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Guamán-Pilco D, Chocano E, Palà E, Lamana-Vallverdú M, Penalba A, García-Rodríguez P, Rubiera M, Bustamante A, Rovira À, Pérez-Sánchez S, Azurmendi L, Reymond S, Sánchez JC, Montaner J. H-FABP as a Biomarker in Transient Ischemic Attack. J Cardiovasc Transl Res 2024:10.1007/s12265-024-10552-4. [PMID: 39160445 DOI: 10.1007/s12265-024-10552-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
The study investigates the utility of heart fatty-acid binding protein (H-FABP) in distinguishing TIA from mimics. Data from 175 patients from the StrokeChip multicenter study was retrospectively analyzed. H-FABP level was measured using a rapid point-of-care test. Findings revealed that H-FABP levels were higher in individuals with TIA compared to mimics [3.10 ng/mL (IQR 2.13-4.78) vs. 1.70 ng/mL (IQR 1.23-2.38)] (p < 0.001). The diagnostic performance of H-FABP, assessed using the area under the curve operating characteristic curve (AUC) was 0. 83 (95% CI = 0.76-0.90) for the final model, indicating good discriminative ability. The PanelomiX determined that a combined cutoff of > 1.85 ng/ml for H-FABP, age > 42.5 years, and baseline NIHSS > 3.5 had a 100% of sensitivity and 23.30% of specificity. The study suggests that H-FABP has potential as a TIA diagnostic biomarker. The rapid application of POCT's for H-FABP measurement supports its potential use in emergency departments and primary care settings.
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Affiliation(s)
- Daisy Guamán-Pilco
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elvira Chocano
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Palà
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcel Lamana-Vallverdú
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Penalba
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paula García-Rodríguez
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Rubiera
- Stroke, Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Alejandro Bustamante
- Department of Neurology, Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, 08916, Badalona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Soledad Pérez-Sánchez
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Leire Azurmendi
- Translational Biomarker Group, Internal Medicine Department, University Medical Center, University of Geneva, Geneva, Switzerland
| | - Sandrine Reymond
- Translational Biomarker Group, Internal Medicine Department, University Medical Center, University of Geneva, Geneva, Switzerland
| | - Jean-Charles Sánchez
- Translational Biomarker Group, Internal Medicine Department, University Medical Center, University of Geneva, Geneva, Switzerland
| | - Joan Montaner
- Neurovascular Research Laboratory Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville, Seville, Spain.
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain.
- Neurovascular Research Group, IBiS/Hospital Universitario Virgen Macarena/CSIC/University of Seville, Av. Manuel Siurot s/n, 41013, Seville, Spain.
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Mills SE, Akbar SB, Hernandez-Santiago V. Barriers, enablers, benefits, and drawbacks to point-of-care testing: a survey of the general practice out-of-hours service in Scotland. BJGP Open 2024; 8:BJGPO.2023.0094. [PMID: 38092440 PMCID: PMC11300988 DOI: 10.3399/bjgpo.2023.0094] [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: 05/22/2023] [Revised: 08/27/2023] [Accepted: 09/13/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The general practice out-of-hours (GPOOH) service is under pressure to treat more patients in less time, while reducing referrals and minimising diagnostic errors. Point-of-care (POC) testing involves rapid clinical tests that can be used to generate results during the consultation, and has the potential to facilitate managing these competing demands safely. AIM To describe current availability of POC tests in GPOOH in Scotland, and identify barriers, enablers, benefits, and drawbacks to its use. DESIGN & SETTING Cross-sectional mixed-methods study, which surveyed opinions of clinicians working in the GPOOH service in NHS Scotland. METHOD An electronic questionnaire was developed, designed, piloted, and distributed to clinicians, which had closed questions and areas for free text. RESULTS In total, 142 responses were received. Urine dipstick testing (99.2%), pregnancy tests (98.5%), oxygen saturation (97.7%), and blood glucose testing (93.9%), were the only POC tests commonly available in GPOOH in NHS Scotland. There was strongest support for the provision of POC tests, particularly C-reactive protein (CRP; 79.4%), strep A (76.0%), and D-dimer (75.2%). Responders felt that POC tests would improve confidence (92.3%) and safety (89.8%) surrounding clinical decision making, improve patient satisfaction (80.6%), and reduce hospital and secondary care referrals (77.5%). Barriers to POC test use were availability of the test kits and machines (94.5%), training requirements on how to use the machine (71.1%) and interpret results (56.3%), and time to do the test (62.0%). CONCLUSION Few POC tests are in regular use in GPOOH in Scotland. GPOOH clinicians are supportive of using POC testing. They identified a number of benefits to its use, with very few drawbacks. Increased provision of POC testing in GPOOH in NHS Scotland should be considered urgently.
