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ACB-CLIN-CHEM-GEN  May 2009

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Subject:

Re: POCT cholesterol

From:

Keith Griffiths <[log in to unmask]>

Reply-To:

Keith Griffiths <[log in to unmask]>

Date:

Wed, 13 May 2009 16:37:32 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (644 lines)

I do n't want to get embroiled in the POCT debate but just to pick up the Wales First Minister (Rhodri Morgan) bit. 
In Wales we are on our 4th or possibly 5th Edition of our POCT document which lays down Quality Standards (the first was published c 1986) which has been fully endorsed by the Wales Government and states that all POCT has to be under the umbrella of the local laboratory. Our Modernisation agenda under the Chairpersonship of Annette Thomas for POCT is driving this policy and results have to be of "equivalent to lab quality". 
Regards
Keith

Dr KD Griffiths
Consultant Biochemist
Chair Wales Scientific Advisory Committee

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ian Barlow
Sent: 11 May 2009 14:44
To: [log in to unmask]
Subject: Re: POCT cholesterol

Thanks Janice,

I accept those arguments for INR testing-assuming result quality of course, but really can't see the justification for it in many other areas. Very few, if any other examples can ensure the "whole patient experience".

The silence on this topic is deafening; guess labs staff are out POC testing??

Ian

-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Janice Still
Sent: 11 May 2009 13:34
To: [log in to unmask]
Subject: Re: POCT cholesterol

The problem Ian, is that someone told the Government that POCT was "A Good Idea". I was at a meeting some while ago with Rhodri Morgan the First Minister for Wales who was highly enthusiastic about POCT. He saw it in terms of whole patient experience. If Mrs Jones has to go to the hospital by transport to get a blood test done for her INR, wait around to be seen, then taken home by transport, then taken to her GP to get the result, and her dose adjusted, it is costly. If she simply goes to her GP (or friendly Pharmacy) and gets her INR done there and then it saves a lot.

And quality? Oh, he said "it does not have to be lab quality, but good enough".POCT EQA scheme organisers please note.

This needs further debate and some serious evaluation of outcomes and cost. Perhaps the ACB FOCUS meeting for POCT co-ordinators on 19th May in Liverpool may provide impetus. In the meantime all POCT coordinators need a robust local POCT policy, an effective POCT or Medical Devices Committee and eyes in the back of their head.

Jan 

Mrs. J. Still,
POCT Manager,
Biochemistry Dept,
Watford General Hospital. 01923-217998.
The views expressed in this message are personal and do not reflect West Herts NHS Hospitals Trust policy.


--- On Mon, 11/5/09, Ian Barlow <[log in to unmask]> wrote:

