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Banfi G, Božič B, Cihan M, Pašalić D, Pennestrì F, Plebani M. Point-of-care testing, near-patient testing and patient self-testing: warning points. Clin Chem Lab Med 2024; 0:cclm-2024-0525. [PMID: 38711414 DOI: 10.1515/cclm-2024-0525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/08/2024]
Abstract
Point-of-care testing (POCT), near-patient testing (NPT) and patient self-tests (PST) are diagnostic examinations performed at the time and place of patient care. While POCT and NPT are performed and analyzed by medical professionals, PST are based on samples and parameters directly collected and analyzed by lay users. These tests are spreading both in high income countries and in low to middle income countries as they are expected to improve healthcare efficiency and equity, by saving resources, releasing pressure from hospitals and reducing logistical barriers. However, accurate multidisciplinary assessment is mandatory to ensure that what they promise is real. We reviewed some important ethical aspects, international standards and regulations. The current risks associated with alternative ways of testing are explained by the principles of respect for patient autonomy and non-maleficence. Further evidence from multidisciplinary assessment is needed to evaluate pros and cons in light of the principles of beneficence and justice. Although POCT or NPT need common regulation and accurate provider training to ensure safe and appropriate interpretation of results, PST needs even more attention as they are subject to direct patient use. Randomized controlled trails including patient education should be conducted in order to provide reliable evidence on clinical outcomes, patient acceptance and cost-effectiveness. Mandatory regulation is needed to avoid harm and EU regulation should help different countries maintain a safe use of devices in a global population of producers and users.
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Affiliation(s)
- Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Borut Božič
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Murat Cihan
- Faculty of Medicine, Ordu University, Ordu, Türkiye
| | - Daria Pašalić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Mario Plebani
- Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
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Trif C, Harpaz D, Eltzov E, Parcharoen Y, Pechyen C, Marks RS. Detection of Cannabinoids in Oral Fluid Specimens as the Preferred Biological Matrix for a Point-of-Care Biosensor Diagnostic Device. BIOSENSORS 2024; 14:126. [PMID: 38534233 DOI: 10.3390/bios14030126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024]
Abstract
An increasing number of countries have started to decriminalize or legalize the consumption of cannabis for recreational and medical purposes. The active ingredients in cannabis, termed cannabinoids, affect multiple functions in the human body, including coordination, motor skills, memory, response time to external stimuli, and even judgment. Cannabinoids are a unique class of terpeno-phenolic compounds, with 120 molecules discovered so far. There are certain situations when people under the influence of cannabis may be a risk to themselves or the public safety. Over the past two decades, there has been a growing research interest in detecting cannabinoids from various biological matrices. There is a need to develop a rapid, accurate, and reliable method of detecting cannabinoids in oral fluid as it can reveal the recent intake in comparison with urine specimens, which only show a history of consumption. Significant improvements are continuously made in the analytical formats of various technologies, mainly concerning improving their sensitivity, miniaturization, and making them more user-friendly. Additionally, sample collection and pretreatment have been extensively studied, and specific devices for collecting oral fluid specimens have been perfected to allow rapid and effective sample collection. This review presents the recent findings regarding the use of oral fluid specimens as the preferred biological matrix for cannabinoid detection in a point-of-care biosensor diagnostic device. A critical review is presented, discussing the findings from a collection of review and research articles, as well as publicly available data from companies that manufacture oral fluid screening devices. Firstly, the various conventional methods used to detect cannabinoids in biological matrices are presented. Secondly, the detection of cannabinoids using point-of-care biosensors is discussed, emphasizing oral fluid specimens. This review presents the current pressing technological challenges and highlights the gaps where new technological solutions can be implemented.
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Affiliation(s)
- Călin Trif
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
| | - Dorin Harpaz
- Institute of Biochemistry, Food Science and Nutrition, Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
- Department of Postharvest Science of Fresh Fruit, Volcani Center, Agricultural Research Organization, Rishon LeZion 7505101, Israel
| | - Evgeni Eltzov
- Department of Postharvest Science of Fresh Fruit, Volcani Center, Agricultural Research Organization, Rishon LeZion 7505101, Israel
| | - Yardnapar Parcharoen
- Chulabhorn International College of Medicine, Thammasat University, Klong Luang 12120, Pathum Thani, Thailand
| | - Chiravoot Pechyen
- Center of Excellence in Modern Technology and Advanced Manufacturing for Medical Innovation, Thammasat University, Klong Luang 12120, Pathum Thani, Thailand
- Department of Materials and Textile Technology, Faculty of Science and Technology, Thammasat University, Klong Luang 12120, Pathum Thani, Thailand
| | - Robert S Marks
- Avram and Stella Goldstein-Goren Department of Biotechnology Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
- The Ilse Katz Center for Meso and Nanoscale Science and Technology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
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Analysis of cannabinoids in conventional and alternative biological matrices by liquid chromatography: Applications and challenges. J Chromatogr A 2021; 1651:462277. [PMID: 34091369 DOI: 10.1016/j.chroma.2021.462277] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/16/2021] [Accepted: 05/18/2021] [Indexed: 11/24/2022]
Abstract
Cannabis is by far the most widely abused illicit drug globe wide. The analysis of its main psychoactive components in conventional and non-conventional biological matrices has recently gained a great attention in forensic toxicology. Literature states that its abuse causes neurocognitive impairment in the domains of attention and memory, possible macrostructural brain alterations and abnormalities of neural functioning. This suggests the necessity for the development of a sensitive and a reliable analytical method for the detection and quantification of cannabinoids in human biological specimens. In this review, we focus on a number of analytical methods that have, so far, been developed and validated, with particular attention to the new "golden standard" method of forensic analysis, liquid chromatography mass spectrometry or tandem mass spectrometry. In addition, this review provides an overview of the effective and selective methods used for the extraction and isolation of cannabinoids from (i) conventional matrices, such as blood, urine and oral fluid and (ii) alternative biological matrices, such as hair, cerumen and meconium.
