Design, implementation and initial assessment of the Northern Territory Point-of-Care Testing Program.

OBJECTIVE: The objective of the study was to improve pathology services in selected remote health centres from the Northern Territory (NT) through the implementation of a quality managed point-of-care pathology testing (POCT) service. DESIGN: Study of the efficacy of the POCT service after 1 year and qualitative survey of POCT device operators. SETTING: The study was set in thirty-three remote health centres in the NT administered by the NT Department of Health. PARTICIPANTS: Remote health centre staff at participating remote health centres participated in the study. INTERVENTIONS: The introduction of the i-STAT device to perform on-site POCT. MAIN OUTCOME MEASURES: The main outcome measures used in the study were the number of remote staff trained, volume of testing performed and satisfaction of POCT device operators. RESULTS: One hundred and sixty-four health professional staff were trained to perform i-STAT POCT during the first year of the program. A total of 2290 POCT tests were performed on the i-STAT. The volume of testing consistently increased across the year. Tests for international normalised ratio were the most frequently performed (averaging 70 tests per month). Stakeholder satisfaction with the i-STAT device was high, with a statistically significant improvement in satisfaction levels with pathology service provision being reported after the introduction of POCT. Greater than 80% of respondents stated POCT was more convenient than the laboratory service and assisted in the stabilisation of acutely ill patients. CONCLUSIONS: The NT POCT Program has been operationally effective and well received by staff working as i-STAT POCT operators in remote health centres. Retention of remote health centre staff is the most significant challenge to ensuring the program's long-term viability.

A novel prosurvival model for cancer under environmental challenge: the "heart-felt" message for therapeutic intervention.

In the present review I propose a novel model system to analyze and to aid prediction of suitable targeted treatments aimed at therapy-resistant cancer cells. The concept of cancer cell prosurvival reaction to adverse external tumor microenvironment is explored in the context of the reaction of myocardium to unfavorable physiologic conditions. Many of the protective and indeed nonprotective (tumor suppressor) reactive mechanisms in both cancer and heart tissue challenged with an adverse environment follow similar and predictable patterns. Based on these observations, a model is constructed that may aid prediction of future therapies aimed to target cancer--particularly chemotherapy/radiotherapy resistance and dormant disease. As another feature of the model, ways to better forecast future therapies aimed at augmenting cardioprotective paths is made possible through understanding of pathways used to sustain cancer cells under external challenges.

Cancer: a novel "no-nonsense" approach to treatment.

Nonsense mutations, which lead to premature termination codons, are prevalent in a wide variety of cancers and many studies highlight clear evidence of functions. Based on these observations, a strategy is proposed for using various natural and synthetic derivatives based on aminoglycosides and their conjugates that have the unique property of read-through of nonsense mutations. The results and current status of this group of drugs are presented to show their effectiveness in treating other nonsense-codon-mediated diseases unrelated to cancer such as cystic fibrosis, thalassaemia, and muscular dystrophy. Concluding remarks indicate that this novel approach to cancer treatment with relatively low toxicity and reversibility of drug action as well as potential good patient acceptance and compliance ought to be now trialed for use in treating a wide variety of cancers.