The Roche Column

Enhance point-of-care testing in emergency settings with Rocheís connectivity solutions

Seamless workflow and rapid diagnoses of cardiovascular diseases

Globally, cardiovascular diseases continue to be a leading cause of death, from myocardial infarctions and strokes to heart failure and venous thromboembolisms1, and yet, their diagnosis remains a challenge in critical care settings and emergency departments, where fast intervention and early treatment is key to a patientís survival. Time is an invaluable puzzle piece to the cardiac healthcare cycle. When every second counts in the life of a patient, solutions that enable early diagnosis are essential, and healthcare professionals need to be able to take immediate action once results are produced. Time is muscle.

Roche Diagnostics Point of Care testing for cardiovascular events eases fast decision-making processes and improves workflow efficiencies for healthcare professionals. Whether used by a general practitioner, nurse or doctor in an emergency department, point-of-care testing (near patient testing) facilitates targeted individual diagnosis and prognosis of detected heart conditions in the patient. As a market leader for cardiac biomarker testing, Rocheís point-of-care portfolio in the cardiac events monitoring segment includes the cobas h 232 system. Management of patients and their hospitalization for cardiovascular cases such as atrial fibrillation, myocardial infarction or heart failure, can be improved with instrumentís accurate and precise results. The portable and easy to use point-of-care instruments can provide physicians with results in as fast as 15 minutes without any additional preparation for the sample or device.

The strength of the systemís quantitative results is evident in cases of acute myocardial infarctions, which can be STEMI or NSTEMI-STEMI (St-Elevated Myocardial Infarction). The ratio between STEMI and NSTEMI is approximately 40/60, where NSTEMI patients have a higher mortality rate2. The diagnosis of NSTEMI relies on observation of the symptoms, ECG and cardiac markers such as Troponins.

NSTEMI patients with positive Troponin T should immediately be sent to the Cardiac Care Unit for further evaluation. More than 30% of the NSTEMI patients (Troponin T >100ng/L) have positive Troponin T in the Ambulance, and 47% of the NSTEMI patients (Troponin T >100ng/L) in the Hospital. If the in hospital Troponin T test is used with the cut-off level 50ng/L, 82% of the NSTEMI patients would be identified. With the cobas h 232 and its cut-off at level at 50ng/L there is a potential to identify even more than 30% NSTEMI patients already in the Ambulance and around 82% in the hospital.3

When active treatment is initiated for AMI patients within one hour, mortality rate decreases by 50%. In addition to Troponin T, Rocheís cobas h 232, pointof- care device can test for a broad menu of biomarkers: NT-proBNP, D-Dimer, CK-MB and Myoglobin; this enables healthcare professionals to make rapid decisions about a patientís condition and level of risk.

Complete management of POC testing

Connectivity capabilities in a system, such as that offered with Rocheís cobas point of care IT solution, contribute to the improvement of laboratory cost and quality, resulting in a beneficial improvement of testing efficiency and patient care. The unique benefit of Rocheís cobas point-ofcare (POC) IT solution is the seamless connection of devices with LIS/HIS connectivity, consolidating patient results throughout the hospitalís laboratories and databases. Healthcare professionals can rely on a system that matches test results to each patient and provides useful analytical reports of results, while maintaining documentation and quality control.


1. World Health Organization. Media centre - Cardiovascular diseases (CVDs). 2014. Available at factsheets/fs317/en/index.html. Last accessed April 2014 2. Boresma et al. Lancet 1996; 348: 771-5 3. Prehospital troponin T testing in the diagnosis and triage of patients with suspected acute myocardial infarction. (SÝrensen JT1, Terkelsen CJ, Steengaard C, Lassen JF,Ö.) Am J Cardiol. 2011 May 15;107(10):1436-40. pubmed/21414596


The Durbin Column

Experts worried about spread


Perusing the pages of the Financial Times on my computer tablet recently, I read with interest that Saudi Arabia has replaced its health minister amid concerns about the spread of the coronavirus, Middle East Respiratory Syndrome (MERS CoV), throughout and beyond the Gulf.

First detected in Saudi Arabia in September 2012, MERS can cause symptoms such as fever, breathing problems, pneumonia and kidney failure, and is from the same family as the SARS virus which killed around 800 people worldwide. Whilst it has not spread as fast as SARS it has been more deadly, and at the time of writing 92 of the 238 people confirmed to have been infected with MERS have died. Concerns that it is being passed between humans has reportedly seen some medical staff express fears about their own increased chances of catching the disease if they treat victims. This in turn has prompted the Saudi government to warn staff that they will be suspended if they refuse to carry out their duties. Figures nonetheless show that over 20 healthcare workers have already been infected in Saudi Arabia and the UAE in recent weeks, and furthermore King Fahd Hospital in Jeddah was forced to close its emergency department recently prior to a thorough clean after an infected healthcare worker died.

Whilst initially it was thought there was no scientific evidence to justify ordering preventative measures such as travel restrictions, virus experts have warned that they are now becoming increasingly concerned about the pace at which the disease is spreading and that it may be becoming difficult to contain. Cases have already been reported in the UK, USA, Germany, Italy, France and Tunisia, and with the death of a Malaysian man who returned home from a pilgrimage to Saudi Arabia and another passenger who travelled on a flight from Abu Dhabi to Manila being diagnosed, the disease has now also reached Asia.

The jump in Saudi cases is of course of particular concern because of the expected influx of pilgrims from around the world during Ramadan in July, followed by the arrival of millions more to perform the annual Haj in Mecca and Medina in early October.

So what can be done to contain the outbreak? Firstly we must consider the source of the problem. Research has linked the virus to a camel infection, although it is not yet known exactly how the infection transfers between camels and humans. Screening camels for infection and then quarantining them is certainly one option, and avoiding their noses and mouths is of particular importance as studies have shown that the greatest amount of the virus is contained in these areas. The World Health Organisation is also warning against close contact with camels when visiting farms or barn areas where the virus is known to be circulating. Medical staff of course need to be particularly vigilant in looking out for possible MERS cases and to follow containment procedures rigorously when it is identified. Saudi butcher shops and restaurants have also reported a decline in the sale of camel meat and milk after the acting health minister advised against consumption as a further preventative measure. Other tips include wearing masks to Haj, washing hands regularly, particularly after coughing or sneezing, and heating unpasturised milk to 70įC before drinking.

As there is as yet no known cure for MERS, the Saudi Health Ministry has said that a major international pharmaceutical company would soon be visiting the kingdom to explore the possibility of manufacturing a vaccine for the virus. Itís certainly a comfort to know that the medical scientists whose work saves lives daily may in time be able to come up with something that helps contain the disease, but until then everyone has a part to play in being as hygienic as possible so as to help keep the spread of this deadly virus in check.


 Date of upload: 12th May 2014


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