VOLUME NO.33

Towards Excellent Customer Service • Utas Maju Sdn Bhd Newsletter

Therapeutic DrugMonitoring In AU Platform

GASTAT-700 SeriesEmbracing The Digital World

Ucapan dariPENGARAHURUSAN

Do you have any article you would like to share with us? Even your feedback about this newsletter is greatly appreciated. Simply send your articles, letters or feedback to: Nur Hasniza Mohd Zaki, Brisk News Editor, Utas Maju Sdn Bhd,No 15, Blok H, Jalan PJU 1A/3, Taipan 2 Damansara, Ara Damansara, 47301 Petaling Jaya, Selangor. • Tel : +603-7839 1000 • Fax: +603-7842 9940 Or email at hasniza.zaki@utasmaju.com • website: www.utasmaju.com

EDITORMohd Fauzi AzmiNur Hasniza Mohd ZakiNur Hidayah Jamaluddin

DESIGNERAsmiza Trading Sdn Bhd

ADVISOREn. Adnan Md NohEn. Ahmad Khusyairi Zubir

Bismillahirrahmanirrahim.Assalamulaikum dan Salam Sejahtera.

Alhamdulillah. Segala puji-pujian dan kesyukuran dipanjatkan kepada Allah SWT – Tuhan Sekalian Alam – dengan kasih sayang-Nya, kita dipanjangkan umur dan diberi kesempatan melalui tahun 2018 yang penuh cabaran dengan jayanya.

Semakin lama, masa terasa berlalu semakin pantas – seiring dengan kepesatan teknologi maklumat dan halatuju ekonomi baharu berasaskan digital. Informasi semakin mudah didapati dan disampaikan – malah banyak proses dan prosedur kerja yang turut berubah sebagai langkah penyesuaian serta persediaan melalui era baru ekonomi.

Di sebalik kesibukan yang berpanjangan, Utas Maju terus melakukan pemerhatian terhadap perkembangan teknologi dan impaknya terhadap ekonomi serta praktis perniagaan.

‘Those who survive are those who adapt fast’.

Prinsip ini memandu perubahan di dalam syarikat – walaupun selalunya, tidak mudah untuk menerima apatah lagi melakukan perubahan tersebut. Namun, berasaskan prinsip nilai Vibrancy dan Learning, kami mengambil satu per satu langkah yang bersesuaian untuk memastikan syarikat tidak ketinggalan.

Kami amat menghargai para pelanggan di sektor awam dan swasta, serta pihak-pihak berkepentingan (stakeholders) seperti Kementerian Kesihatan Malaysia, Teraju dan pelbagai lagi – yang berterusan memberi maklumat, kerjasama dan sokongan yang penting - agar syarikat terus dapat bersaing, menjana pendapatan dan keuntungan, seterusya menyumbang kembali kepada kakitangan dan masyarakat.

Bagi tahun 2019, pihak syarikat telah menyediakan beberapa pelan dan inisiatif untuk memastikan kesemua pelanggan kami menerima perkhidmatan terbaik dari Utas Maju. Kami sentiasa menganggap pelanggan kami di makmal-makmal diagnostik seluruh negara khususnya, sebagai rakan penting dalam mencapai sasaran tahunan. Penekanan masih diberikan kepada knowledge enhancement, dan penambahbaikan kualiti servis melalui strategi broadening service coverage and in depth service quality.

Kami menjangkakan melalui pendekatan ini, pihak pelanggan akan menikmati instrument / system uptime yang lebih baik – seterusnya membolehkan makmal menghasilkan jumlah dan kualiti ujian yang meningkat. Kita harus sama-sama mendukung dan menjayakan hasrat ini. Wakil-wakil syarikat akan berterusan berbincang dengan para pengendali makmal bagi menyelesaikan sebarang isu berbangkit.

Akhir kata, sekali lagi saya mewakili warga Utas Maju – mengucapkan setinggi-tinggi terima kasih kepada semua pelanggan, rakan niaga, dan kenalan kami – untuk segala pencapaian pada tahun 2018. Kami yakin masa depan yang lebih baik bermula pada tahun 2019, insyaallah. Didoakan segala kejayaan, kemudahan urusan dan beroleh keberkatan – kepada semua pembaca Brisk News kali ini.

SELAMAT MAJU JAYA!