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Affiliation(s)
- Sarah Ee Mills
- University of St Andrews, School of Medicine, North Haugh, St Andrews, UK
| | - Sm Babar Akbar
- NHS Fife, General Practice Out of Hours Department, Victoria Hospital Kirkcaldy, Kirkcaldy, USA
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Wilcox CR, Odeh N, Clark TW, Muller I, Becque T, Todd A, Islam N, Little P, Davies F, McGavin J, Francis N. Use of the FebriDx® host-response point-of-care test may reduce antibiotic use for respiratory tract infections in primary care: a mixed-methods feasibility study. J Antimicrob Chemother 2024; 79:1441-1449. [PMID: 38708643 PMCID: PMC11144485 DOI: 10.1093/jac/dkae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION FebriDx® is a CE-marked, single-use point-of-care test with markers for bacterial [C-reactive protein (CRP)] and viral [myxovirus resistance protein A (MxA)] infection, using finger-prick blood samples. Results are available after 10-12 min. We explored the usability and potential impact of FebriDx® in reducing antibiotic prescriptions for lower respiratory tract infection (LRTI) in primary care, and the feasibility of conducting a randomized controlled trial (RCT). METHODS Patients (aged ≥1 year) with LRTI deemed likely to receive antibiotic prescription were recruited at nine general practices and underwent FebriDx® testing. Data collection included FebriDx® results, antibiotic prescribing plan (before and after testing) and re-consultation rates. Staff completed System Usability Scale questionnaires. RESULTS From 31 January 2023 to 9 June 2023, 162 participants participated (median age 57 years), with a median symptom duration of 7 days (IQR 5-14). A valid FebriDx® result was obtained in 97% (157/162). Of 155 patients with available results, 103 (66%) had no detectable CRP or MxA, 28 (18%) had CRP only, 5 (3%) had MxA only, and 19 (12%) had both CRP and MxA. The clinicians' stated management plan was to prescribe antibiotics for 86% (134/155) before testing and 45% (69/155) after testing, meaning a 41% (95% CI: 31%, 51%) difference after testing, without evidence of increased re-consultation rates. Ease-of-use questionnaires showed 'good' user-friendliness. CONCLUSIONS Use of FebriDx® to guide antibiotic prescribing for LRTI in primary care was associated with a substantial reduction in prescribing intentions. These results support a fully powered RCT to confirm its impact and safety.
