When Should We Order Preoperative Complete Blood Count and Urinalysis? : A systematic review and clinical practice guidelines

Routine preoperative investigation is expensive especially at this time when Thailand is suffering a severe financial crisis. Objectives of the study were to apply a systematic review to answer the question whether routine preoperative investigation affected health outcomes; and to construct clinical practice guidelines for preoperative complete blood count (CBC) and urinalysis (UA). The guidelines were prepared for elective, non-cardiothoracic surgery in adult patients. Methods of the study were Medline search (1980-1998) and a search of studies published in Thailand. Criteria for high validity and reliability were applied to paper selection. The results of the systematic review were discussed among anesthesiologists and other specialists and the guidelines were drawn by consensus. Results from the systematic review found that there were no randomized controlled trials to answer the question and no studies reported health outcomes. Routine preoperative CBC and urinalysis yielded few clinically significant positive results and was not very useful for patient care. From this review and the consensus, we proposed a guidelines, which consisted of a history questionnaire, physical examination and indication for investigation. For the pre-operative CBC the indication were: age ≥ 60 years, would have an operation that needed blood transfusion, had acute or chronic blood loss, malnutrition, pregnancy, heart disease, cancer, chronic renal failure, liver disease, severe infection, SLE, connective tissue disease, radiotherapy or chemotherapy. The guidelines for preoperative UA were: pregnancy, diabetes, abnormal urination, chronic renal failure, SLE or connective tissue disease. Preoperative CBC and UA requests according to these guidelines should be more cost-effective and routine preoperative investigation should be abandoned

Ethnicity and cardiovascular disease prevention in the United Kingdom : a practical approach to management

The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community