ADNAN MD NOHPengarah Urusan Utas Maju Sdn. Bhd.

OUREDITORIALBOARD

BRISK NEWS • VOLUME NO. 33 • 3

Introduction to Point of Care TestingAccording to National Point of Care Testing Policy and Guidelines, Point of Care Testing (POCT) is a term used to describe laboratory testing performed usually near to the patient by non laboratory staff – mainly medical and nursing staff outside of main laboratory. Due to technology advancement and changes in the clinical practices, POCT becomes widely used in Malaysia that made it necessary for the rapid diagnosis and treatment especially for critically ill patient.

POCT allow the role of Pathology if necessarily represented by another department of clinical services such as; Emergency & Trauma, Anaesthetics, Critical Care, Medical, Obstetrics & Gynaecology, Paediatrics, Surgery, Outpatient, Public Health Facilities). However, professional partnership between Pathology and other clinical departments are required to ensure that the whole process of POCT analyser is handling correctly conducted in accordance with the principles of clinical governance and national accreditation standards.

To provide accurate and safe usage, POCT needs to deliver excellent performances in specifi c places and purposes. For examples POCT, fulfi l the clinical needs for bedside glucose testing, coagulation monitoring, and intensive care such as blood gases and ionized calcium analysis. With these POCT analyser, analysis using unprocessed whole blood provides impact bedside information for a rapid diagnosis and treatment to the patient.

What is Blood Gas Test?Blood gas measurements are used to evaluate a person’s lung function and acid/base balance by using a laboratory analyser that currently can be specifi ed as POCT analyser, which usually designed in form of bench top analyser. A blood gas test measures the amount of oxygen and carbon dioxide in the blood. It may also be used to determine the pH of the blood, or how acidic it is. The test is commonly known as a blood gas analysis or arterial blood gas (ABG) test.

The red blood cell transport oxygen and carbon dioxide throughout our body. These are known as blood gases. As blood passes through our lungs, oxygen fl ows into the blood while carbon dioxide fl ows out of the blood into the lungs. The blood gas test can determine how well our lungs are able to move oxygen into the blood and remove carbon dioxide from the blood.

Imbalances in the oxygen, carbon dioxide, and pH levels of our blood can indicate the presence of certain medical conditions. These may include:

• Kidney failures• Heart failures• Uncontrolled diabetes• Shock• A drug overdose

When is Blood Gas Test Ordered?Unknown Causes Known DiseasesSymptoms

■ Shortness of breath ■ Diffi culty breathing■ Confusion ■ Nausea■ Lung disease ■ Kidney disease■ Metabolic disease ■ Head or neck injuries that aff ect breathing

Interpreting the Results ofa Blood Gas Test

Blood pH Bicarbonate

Partial Pressure

of Carbon Dioxide

Condition Common Causes

Less than 7.4

Low Low MetabolicAcidosis

Kidney failure, shock, diabetic ketoacidosis

Greater than 7.4

High High MetabolicAlkalosis

Chronic vomiting, low blood potassium

Less than 7.4

High High RespiratoryAcidosis

Lung disease, including pneumonia or COPD

Greater than 7.4

Low Low RespiratoryAlkalosis

Breathing too fast, pain or anxiety

* Normal and abnormal ranges can be varies depending on the lab because of using diff erent measurements or methods to analyze blood samples.

How is Blood Gases Measured?Blood gases refer to the parameters pH, pCO2 and pO2 which are commonly measured in blood by electrochemical (potentiometric or amperometric) methods using ion-selective or gas selective electrodes. It is one of the oldest and most popular laboratory test which fi rst conceived around 1920 by Van Slyke using “gasometric” method (measured released O2 gas) for measuring oxygen saturation in blood. A blood gas test measures the acidity (pH) and the levels of carbon dioxide and oxygen in the blood from artery or venous. Most common measurement are the Partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), pH, Bicarbonate (HCO3), Oxygen content (O2CT) and oxygen saturation (O2Sat) values.

Blood Gases analyzer used to measure the value of acidity, gases and ionized values using a specifi c electrode for each kind of gases (pO2, pCO2). A small volume of sample usually aspirated from the syringe or capillary to go through into each electrodes within a short analysis time. For each sample, the value of acidity, gases and ionized in blood are obtained. The principle of measurement is the study of basic electrical principles and changes with chemical measurements. Blood gas electrodes are electrochemical devices that measure either electrical current or voltage.

