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[Assessment of the guidelines for efficacious utilization of laboratory tests in primary care medicine].

The Japan Society of Clinical Pathology has proposed guidelines for efficacious utilization of laboratory tests in primary care medicine. In a series of our studies, attempts were made to assess the usefulness of the "Essential laboratory tests" which are common laboratory tests to be applied for new outpatients regardless of the clinics and disease categories. We looked the individual test item again in the aspect of diagnostic efficiency for the next version of the guideline. An analysis of 1026 new outpatients in Comprehensive Medicine, National Defense Medical College, demonstrated the usefulness of the "Essential laboratory tests" not only for the establishment of more accurate initial diagnosis but also for the screening of the occult diseases unrelated to the patient's chief complaints. Another clinical study with 520 new outpatients established diagnostic efficiency of the individual test item by calculating diagnostic sensitivity, specificity and positive predictive value. There were test items such as urine urobilinogen to be taken away from the guideline because of its extremely low sensitivity, and such as random blood glucose and serum cholinesterase to be added for the screening of urine-glucose negative diabetes mellitus and possible fatty liver, respectively. There have been some controversies in the selection of inflammation markers such as erythrocyte sedimentation rate or serum sialic acid; the former revealed higher diagnostic sensitivity but had lower specificity in infectious or inflammatory diseases than the latter.