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Avcioglu G, Yilmaz G, Yalcin Sahiner S, Kozaci LD, Bal C, Yilmaz FM. Evaluation of the diagnostic performance of an oral fluid screening test device for substance abuse at traffic controls. Clin Biochem 2021; 93:112-118. [PMID: 33882283 DOI: 10.1016/j.clinbiochem.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 03/22/2021] [Accepted: 04/03/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the analytical performance of the Kite Biotechnology Oral fluid (OF) screening test device, which is used for roadside screening of cannabis, opiates, amphetamines, methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), cocaine and benzodiazepines by comparing samples with matched plasma samples, analysed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) for confirmation. METHODS OF and plasma samples were obtained simultaneously from a total of 100 subjects. OF samples were analysed by OF screening test based on immunochromatography. The OF screening test cut-off values were 50 ng/mL for amphetamines (d-amphetamine) and methamphetamine/MDMA (d-methamphetamine), 30 ng/mL for cocaine (benzoylecgonine), 40 ng/mL for opiates (morphine), 20 ng/mL for benzodiazepines (nordazepam), and 25 ng/mL for cannabis (Δ9-tetrahydrocannabinol). LC-MS/MS method validation was performed according to the CLSI C62-A recommendations with the following parameters: matrix effect, lower limit of quantification (LLOQ), linearity, intra-day and inter-day precision and accuracy. RESULTS The overall specificity, accuracy and negative predictive values (NPV) were acceptable and met the DRUID standard of >80%. The OF screening test device showed good sensitivity for cocaine, amphetamines and opiates, whereas it indicated poor sensitivity for methamphetamine/MDMA (66.7%) and failed to detect cannabis and benzodiazepines. CONCLUSION The present study is the first report to evaluate the Kite Biotechnology OF screening test device. The diagnostic performance of the OF screening test device was acceptable for opiates, cocaine and amphetamines, but it was insufficient for methamphetamine/MDMA, benzodiazepines and cannabis because of sensitivity issues.
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Affiliation(s)
- Gamze Avcioglu
- Department of Medical Biochemistry, Karadeniz Ereğli State Hospital, Zonguldak, Turkey.
| | - Gulsen Yilmaz
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | | | - L Didem Kozaci
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Ceylan Bal
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
| | - Fatma Meric Yilmaz
- Department of Medical Biochemistry, Ankara Yıldırım Beyazıt University Faculty of Medicine, Ankara, Turkey
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Park HD. Current Status of Clinical Application of Point-of-Care Testing. Arch Pathol Lab Med 2021; 145:168-175. [PMID: 33053162 DOI: 10.5858/arpa.2020-0112-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The clinical applications of point-of-care testing (POCT) are gradually increasing in many health care systems. Recently, POCT devices using molecular genetic method techniques have been developed. We need to examine clinical pathways to see where POCT can be applied to improve them. OBJECTIVE.— To introduce up-to-date POCT items and equipment and to provide the content that should be prepared for clinical application of POCT. DATA SOURCES.— Literature review based on PubMed searches containing the terms point-of-care testing, clinical chemistry, diagnostic hematology, and clinical microbiology. CONCLUSIONS.— If medical resources are limited, POCT can help clinicians make quick medical decisions. As POCT technology improves and menus expand, areas where POCT can be applied will also increase. We need to understand the limitations of POCT so that it can be optimally used to improve patient management.
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Affiliation(s)
- Hyung-Doo Park
- From the Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Li Z, Wang P. Point-of-Care Drug of Abuse Testing in the Opioid Epidemic. Arch Pathol Lab Med 2020; 144:1325-1334. [PMID: 32579399 DOI: 10.5858/arpa.2020-0055-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The United States is experiencing an opioid overdose epidemic. Point-of-care (POC) drug of abuse testing is a useful tool to combat the intensified opioid epidemic. OBJECTIVES.— To review commercially available POC drug of abuse testing involving opioids, to review opportunities and challenges for POC opioid testing and emerging testing methods in research literature, and finally to summarize unmet clinical needs and future development prospects. DATA SOURCES.— The Google search engine was used to access information for commercial opioid POC devices and the Google Scholar search engine was used to access research literature published from 2000 to 2019 for opioid POC tests. CONCLUSIONS.— The opioid epidemic provides unprecedented opportunities for POC drug testing, with significant clinical needs. Compared with gold standard tests, limitations for commercially available opioid POC testing include lower analytical sensitivity, lower specificity, and cross-reactivity. In response to unmet clinical needs, novel methods have emerged in research literature, such as microfluidics and miniature mass spectrometry. Future prospects include the development of quantitative POC devices and smarter and real-time drug testing.
