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"citrullinated cross-linked peptides"? Rheumatology labs - sm

Posted: May 20, 2011

Doc is referring patient for labs to rule out rheumatoid arthritis. He's listed these a million times and always says "CCP level." This time he said "citrullinated cross-linked peptides." I'm thinking he just doesn't know what CCP stands for, as I can only find "cyclic citrullinated peptide". He's not a rheumatologist, but then again, neither am I. Can someone with rheumatology experience weigh in?

citrullinated cross-linked peptides - sweetgirlsmom

[ In Reply To ..]
I have heard that in reports. Pubmed has 283 listings for cross-linked peptides.

I believe the doctors know what words they want in their reports. Our responsibility is to type the medical content they dictate. I would never change the words into an abbreviation just because the doctor uses it elsewhere.

Our responsibility... - see message

[ In Reply To ..]
On a verbatim account, yes, we type whatever they dictate. Otherwise, our responsibility is to type an accurate report, which includes fixing any mistakes they make (and flagging the ones we're not sure of). It causes major problems if a report is inconsistent with what's billed to the insurance company.

I'm aware of labs for citrullinated peptides and for cross-linked peptides, but not for citrullinated cross-linked peptides. Maybe "citrullinated/cross-linked peptides," but there's also a good chance he meant ACPA/anti-CCP, which is a common test when screening for RA.

How does disregarding the doctor's dictation ensure accuracy? - sweetgirlsmom

[ In Reply To ..]
When the doctor dictated citrullinated cross-linked peptides, I transcribed citrullinated cross-linked peptides (after verifying the spelling). When a doctor dictates abbreviations, I type the abbreviations (after I verify the accuracy based on the context of the report to make sure I heard it right). MTs must never insert an abbreviation just because a doctor uses it in other reports.

Doctors have a medical degree and clinical experience that MTs lack. They read medical journals, attend medical conferences, and have continuing education. Most MTs do not have that formal training.

Medical knowledge advances rapidly and MTs will never know everything. When a doctor dictates something that is new to us, it exists somewhere. It is our responsibility to type their actual words and not substitute other terms.

Verifying, not disregarding - sm

[ In Reply To ..]
I'm not sure we really disagree here, as I wouldn't correct anything unless I was absolutely certain it was a mistake and the intended meaning was clear. Maybe I just happen to get all the scatterbrained dictators, but a lot of the "new" terms I come across *don't* exist. It's usually due to simple mispronunciation, but I do occasionally come across an incorrectly expanded abbreviation. I don't have a medical degree, so I wouldn't question a doctor's medical knowledge, but I have no problem questioning a doctor's knowledge and usage of medical terminology (though to be fair, I have had formal training in that area).

Also, you're right about substituting an abbreviation for an expanded term. Even if it's the correct abbreviation, it goes against ADHI guidelines.

citrullinated cross-linked peptides is correct - sweetgirlsmom

[ In Reply To ..]
Citrulline is an amino acid. Citrullinated is just another form of the same word.

"Citrullinated cross-linked peptides" in the browser does not show anything.
"Citrulline cross-linked peptides" in the browser brings up numerous websites.

One is freepatentsonline.com/EPO949270.html. The title is "Synthetic peptides containing citrulline recognized by rheumatoid arthritis sera as tools for diagnosis and treatment."

Here are 2 NIH websites. ncbi.nlm.nih.gov/pmc/articles/PMC2719781 and ncbi.nlm.nih.gov/pubmed/20302351.

PubMed has 6 results for citrulline cross-linked peptides and 5649 results for cross-linked peptides.

cross-linked = cyclic - sm

[ In Reply To ..]
That freepatentsonline link is broken, but your info lead me here: http://www.healthscopepathology.com.au/pdf/HPG-1099_W_Rheumatoid_Arthritis.pdf

"Crosslinking of citrulline molecules to each other produces 'cyclic' peptides."

So apparently it's the same as CCP, though the correct word order would be cross-linked citrullinated peptides rather than citrullinated cross-linked peptides. That explains why it sounded a little off.

Thanks.

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