Diagnosis of myocardial infarction in the absence of characteristic electrocardiographic (ECG) changes depends on measurement of circulating cardiac troponin (cTn); either cardiac troponin I (cTnI) or cardiac troponin T (cTnT).  By definition myocardial infarction is associated with increased serum cTnI and cTnT;...

Emergency Department (ED) overcrowding is becoming an increasingly international issue.  Although the problem is not only resolved by ED change management (but rather requires a system-wide solution recognizing the complex interdependencies of consumer expectations, human resources, information systems immaturity and...

Point of care (POC) testing has become an important part of nephrological care. In cases of acute renal failure, POC is indispensable in deciding the need for dialysis, but is also essential in the management of patients on regular dialysis. For example, hyperhydration, cardiovascular adverse events and inflammation...

Diagnosing heart failure (HF) in patients presenting in primary care is difficult. Clinical assessment of symptoms and signs has limited sensitivity and specificity. NT-proBNP determination has been proven to be useful and accurate for ruling out the diagnosis of systolic HF, and some have even proposed different...

Chris Price and Andrew St John have followed their book Point-of-Care Testing for Managers and Policymakers with another look at the subject from strategic vision to change management and implementation in Point-of-Care Testing: Making Innovation Work for Patient-Centered Care. In their latest book the authors give...

Despite the pervasive measurement of cardiac troponin (cTn) for the diagnosis of myocardial infarction (AMI) and acute coronary syndromes (ACS), the continuous evolution of assays and guidelines for their application has created uncertainty among laboratorians and clinicians: criteria for the choice of assay and...

A new parameter called critical reference change value (CrRCV) to be applied for the interpretation of serial measurements of cardiac troponin I (cTnI) is introduced. To illustrate the practical utility of CrRCV a set of clinical examples based on two consecutive cTnI results are presented. Thus three cTnI changes...

In the ED, 25 % of patients with angina pectoris with suspected AMI are wrongly diagnosed (no cardiac involvement). As a result, the patient risks are increased and resources are wasted. We investigated the effect of point-of-care testing (POCT) on ED processes, resource needs, patient risks and overall costs. POCT...

Various guidelines and recommendations are available for the use of natriuretic peptides in the diagnosis of heart failure. As it is known that old age may lead to higher natriuretic peptide values in the absence of heart failure, it is relevant to decide whether to use age-dependent reference intervals for clinical...

Emergency departments (ED) are challenged by increasing patient visits, overcrowding and prolonged length of stay (LOS). The cause of these problems is multifactorial. Delays in the laboratory are often perceived as contributing to delays in care and increased LOS. Implementation of selected point-of-care tests in...