FEATURE ARTICLES

Roche cobas IT 1000 software improves the quality of patient information, ensures accuracy of testing, and provides immediate access to results for authorised staff in the point-of-care setting. As the National Patient Safety Agency (NPSA) reports more than half a million safety incidents in NHS trusts across England in the first half of this financial year (a rise of 4% over the previous six months),1 Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex has been taking steps to enhance patient safety when it comes to performing point-of-care (POC) diagnostic tests.

For those who may not have been able to attend the recent Joint Congress of the European Society for Clinical Microbiology and Infectious Diseases and the International Society of Chemotherapy in Milan, Oxoid provides a round up of the new products shown on the company’s stand in the associated exhibition. A joint meeting of the European Society for Clinical Microbiology and Infectious Diseases and the International Society of Chemotherapy was held in May in Milan. On offer was an excellent scientific programme, running over four days, with stimulating keynote lectures and symposia on parallel tracks, supported by the involvement of a high number of internationally-renowned experts.

West Suffolk Hospital recently implemented an order communications system for users of its diagnostic services. It is intended to make requesting easier for GPs, to improve pathology laboratory efficiency, reduce duplicate tests, and comply with national policies requiring tracking to ensure that results are actually read and acted upon. West Suffolk Hospital is a 460-bed hospital located on the edge of Bury St Edmunds. Serving an area of 600 square miles, with a population of around 275,000, the hospital has seen significant expansion in recent years and continues to grow to meet the developing healthcare needs of the community.

Customer training and support are both vital to the delivery of quality diagnostics to the pathology community, as transfusion scientist Barry Hill discovered during a recent behind-the-scenes visit to Ortho Clinical Diagnostics’ European Support Centre in Strasbourg. Ortho Clinical Diagnostics (OCD) serves the transfusion medicine community and laboratories around the world by producing total solutions for the screening, diagnosis, monitoring and confirmation of disease. As a result, OCD assists hospitals, transfusion laboratories and blood centres to deliver meaningful and timely results. As a leading provider of immunohaematology reagents and instrumentation such as the Ortho AutoVue Innova (AVI) automated blood grouping analyser and the groundbreaking Ortho BioVue column agglutination technology system, OCD invests heavily in user training and in its customer support network to ensure laboratories gain greater operational efficiency with their own analysers and serological procedures. Fundamental to this service is the OCD European Technical Support Centre based in Strasbourg, France, which provides both the dedicated in-house training and support its customers require in order to deliver the quality results that ultimately support patient safety, treatment and care.

A €3.6 million project co-funded by a European Union Framework Programme is developing a biosensor platform for the point-of-care diagnosis of cerebrovascular disease. The P3SENS (Polymer Photonic multiParametric biochemical SENSor for point-of-care diagnostics) consortium has been formed to develop an immunoassay detection device suitable for use in emergency medicine, whether diagnosis is required in an ambulance, emergency room or as part of a rapid near-patient laboratory test in a hospital environment. The requirement for such a technology to be standalone, without the infrastructure associated with a laboratory, dictates that a number of key processes be completed automatically within the system. The ability of a biosensor platform to manipulate liquid samples and deliver any biomarkers which may be present to the surface of the sensor in a manner which ensures accurate and reliable detection is critical.

Blood Science is the next step on the road to a fully integrated pathology service. Core disciplines of haematology and biochemistry are merged, but many also see the inclusion of immunology in this new super-discipline. Its development is driven by the need for cost reductions, commonality in laboratory processing and by roles in clinical diagnosis and management. The new discipline will demand a new breed of scientist, as Andrew Blann, Ian Jennings and Nessar Ahmed explain. Historically, pathology has evolved into distinct disciplines, and training and practice has reflected this. The past decade has seen the birth and slow development of a new branch of pathology – blood science – which merges aspects of haematology, biochemistry and immunology.

A guidebook on cytogram interpretation, written by Graham Gibbs and published recently, should prove very useful to anyone who uses a haematology analyser. Assessment of blood film morphology following an abnormal full blood count (FBC) is a traditional and fundamental aspect of diagnostic haematology. Nationally, review rates vary from below 5% to as much as 100% in certain specialist laboratories. However, as boundaries between different sections of pathology disappear and workload and skill-mix change, the level of morphology skill often varies among staff members.

In recent years, clinical microbiology has turned to state-of-the-art technologies in order to automate workload. Here, Jamie Laughlin discusses the gradual transformation of his department, from traditional bench-based techniques to the Lean working principles of automation.

The Heatherwood and Wexham Park Hospitals NHS Foundation Trust in Slough serves a wide area of Berkshire from its base at Wexham Park Hospital, with satellite hospitals at the Heatherwood in Ascot and St Mark’s in Maidenhead. Pathology services are centralised at Wexham Park, and the microbiology department processes about 317,000 samples a year received from hospitals and GPs in the trust. Over the past few years, the microbiology department has undergone a programme of automation, taking a thorough look at workflow and the equipment options available, as well as learning from the experiences of other laboratories.