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Affiliation(s)
- Christopher R Wilcox
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nour Odeh
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Tristan W Clark
- School of Clinical and Experimental Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Taeko Becque
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Alexander Todd
- Lilliput Surgery, Shore Medical Group, Elms Avenue, Poole BH14 8EE, UK
| | - Nazrul Islam
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Paul Little
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Firoza Davies
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - John McGavin
- Patient and Public Involvement Representative, Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
| | - Nick Francis
- Primary Care Research Centre, Aldermoor Health Centre, Aldermoor Close, University of Southampton, Southampton SO16 5ST, UK
- NIHR Southampton Biomedical Research Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
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Tolley A, Bansal A, Murerwa R, Howard Dicks J. Cost-effectiveness of point-of-care diagnostics for AMR: a systematic review. J Antimicrob Chemother 2024; 79:1248-1269. [PMID: 38498622 PMCID: PMC11144491 DOI: 10.1093/jac/dkae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major threat to global health. By 2050, it is forecast that AMR will cause 10 million deaths and cost 100 trillion USD annually. Point-of-care tests (POCTs) may represent a cost-effective approach to reduce AMR. OBJECTIVES We systematically reviewed which POCTs addressing AMR have undergone economic evaluation in primary and secondary healthcare globally, how these POCTs have been economically evaluated, and which are cost-effective in reducing antimicrobial prescribing or the burden of AMR. Clinical cost-effectiveness was additionally addressed. METHODS This systematic review, accordant with PRISMA guidelines, was pre-registered on PROSPERO (CRD42022315192). MEDLINE, PubMed, Embase, Cochrane Library, and Google Scholar were searched from 2000 to 2023 for relevant publications. Quality assessment was performed using the Consensus of Health Economic Criteria. RESULTS The search strategy identified 1421 studies, of which 20 met the inclusion criteria. The most common POCTs assessed were for respiratory infections (n = 10), STIs (n = 3), and febrile patients in low- and middle-income countries (n = 3). All studies assessed costs from a healthcare provider perspective; five additionally considered the societal cost of AMR.Eighteen studies identified POCT strategies that reduced antimicrobial prescribing. Of these, 10 identified POCTs that would be considered cost-effective at a willingness-to-pay (WTP) threshold of £33.80 per antibiotic prescription avoided. Most POCT strategies improved clinical outcomes (n = 14); the remainder were clinically neutral. CONCLUSIONS There is evidence that some POCTs are cost-effective in reducing antimicrobial prescribing, with potential concomitant clinical benefits. Such interventions-especially CRP POCTs in both high- and low-income settings-merit further, large-scale clinical evaluation.
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Affiliation(s)
- Abraham Tolley
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Akhil Bansal
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Internal Medicine, St Vincent’s Hospital, Sydney, Australia
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Smedemark SA, Laursen CB, Jarbøl DE, Rosenvinge FS, Andersen-Ranberg K. Improving diagnostics using extended point-of-care testing during in-home assessments of older adults with signs of emerging acute disease: a prospective observational non-randomised pilot and feasibility study. BMC Geriatr 2024; 24:373. [PMID: 38664633 PMCID: PMC11046810 DOI: 10.1186/s12877-024-04914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Delayed recognition of acute disease among older adults hinders timely management and increases the risk of hospital admission. Point-of-Care testing, including Focused Lung Ultrasound (FLUS) and in-home analysis of biological material, may support clinical decision-making in suspected acute respiratory disease. The aim of this study was to pilot test the study design for a planned randomised trial, investigate whether in-home extended use of point-of-care testing is feasible, and explore its' potential clinical impact. METHODS A non-randomised pilot and feasibility study was conducted during September-November 2021 in Kolding Municipality, Denmark. A FLUS-trained physician accompanied an acute community nurse on home-visits to citizens aged 65 + y with signs of acute respiratory disease. The acute community nurses did a clinical assessment (vital signs, capillary C-reactive protein and haemoglobin) and gave a presumptive diagnosis. Subsequently, the physician performed FLUS, venipuncture with bedside analysis (electrolytes, creatinine, white blood cell differential count), nasopharyngeal swab (PCR for upper respiratory pathogens), and urine samples (flow-cytometry). Primary outcomes were feasibility of study design and extended point-of-care testing; secondary outcome was the potential clinical impact of extended point-of-care testing. RESULTS One hundred consecutive individuals were included. Average age was 81.6 (SD ± 8.4). Feasibility of study design was acceptable, FLUS 100%, blood-analyses 81%, PCR for upper respiratory pathogens 79%, and urine flow-cytometry 4%. In addition to the acute community nurse's presumptive diagnosis, extended point-of-care testing identified 34 individuals with a condition in need of further evaluation by a physician. CONCLUSION Overall, in-home assessments with extended point-of-care testing are feasible and may aid to identify and handle acute diseases in older adults.
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Affiliation(s)
- Siri Aas Smedemark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 2D, Indgang 112, 7. Sal, Odense, 5000, Denmark.
