The Roche Column
Enhance point-of-care testing in emergency
settings with Rocheís connectivity solutions
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.
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
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 http://www.who.int/mediacentre/ 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.
The Durbin Column
Experts worried about
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.
of upload: 12th May 2014