BLOOD GASES ANALYSISHow Techno Medica Gastat

700 Series Fulfi ll Your Needsby: Mohd Khairul Idzuan Bin Othman | Sales Executive | UTAS MAJU SDN BHD

4 • BRISK NEWS • VOLUME NO.33

Latest Blood Gas Analyzer by Techno Medica: Gastat 700 SeriesGastat 700 Series are the latest model of blood gas analyser introduced by Techno Medica Japan in 2017. This blood gas analyser came out with 8 models that suit all critical care organisations in medical diagnostic area and equipped with better improvement from their previous models. The models and parameter measured by each model of Gastat 700 Series are as follows:

Models 710 720 730 735 710 aqc

720 aqc

730 aqc

735 aqc

pH, pCO2

pO2, cHb• • • • • • • •

cNa+,cK+cCl-, cCa2+

- • • • - • • •

cGlucosecLactate

- - • • - - • •

CO-

Oximetry- - - • - - - •

AutoQC - - - - • • • •

Improvement In Gastat 700 Series

Sophisticated Technology of Gastat 700 Series: IOT Maintenance SupportIOT maintenance support provides real-time monitoring of your GASTAT-700 Model instrument to capture and analyze “real-time” performance data. By remotely monitoring your instruments through internet, TMC distributors automatically and proactively provide corrective action even before you realize the problem.

When error happens or being out of pre-registered threshold, instrument sends notifi cation to pre-registered email address (e.g. TMC distributor service engineer). It enables quick troubleshooting and resulting in reduce instrument downtime.

1) Precaution Function

2) Mutual Communication

Other features included in this GASTAT-700:Perfect Hands Free Sampling for Operator Safety• Auto QC Models for Better Quality Management• Built in Barcode Reader for Broad Data Patient

Management• Zero Maintenance Electrodes for Better

Performance• Built in Battery for Power Failure Protection• Touch Screen Panel Comes with On-Screen Video

for Daily Operation• Machine Status for Easy Monitoring Performance of

the Machine at One Glance• Informative Self Diagnostics for Better

Troubleshooting Procedures

Benefi ts using Gastat 700 Series• Fewer reagents needed as the Cal Cartridge

only used for Calibration and Quality Control for better reagents inventory management and cost eff ectiveness.

• Security Password for safety purposes.• Long shelf life for Glucose & Lactate (Metabolites)

compared to other brands (3 months from installation date) to avoid downtime.

• IOT function to prompt support team condition of analyzers.

• 24/7 after sales support.

ConclusionPOCT is now an established part of clinical practice. It is important that we viewed it as part of an integrated activity in which the objective is caring for the patient in the best clinical and most cost-eff ective way in a timely manner. This may lead to improve turnaround time which allow rapid clinical intervention and informed counselling for clinical management. By using the latest technology of Blood Gas 700 Series analyser, we believe that improvements in measurement of blood gases would be easier and comprehensive.

BRISK NEWS • VOLUME NO. 33 • 5

What is Therapeutic drug monitoring (TDM)?Therapeutic drug monitoring (TDM) is generally defi ned as the clinical laboratory measurement of a chemical parameter that with appropriate medical interpretation will directly infl uence drug prescribing procedures. Otherwise, TDM refers to the individualization of drug dosage by maintaining plasma or blood drug concentrations within a targeted therapeutic range or window. By combining knowledge of pharmaceutics, pharmacokinetics, and pharmacodynamics, TDM enables the assessment of the effi cacy and safety of a particular medication in a variety of clinical settings. The goal of this process is to individualize therapeutic regimens for optimal patient benefi t. Traditionally, TDM involves measuring drug concentrations in various biological fl uids and interpreting these concentrations in terms of relevant clinical parameters. Clinical pharmacists and pharmacologists use pharmacokinetic principles to assess these interpretations. The science of TDM introduced a new aspect of clinical practice in the 1960s with the publication of initial pharmacokinetic studies linking mathematical theories to patient outcomes.

Purpose of Therapeutic Drug Monitoring (TDM)Drug assays are costly, so the reason for monitoring and the additional information to be gained (if any) should be carefully considered. For some drugs, therapeutic drug monitoring helps to increase effi cacy (e.g. vancomycin), to decrease toxicity (e.g. paracetamol) and to assist diagnosis (e.g. salicylates). Routine monitoring is not advocated for most drugs. Only clinically meaningful tests should be performed.