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 2D, Indgang 112, 7. Sal, Odense, 5000, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Kløvervænget 2D, Indgang 112, 7. Sal, Odense, 5000, Denmark
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Dineen-Griffin S, Benrimoj SI. The landscape of self-care in Australia: A pharmacy perspective. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100396. [PMID: 38174289 PMCID: PMC10762451 DOI: 10.1016/j.rcsop.2023.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
The evolving landscape of self-care in Australia underscores the imperative of recognizing and integrating the crucial role of pharmacists in promoting greater levels of self-care. Although the social and economic justifications for self-care are acknowledged internationally and in the literature, there is very little policy recognition in relation to self-care specifically in Australian health policy. Additionally, the distinct contributions of pharmacies to self-care, i.e., their experiences and accessibility in primary health care, are not consistently highlighted. Community pharmacies in Australia are currently navigating a transformative shift, expanding their scope of practice to deliver highly individualized care, with a special emphasis on the implementation of professional services crucial for the sector's enduring viability. Although pharmacists already play a substantial role in supporting self-care, there exists a compelling demand for a systematic and structured approach. Despite the limited availability of theoretical frameworks or models for pharmacists in self-care support within the existing literature, tangible practical evidence attests to the success of interventions. In an era where patients increasingly assume responsibility for self-managing conditions, the pharmacist's role in facilitating self-care and judicious self-medication is pivotal, promising not only tangible benefits for individuals but also contributing significantly to the long-term sustainability of the healthcare system in Australia. This necessitates a strategic and comprehensive framework that positions pharmacists as essential catalysts in the broader landscape of healthcare, ensuring their contributions are optimally leveraged to enhance patient outcomes and system efficiency.
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Affiliation(s)
- Sarah Dineen-Griffin
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, New South Wales, Australia
| | - Shalom I. Benrimoj
- Pharmaceutical Care Research Group, Faculty of Pharmacy, University of Granada, Spain
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Maduabuchi Ihekoronye R, Oore-Ofe Akande D, Patrick Osemene K. Management of Point-of-Care Testing (POCT) Services by Community Pharmacists in Osun State Nigeria. Innov Pharm 2023; 14:10.24926/iip.v14i3.5576. [PMID: 38487390 PMCID: PMC10936449 DOI: 10.24926/iip.v14i3.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background: Point-of-care testing (POCT) provides important opportunity for community pharmacists to participate in oriented primary patient care. Effective management of these services is required to deliver their currently- underexploited benefits. Objectives: Assessed attitudes and practice, examined management functions deployed and identified factors affecting provision of POCTs by community pharmacists. Methods: A questionnaire-guided cross-sectional survey of 146 randomly-selected community pharmacists was conducted in Osun State Southwestern Nigeria. Study variables were measured on 5-point Likert scales with weighted averages, median scores and ranks used to present item performances. Interquartile ranges were computed to categorize practice scores. Chi square statistic was used to examine association of variables. ANOVA and 2-sample t-test were used to compare means. Results: A response rate of 94.5% was achieved. Respondents had a positive attitude (MWA 3.75) towards provision of POCTs as core component of their practice (MWA 4.58) with potential to contribute significantly to profitability (MWA 4.31). Respondents' median practice score was 3.01(moderate practice) with blood pressure screening (4.77), weight measurement (4.45), and blood glucose screening (4.18) as leading POCTs, while cervical cancer screening (1.09) was least practiced. Management of POCTs was fair (MWA 3.33) with organisation of work as pre-eminent domain (MWA 3.66). Management practices were significantly associated with almost all demographic variables (p< .05). Positive public perception of pharmacists' roles (MWA 4.31) and their improving clinical skills (MWA 4.01) were the leading enablers while the lack of enabling policy framework (MWA 3.80) and poor health information backbone (MWA 3.78) were major challenges to routine adoption of POCTs by respondents. Conclusion: The community pharmacists had positive attitude and moderate practice of POCTs. Management of these services was fair. Improving public perception of pharmacists should be exploited while enabling legal and health information systems should be provided to drive routine adoption of POCTs.