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Affiliation(s)
- Zhao Li
- From the Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Ping Wang
- From the Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
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Böttcher M, Kühne D, Beck O. Compliance testing of patients in ADHD treatment with lisdexamphetamine (Elvanse®) using oral fluid as specimen. CLINICAL MASS SPECTROMETRY 2019; 14 Pt B:99-105. [DOI: 10.1016/j.clinms.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 04/15/2019] [Accepted: 04/21/2019] [Indexed: 10/27/2022]
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Colby JM, Patel PC, Fu DY, Rutherford NJ. Commonly used fluoroquinolones cross-react with urine drug screens for opiates, buprenorphine, and amphetamines. Clin Biochem 2019; 68:50-54. [DOI: 10.1016/j.clinbiochem.2019.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 11/17/2022]
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Van Wijk XMR, Goodnough R, Colby JM. Mass spectrometry in emergency toxicology: Current state and future applications. Crit Rev Clin Lab Sci 2019; 56:225-238. [DOI: 10.1080/10408363.2019.1585415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Xander M. R. Van Wijk
- Department of Pathology, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
| | - Robert Goodnough
- California Poison Control System, San Francisco Division, San Francisco, CA, US
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, US
| | - Jennifer M. Colby
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, US
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Picht F, Beck O, Böttcher M. Evaluation of an on‐site test device for the heroin metabolite 6‐acetylmorphine in urine. Drug Test Anal 2019; 11:536-540. [DOI: 10.1002/dta.2559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/15/2018] [Accepted: 12/15/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Olof Beck
- MVZ Labor Dessau GmbH Dessau Germany
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11
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Cannabinoid concentrations in confiscated cannabis samples and in whole blood and urine after smoking CBD-rich cannabis as a “tobacco substitute”. Int J Legal Med 2019; 133:821-832. [DOI: 10.1007/s00414-018-01994-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/19/2018] [Indexed: 12/21/2022]
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Combining ecological momentary assessment with objective, ambulatory measures of behavior and physiology in substance-use research. Addict Behav 2018; 83:5-17. [PMID: 29174666 DOI: 10.1016/j.addbeh.2017.11.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/02/2017] [Accepted: 11/02/2017] [Indexed: 02/06/2023]
Abstract
Whereas substance-use researchers have long combined self-report with objective measures of behavior and physiology inside the laboratory, developments in mobile/wearable electronic technology are increasingly allowing for the collection of both subjective and objective information in participants' daily lives. For self-report, ecological momentary assessment (EMA), as implemented on contemporary smartphones or personal digital assistants, can provide researchers with near-real-time information on participants' behavior and mood in their natural environments. Data from portable/wearable electronic sensors measuring participants' internal and external environments can be combined with EMA (e.g., by timestamps recorded on questionnaires) to provide objective information useful in determining the momentary context of behavior and mood and/or validating participants' self-reports. Here, we review three objective ambulatory monitoring techniques that have been combined with EMA, with a focus on detecting drug use and/or measuring the behavioral or physiological correlates of mental events (i.e., emotions, cognitions): (1) collection and processing of biological samples in the field to measure drug use or participants' physiological activity (e.g., hypothalamic-pituitary-adrenal axis activity); (2) global positioning system (GPS) location information to link environmental characteristics (disorder/disadvantage, retail drug outlets) to drug use and affect; (3) ambulatory electronic physiological monitoring (e.g., electrocardiography) to detect drug use and mental events, as advances in machine learning algorithms make it possible to distinguish target changes from confounds (e.g., physical activity). Finally, we consider several other mobile/wearable technologies that hold promise to be combined with EMA, as well as potential challenges faced by researchers working with multiple mobile/wearable technologies simultaneously in the field.
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Hoegberg LCG, Christiansen C, Soe J, Telving R, Andreasen MF, Staerk D, Christrup LL, Kongstad KT. Recreational drug use at a major music festival: trend analysis of anonymised pooled urine. Clin Toxicol (Phila) 2017; 56:245-255. [DOI: 10.1080/15563650.2017.1360496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lotte Christine Groth Hoegberg
- Department of Anaesthesiology, The Danish Poisons Information Center, Copenhagen University Hospital Bispebjerg-Frederiksberg, Copenhagen, Denmark
| | - Cecilie Christiansen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jesper Soe
- Department of Anaesthesiology, Copenhagen University Hospital Hvidovre, Copenhagen and Roskilde Festival, Roskilde, Denmark
| | - Rasmus Telving
- Department of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | | | - Dan Staerk
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lona Louring Christrup
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kenneth Thermann Kongstad
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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