients. We investigated the validity and clinical utility of this locally derived aCa formula. Methods: The tCa, albumin and iCa were analysed in blood from 162 inpatients and outpatients at GSH. Corrected calcium (cCa) was calculated using the Payne cCa formula, and aCa was calculated with the new aCa formula. Patients were classified as hypo-, normoor hypercalcaemic using iCa, tCa, cCa and aCa measurements. Cohen's kappa statistic, loglinear and logistic regression models and interclass and concordance correlation coefficients were used to assess agreement between tCa, Payne cCa and aCa against iCa (gold standard). Agreement was further assessed according to renal status and albumin concentrations. Results: The aCa demonstrated good correlation with iCa, but its performance was not significantly better than tCa or Payne cCa in correctly classifying calcium status. Furthermore, albumin concentration was demonstrated to predict the performance of the calcium status classification by the aCa and cCa formulae, irrespective of renal status. Conclusion: The laboratory-specific aCa formula did not perform significantly better than tCa and the Payne cCa formula. This implies that aCa does not add value over tCa where iCa measurements are not readily available.