Further on the theme of POCT, we recently had a
conversation with one of our A/E department consultants
regarding POCT troponin testing. His reply was:
"My initial reaction is negative although I'm happy to be
persuaded otherwise.
Turnaround times with the lab are generally good, which
has discouraged us from
looking into PoC in the past. The main reason why we want
urgent troponin
results is for chest pain unit patients. These do not fall
under the 4 hour
target so the time saving from PoC troponin would not be
crucial. Karen may
correct me on this though.
I would advise against making troponin testing more
available to ED staff -
especially for patients with unstable angina who are going
to be admitted
anyway. We already have problems with junior doctors doing
unnecessary tests
and slowing patient progress. Giving them another machine
to play with would be
counter-productive."
Sensible comments about junior doctors doing unnecessary
tests but still driven by target times. I get the
impression that with a slight tweak of these targets he
will be hammering on my door asking for POCT everything!
Trevor
Dr. T.A. Gray
Consultant Chemical Pathologist
Northern General Hospital
Sheffield S5 7AU
On Mon, 11 May 2009 10:09:37 +0100
IAN WATSON <[log in to unmask]> wrote:
> 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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