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July 2015

Best Tests

Monitoring diabetes before, during and after pregnancy

Hyperglycaemia during pregnancy is associated with a range of adverse outcomes which can affect both mother and child, and can occur during pregnancy, childbirth or later in life. Due to physiological changes associated with pregnancy, women are at increased risk of developing diabetes, or having worsening glycaemic control if they have pre-existing diabetes. In December, 2014, the Ministry of Health released the Screening, Diagnosis and Management of Gestational Diabetes in New Zealand clinical practice guideline and some changes to testing for gestational diabetes are recommended. In this article, we summarise the recent Ministry of Health guidelines, with a focus on the role of the general practitioner in testing for undiagnosed diabetes early in pregnancy and monitoring for the development of type 2 diabetes after pregnancy. View Article

The New Zealand Laboratory Schedule and Test Guidelines: Immunology Tests

Over the last few editions of Best Tests we have outlined the various sections of the New Zealand Laboratory Schedule. The aim of this Schedule is to provide clinicians with consistent guidance when considering requesting laboratory tests and to ensure the uniform availability of tests across District Health Boards (DHBs) in the future. The final section of the series focuses briefly on immunology testing. View Article

A pragmatic guide to asymptomatic bacteriuria and testing for urinary tract infections (UTIs) in people aged over 65 years

Asymptomatic bacteriuria and urinary tract infections (UTIs) frequently occur in people aged over 65 years. Bacteriuria in older people without urinary symptoms, i.e. asymptomatic bacteriuria, is generally harmless and does not need to be routinely treated. Diagnosing and managing UTIs is more difficult in older patients as long-term urinary conditions (e.g. incontinence) or genitourinary abnormalities (e.g. anterior vaginal prolapse) are more common. The patient’s symptoms and signs are the strongest predictor of a UTI and clinical information should always be included on laboratory requests for urine culture as it will influence the interpretation of results and how the patient is subsequently managed. Guidance on the investigation of suspected UTIs varies depending on whether the patient is female, male or if they have a urinary catheter. Antibiotic treatment for uncomplicated UTIs can often be initiated empirically, but local susceptibility data is crucial to guide the choice of antibiotic. View Article