EH 6_2015

Every Heart Speaks Its Own Language. We Understand Them All. The new cardiac remote monitor demonstrates accurate arrhythmia detection and reliable Home Monitoring transmission. BioMonitor 2 Always On www.biotronik.com EUROPEAN HOSPITAL  Vol 24 Issue 6/15 2 NEWS & MANAGEMENT Continued from page 1 POCT could lose economic attraction stages needs to be trained. One of the key features of POCT is the number of people involved. Whereas a core laboratory has a rather limited number of staff, POCTs are often carried out by even thousands of hospital staff members across different healthcare profes- sions. Even if training for one type of device takes a minimum amount of time, it immediately builds up huge demands of time and organis- ing resources, if professionally done. Skills also need to be practised and maintained, or quality will falter. Regardless of whether a test result was obtained from a core labora- tory, or a POCT, the same quality standards must be met. Therefore, there can be no compromises in quality assurance and quality man- agement in POCT. Unfortunately, this is not always realised or prac- ticed and imposes risks for patient safety. For instance, if connectivity to the hospital information system is missing, faulty instruments and reagents may be overlooked and create threats to patient safety. Also, the use of analytically poor devices, untrained or unlicensed users might lead to erroneous test results and errors in patient care. By the time thousands of users are involved, the risk of errors increases, bearing immense challenges for any quality management system. Do the benefits of POCT exceed these risks for patient care and eco- nomic efforts? If properly used, cer- tainly yes. Not without reason POCT has a long tradition in patient care. Measurements of blood glucose and blood gas analysis are well-known examples. One common key feature is their immediate impact on patient care that can hardly be achieved by the core laboratories. Even though a few hospitals manage to offer centralised blood gas analyses with the help of fast transport e.g. pneu- matic tube systems, most hospitals operate blood gases as a POCT to meet urgent needs in intensive care. An immediately available glucose test result is often crucial in dia- betic patients, when insulin dosage depends on it. When it comes to hospital pro- cesses the issue becomes a little more complicated. POCT is thought to improve workflows by cutting short the time a test result from the core laboratory becomes avail- able. Especially in emergency rooms this has become a trend that first focused on a few assays, such as Troponin. Nowadays, the assay menu offered in emergency rooms begins to broaden as suitable and consolidated multiple assay POCT instruments become available. Some hospitals even create dedi- cated satellite labs in the emergency room equipped with POCT. If done professionally, this may be of con- siderable value for patient, hospital and staff. Still, the benefit of POCT on workflow, and consequently on costs, is controversially discussed. Even if theoretical scenarios for the positive impact of POCT on clinical workflows appear promising, suf- ficient and comprehensive studies are still missing. One reason may be that clinical workflows contain many steps and also depend on human beings. They can only be standardised to a certain extent, which is challenging for the evalua- tion of economic effects. How then should POCT be used? Naturally, because both core labo- ratory tests and POCT are used for patient care in hospitals, they should have the same demands on quality standards. They are both subject to legal requirements, such as the EU-IVD and subsequent- ly many other national and local regulations. To meet those stand- ards POCT uses up more human resources than a core laboratory. These human resources are diffi- cult to estimate and therefore often neglected in justifying a POCT solu- tion. Neglecting the training efforts, maintenance, quality assurance and troubleshooting cost causes an enor- mous bias in economic considera- tions. The burden is often imposed upon health care professions, such as nurses or physicians who already are overloaded by tasks that are not directly experienced as related to their respective profession. There are needs in patient care that can best be met by profession- ally and centrally managed POCT. Professional POCT management includes IT solutions that go hand in hand with the laboratory and hospi- tal information system and also suit- able instruments that fulfil analytical and workflow needs. With all this in mind, POCT should be used as much as necessary and as little as possible. A point of care testing concept represents a key responsibility that should be inter- disciplinarily developed and cen- trally decided in each hospital. Immun strikinCheckpoint inhibitors can achieve a lasting treatment response in around 20% of some kinds of advanced cancer cases Report: Michael Krassnitzer ‘Immunotherapies are given the highest possible rating on the Magnitude of Clinical Benefit Scale of the European Society for Medical Oncology (ESMO), which assess- es the actual clinical benefit of tumour treatments,’ emphasises Professor Christoph Zielinski MD, Head of the University Clinic for Internal Medicine I at the Medical University of Vienna and head of the Comprehensive Cancer Centre (CCC) in Vienna. ‘We are on the brink of a revolution in treatment. The new concept is astonishingly logical as it is aimed at activating the immune system through switch- ing off suppressive mechanisms against a tumour,’ says the Viennese researcher who was involved in the development of immunotherapy for bronchial carcinoma, which is cur- rently making international head- lines. At a November event held by the CCC, Zielinski explained that new immunotherapies no longer only work on tumours long-associ- ated with the immune system: ‘In patients with advanced non-small- cell lung cancer, who had received extensive previous treatment, we have achieved a one-year survival rate of 42%, a two-year survival rate of 24% and a rate of 18% after three years through treatment with the monoclonal antibody Nivolumab.’ At Vienna’s University Clinic for Dermatology the new generation of checkpoint inhibitors (Nivolumab and Pemprolizumab) have recently begun to be used as first line treat- ments. Various studies, in which the clinic has participated for almost a In May 2015 the Executive Council of the European Society of Radiology (ESR) decided to establish a new subspecialty society, the European Society for Hybrid Medical Imaging (ESHI). Under ESR’s umbrella, it will improve hybrid imaging train- ing for practitioners to can make the best use of PET/CT and PET/ MR. ‘We hope this new society will help to stimulate a much closer collaborative relationship between radiology and nuclear medicine, and will provide a framework for future development of training, education and standards in hybrid imaging. It’s very important that this unique field is represented by its own European body,” said ESR President, Luis Donoso Bach, from Barcelona. . The use of PET/CT and PET/MR is increasing alongside a growing need for knowledge/skills. In 2007, the ESR and European Association of Nuclear Medicine (EANM) pub- lised a white paper on multimodal- ity imaging. In 2011, the multimo- dality imaging training curriculum, written by the ESR and EANM, was New subspec hybrid imagin

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