The appropriate indications for therapeutic drug monitoring (and examples) include:■ toxicity • diagnosing toxicity when the clinical syndrome is undiff erentiated (unexplained nausea in a patient taking

digoxin) • avoiding toxicity (e.g. aminoglycosides, cyclosporin)■ dosing • after dose adjustment (usually after reaching a steady state) • assessment of adequate loading dose (after starting phenytoin treatment) • dose forecasting to help predict a patient’s dose requirement (aminoglycosides)■ monitoring • assessing compliance (anticonvulsant concentrations in patients having frequent seizures) • diagnosing under treatment (particularly important for prophylactic drugs such as anticonvulsants,

immunosuppressants) • diagnosing failed therapy (therapeutic drug monitoring can help distinguish between ineff ective drug

treatment, non-compliance and adverse eff ects that mimic the underlying disease).

The target concentration may depend on the indication. For example, the recommended concentration for digoxin depends on whether it is being used to treat atrial fi brillation or congestive heart failure.

Therapeutic Drug Monitoringin AU Platform

by: Muhammad Ariff bin Zainol | Application Specialist | UTAS MAJU SDN BHD

Figure 1: Process of reaching dosage decisions with therapeutic drug monitoring

6 • BRISK NEWS • VOLUME NO.33

Clinical Signifi cance of TDM

Drugs Category

Drug Category Drug Treatment use

Cardiac drugs Digoxin, digitoxin, amiodarone, lidocane, quinidine, procainamide, N-acetyl-procainamide (a metabolite of procainamide)

Congestive heart failure, angina, arrhythmias

Antibiotics Aminoglycosides (gentamicin, tobramycin, amikacin), vancomycin, chloramphenicol

Infections with bacteria that are resistant to less toxic antibiotics

Antiepileptics Phenobarbital, phenytoin, valproic acid, carbamazepine, ethosuximide, sometimes gabapentin, lamotrigine, levetiracetam, topiramate, zonisamide, eslicarbazepine acetate, felbamate, lacosamide, oxcarbazepine, pregabalin, rufi namide, stiripentol, tiagabine, vigabatrin

Epilepsy, prevention of seizures, sometimes to stabilize moods

Bronchodilators Theophylline, caff eine Asthma, chronic obstructive pulmonary disorder (COPD), neonatal apnea

Immunosuppressants Cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, azathioprine

Prevent rejection of transplanted organs, autoimmune disorders

Anti-cancer drugs Methotrexate, all cytotoxic agents Psoriasis, rheumatoid arthritis, various cancers, non-hodgkin lymphomas, osteosarcoma

Psychiatric drugs Lithium, valproic acid, some antidepressants (imipramine, amitriptyline, nortriptyline, doxepin, desipramine

Bipolar disorder (manic depression), depression

Therapeutic drug monitoring in AU PlatformBeckman Coulter AU TDM assays are specifi cally engineered, formulated and packaged to provide the critical elements of eff ective TDM analysis — speeds, accuracy, ease of-use and economy. When used in conjunction with a Beckman Coulter AU Clinical System, these high quality assays provide timely, reliable and effi cient TDM results. Our comprehensive panel of TDM assays is enhanced to provide accurate, effi cient analysis of anticonvulsants, antiarrhythmics, aminoglycoside antibiotics and antiasthmatics.

Several features of our Beckman Coulter TDM reagents that’s impress customers are the reagents has minimum step to prepare that can avoid contamination and errors. Besides that, our TDM reagents have less calibrator. For example Core TDM Multicalibrators can be used for carbamazepine, phenobarbital, phenytoin, theophylline and valproic acid on Beckman Coulter analyser. Most of our reagents have longer onboard stability which is 30 to 60 days. For example valproic acids are stable onboard for 45 days while carbamazepine is stable onboard for 60 days. Furthermore, all Beckman Coulter TDM reagents can be used on all type of AU platform likes all our AU chemistry reagents. This will made it easier to purchase and control reagents stocks.

Beckman Coulter’s complete panel of high-quality TDM assays include:

BRISK NEWS • VOLUME NO. 33 • 7

8 • BRISK NEWS • VOLUME NO.33

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