Cardiac and thrombosis testing in accident and emergency in Buckinghamshire has benefited from use of a point-of-care immunoassay system from Radiometer, saving time and resources and improving patient care. Instant bedside immunoassay testing for critical cardiac biomarkers can be crucial to the provision of swift and appropriate treatment in an acute care setting, allowing further assessment or urgent treatment of a patient to be ruled in or ruled out without delay. Buckinghamshire Healthcare NHS Trust has introduced point-of-care immunoassay analysis in the accident and emergency (A&E) department at Stoke Mandeville Hospital, improving turnaround times for troponin I (TnI) and D-dimer, and consequently patient flow. Unnecessary treatment has now been reduced, with corresponding time and cost savings.

The latest developments in automation will come to the aid of histopathology departments that offer fluorescence in situ hybridisation testing for HER2 gene amplification. Human epidermal growth factor 2 (HER2) is a transmembrane receptor with tyrosine kinase activity that exist in low levels on normal breast epithelial cells but is over-expressed in 20–30% of patients with invasive breast cancer. This is caused by amplification of the HER2 gene on chromosome 17, and there is a very good correlation between HER2 receptor protein over-expression and HER2 gene amplification in breast cancer.

Managed service contracts continue to provide a valuable asset in the provision of modern pathology services. Two years after introducing Beckman Coulter’s Three60 inventory management to the laboratory in Chester, the department comfortably meets and often exceeds expected service levels. The Countess of Chester Hospital NHS Trust decided to enter a partnership with laboratory automation expert Beckman Coulter when it developed one of the first combined blood science units in the NHS. Now, two years on, the impact is already recognised – workflow improvements, a consistently reduced turnaround time, increased revenue opportunities, and staff able to multitask in a less stressful environment.

A powerful but comopact NMR analysers has enabled one contract laboratory to eliminate bottlenecks associated with fat testing and dramatically increase sample throughput. The quickening pace of business has caused one of Europe’s leading independent testing laboratories to seek an alternative to the standard solvent extraction/acid hydrolysis (Soxhlet) method for testing the amount of fat in foods.

Nephelometry is used to measure the specific level immunoglobulins circulating in the blood. With 50 years’ experience, Siemens is one of the leaders in the field, as workers in hospitals in Cambridge and the south-east are able to testify. The BN II and the BN ProSpec allow laboratories to provide uncompromising performance in plasma proteins analysis, favoured by the majority of nephelometry users in the UK. The ease of use and comprehensive menu make the BN II and the BN ProSpec the ideal solution for any size of laboratory, including protein reference units and dedicated immunology departments, as well as special chemistry laboratories and clinical trials organisations.

The recently launched Congress programme clearly demonstrates the vital importance of the symbiotic relationship that exists between the commercial sector and the profession it supports. Attendance, however, offers so much more, and now is the most cost-effective time to book and pay.

As hospital admissions increase due to severe cases of influenza infection, so does the demand for isolation facilities. With the ever present threat of healthcare-associated infections, Michelle Holland explores the importance of the rapid diagnosis of Clostridium difficile infection as an aid to patient prioritisation and appropriate resource allocation.

The Sebia Capillarys instrument is an automated capillary electrophoresis (CE) system for serum protein analysis, and is now a popular platform for the routine analysis of serum proteins in the investigation of myeloma. Clinical interpretation of protein electrophoresis requires experience of pattern recognition and can be subjective.

A new cobas point-of-care blood gas analyser was previewed at the UK Roche Symposium last year. Destined to find application across the hospital setting, the cobas b 123 is compact, configurable and flexible in use. Diagnostic tests or associated pre-analytical steps are being performed increasing outside the confines of the medical laboratory on a point-of-care (POC) basis. In the hospital setting, such procedures include blood gas testing in theatre and intensive care units. Modern POC blood gas analysers also provide the facility to test for other critical care parameters, such as electrolytes and glucose, as the system introduced in this article demonstrates.

A new 10-minute nasal swab test for influenza has been introduced by Washington, Tyne & Wear-based diagnostics company CDx. It claims to allow A & E departments to triage incoming patients showing signs of influenza and allocate resources appropriately to treat each patient more effectively.

In a regular feature, Pathology in Practice will speak with leading personalities from the diagnostic industry to gain their views and opinions on current topical issues facing the profession. In the spotlight in this issue is Peter Nest, who is no stranger to the diagnostics industry, having been employed within it since 1987 following a 10-year career as a biomedical scientist at the Royal East Sussex Hospital in Hastings. Peter eventually left the NHS to commence work as a sales engineer for Clandon Scientific, following which he enjoyed a spell in sales at Roche, before forming a small company called Apex Diagnostics, selling Biotrol chemistry reagents to the UK market. Later he became a product manager for Alpha Laboratories, and then their UK sales manager (diagnostics), before joining IBG Immucor in 2003 as sales and marketing manager. Peter took up his present post as UK general manager for IBG Immucor in September 2009.

Recently Selly Oak Hospital added serology testing to its automated Roche serum work area platform running in the blood science laboratory. The result is an improved service to the trust’s transplantation programme. Increasingly over the past decade or so the boundaries between the distinct pathology disciplines has become blurred. Furthermore, the advantages of a more holistic, centralised approach to the provision of, for example clinical chemistry, haematology and immunology has seen the evolution of blood sciences as a 21st-century pathology specialty. An excellent exemplar of this service consolidation is reported in this article.