> From: Ian Barlow <[log in to unmask]>
> Subject: Re: POCT cholesterol
> To: [log in to unmask]
> Date: Monday, 11 May, 2009, 12:16 PM
> "As for evidence there is very
> little"
> "though bad practices undermined its usefulness"
> 
> I think these statements sum things up nicely. So why is it
> that
> some of us continue to promote and advocate widespread,
> expensive, fairly useless and potentially unsafe PCOT? Of
> course we can make it safer and keep CPA happy by throwing
> lots of resources at it to ensure that appropriate
> governance is in place but is the cost of this really
> justified? 
> 
> It seems to me that just because we can do things at POC;
> lots of us seem think it a good idea to do so. As a
> laboratory professional I find this staggering.
> 
> Ian Barlow
> Chairman of local POCT committee
> 
> -----Original Message-----
> From: Clinical biochemistry discussion list [mailto:[log in to unmask]]
> On Behalf Of IAN WATSON
> Sent: 11 May 2009 10:10
> To: [log in to unmask]
> Subject: Re: POCT cholesterol
> 
> The ACB along with RCPath, IBMS, MHRA, RPS, and others are
> working on POCT in Primary Care guidance on the basis that
> we are not going to stop POCT so users should do it properly
> and be aware of the limitations. This is supported by DH.
> As for evidence there is very little to show POCT affects
> outcomes positively or negatively. The NACB conducted a
> systematic review of all POCT and showed no evidence for
> POCT, though bad practices undermined its usefulness. This
> can be accessed at: http://www.aacc.org/members/nacb/LMPG/OnlineGuide/PublishedGuidelines/poct/Pages/default.aspx
>  
> Ian
> 
> Dr Ian D Watson PhD FRCPath
> President
> Association for Clinical Biochemistry
> Dept Clinical Biochemistry
> University Hospital Aintree 
> Longmoor Lane
> Liverpool
> L9 7AL
> Tel +44 151 529 3575
> Fax +44 151 529 3310
> Email: [log in to unmask]
> 
> -----Original Message-----
> From: Clinical biochemistry discussion list [mailto:[log in to unmask]]
> On Behalf Of David Brown
> Sent: 11 May 2009 09:52
> To: [log in to unmask]
> Subject: Re: POCT cholesterol
> 
> I also think it is time for a joint scientific and medical
> review of the usefulness of POCT in large urban hospitals,
> in particular, and smaller rural hospials and GPs in
> general.
> The only POCT I ever thought worthwhile were neonatal blood
> gases and home monitoring glucose testing. The rest seem to
> be a public relations exercise or a false feeling of
> self-sufficiency
> David Brown
> Ex-MLSO
> 
> 
> --- On Mon, 11/5/09, Ian Barlow <[log in to unmask]>
> wrote:
> 
> > From: Ian Barlow <[log in to unmask]>
> > Subject: Re: POCT cholesterol
> > To: [log in to unmask]
> > Date: Monday, 11 May, 2009, 10:40 AM
> > My thoughts too Tim.
> > 
> > As a profession I think it is about time some of us
> jumped
> > off this POCT
> > bandwagon and started to be a little more critical of
> its
> > usefulness.
> > 
> > I find it startling that you are the only person to
> respond
> > to this.
> > 
> > Ian
> > 
> > -----Original Message-----
> > From: Reynolds Tim [mailto:[log in to unmask]]
> > 
> > Sent: 11 May 2009 09:33
> > To: Ian Barlow; [log in to unmask]
> > Subject: RE: POCT cholesterol
> > 
> > Overall, I would say the imprecision of POCT
> cholesterol is
> > not
> > acceptable.
> > 
> > When a dose titration gives a 6% improvement, you
> need
> > precision better
> > than that to know whether the change has worked.
> > 
> > And using POCT devices for screening is even less
> > helpful...
> > 
> > But that won't stop DoH from pushing for its use on
> grounds
> > of patient
> > choice - though why anyone would knowingly choose to
> be
> > given the wrong
> > result I don't know.
> > 
> > TIM
> > 
> > 
> >
> ************************************************************************
> > *************
> > Prof. Tim Reynolds,
> > Queen's Hospital,
> > Belvedere Rd,
> > Burton-on-Trent,
> > Staffordshire,
> > DE13 0RB
> > 
> > work tel: 01283 511511 ext. 4035
> > work fax: 01283 593064
> > work email: [log in to unmask]
> > home email: [log in to unmask]
> >
> ************************************************************************
> > **************
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> > 
> > -----Original Message-----
> > From: Clinical biochemistry discussion list
> > [mailto:[log in to unmask]]
> > On Behalf Of Ian Barlow
> > Sent: 08 May 2009 16:55
> > To: [log in to unmask]
> > Subject: Re: POCT cholesterol
> > 
> > 
> > Thanks Katie.
> > 
> > A question for all the lipidologists out there:-
> > 
> > Is imprecision of these analysers acceptable?
> > 
> > Regards
> > 
> > Ian Barlow
> > Scunthorpe
> > UK
> > 
> > 
> > -----Original Message-----
> > From: Clinical biochemistry discussion list
> > [mailto:[log in to unmask]]
> > On Behalf Of Garner, Katie
> > Sent: 08 May 2009 16:33
> > To: [log in to unmask]
> > Subject: Re: POCT cholesterol
> > 
> > CEP are preparing a buyers' guide to POC cholesterol
> > systems to support
> > the NHS Health Checks programme. This will set out all
> of
> > the technical,
> > operational, purchasing and economic issues and
> include a
> > market review
> > with comparative tables. This guide is partly funded
> by DH
> > and will be
> > available to download free from our website at the end
> of
> > August. Sign
> > up to received a notification at www.pasa.nhs.uk/cep.
> > 
> > We evaluated a number of these systems in detail when
> we
> > were part of
> > MHRA. These reports are a bit older but should still
> be
> > relevant. See
> > attached.
> >   
> > CardioCek 2005
> > Cholestech LDX
> > Accutrend GC or Accutrend Plus
> > 
> > Katie Garner
> > Business Development Manager
> > Tel: 020 7972 5388 Mob: 0774 7816958
> > 
> > The Centre for Evidence-based Purchasing (CEP)
> generates,
> > gathers and
> > assesses evidence on medical products and related
> services
> > to encourage
> > informed decision-making around the purchase and
> choice of
> > products used
> > in the NHS. 
> > 
> > You can sign up for notification of publications,
> suggest
> > new projects
> > and view our work programme at www.pasa.nhs.uk/cep
> > 
> > -----Original Message-----
> > From: Clinical biochemistry discussion list
> > [mailto:[log in to unmask]]
> > On Behalf Of Mike Howell
> > Sent: 07 May 2009 12:33
> > To: [log in to unmask]
> > Subject: POCT cholesterol
> > 
> > Hi
> > 
> > Does anyone have experience of POCT cholesterol and
> can
> > anyone tell me
> > about QA schemes for POCT cholesterol please
> > 
> > Thanks
> > Mike Howell
> > 
> > Mike Howell
> > Clinical Biochemistry
> > The Hillingdon Hospital
> > Pield Heath Road
> > Uxbridge
> > Middx
> > UB8 3NN
> > Tel 01895 279225
> > 
> > 
> >
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