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Affiliation(s)
- Romanus Maduabuchi Ihekoronye
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile Ife Nigeria
| | - Debora Oore-Ofe Akande
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile Ife Nigeria
| | - Kanayo Patrick Osemene
- Department of Clinical Pharmacy & Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile Ife Nigeria
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Azizian P, Casals-Terré J, Ricart J, Cabot JM. Diffusion-free valve for preprogrammed immunoassay with capillary microfluidics. MICROSYSTEMS & NANOENGINEERING 2023; 9:91. [PMID: 37469685 PMCID: PMC10352302 DOI: 10.1038/s41378-023-00568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 07/21/2023]
Abstract
By manipulating the geometry and surface chemistry of microfluidic channels, capillary-driven microfluidics can move and stop fluids spontaneously without external instrumentation. Furthermore, complex microfluidic circuits can be preprogrammed by synchronizing the capillary pressures and encoding the surface tensions of microfluidic chips. A key component of these systems is the capillary valve. However, the main concern for these valves is the presence of unwanted diffusion during the valve loading and activation steps that can cause cross-contamination. In this study, we design and validate a novel diffusion-free capillary valve: the π-valve. This valve consists of a 3D structure and a void area. The void acts as a spacer between two fluids to avoid direct contact. When the valve is triggered, the air trapped within the void is displaced by pneumatic suction induced from the capillary flow downstream without introducing a gas bubble into the circuit. The proposed design eliminates diffusive mixing before valve activation. Numerical simulation is used to study the function and optimize the dimensions of the π-valve, and 3D printing is used to fabricate either the mould or the microfluidic chip. A comparison with a conventional valve (based on a constriction-expansion valve) demonstrates that the π-valve eliminates possible backflow into the valve and reduces the mixing and diffusion during the loading and trigger steps. As a proof-of-concept, this valve is successfully implemented in a capillary-driven circuit for the determination of benzodiazepine, achieving the successive release of 3 solutions in a 3D-printed microfluidic chip without external instrumentation. The results show a 40% increase in the fluorescence intensity using the π-valve relative to the conventional value. Overall, the π-valve prevents cross-contamination, minimizes sample use, and facilitates a sophisticated preprogrammed release of fluids, offering a promising tool for conducting automated immunoassays applicable at point-of-care testing.
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Affiliation(s)
- Pooya Azizian
- Energy and Engineering Department, Leitat Technological Center, Terrassa, Barcelona Spain
- Mechanical Engineering Department, Technical University of Catalonia, Terrassa, Barcelona Spain
| | - Jasmina Casals-Terré
- Mechanical Engineering Department, Technical University of Catalonia, Terrassa, Barcelona Spain
| | - Jordi Ricart
- Energy and Engineering Department, Leitat Technological Center, Terrassa, Barcelona Spain
| | - Joan M. Cabot
- Energy and Engineering Department, Leitat Technological Center, Terrassa, Barcelona Spain
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Matthes A, Wolf F, Schmiemann G, Gágyor I, Bleidorn J, Markwart R. Point-of-care laboratory testing in primary care: utilization, limitations and perspectives of general practitioners in Germany. BMC PRIMARY CARE 2023; 24:96. [PMID: 37038122 PMCID: PMC10088261 DOI: 10.1186/s12875-023-02054-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Due to their fast turnaround time and user-friendliness, point-of-care tests (POCTs) possess a great potential in primary care. The purpose of the study was to assess general practitioners' (GPs) perspectives on POCT use in German primary care, including utilization, limitations and requirements. METHODS We conducted a cross-sectional survey study among GPs in Germany (federal states of Thuringia, Bremen and Bavaria (Lower Franconia), study period: 04/22-06/2022). RESULTS From 2,014 GPs reached, 292 participated in our study (response rate: 14.5%). The median number of POCTs used per GP was 7.0 (IQR: 5.0-8.0). Six POCTs are used by the majority of surveyed GPs (> 50%): urine dipstick tests (99%), glucose (urine [91%] and plasma [69%]), SARS-CoV-2 (80%), urine microalbumin (77%), troponin I/T (74%) and prothrombin time / international normalized ratio (65%). The number of utilized POCTs did not differ between GP practice type (p = 0.307) and population size of GP practice location (p = 0.099). The great majority of participating German GPs (93%) rated POCTs as useful diagnostic tools in the GP practice. GPs ranked immediate decisions on patient management and the increase in diagnostic certainty as the most important reasons for performing POCTs. The most frequently reported limitations of POCT use in the GP practice were economic aspects (high costs and inadequate reimbursement), concerns regarding diagnostic accuracy, and difficulties to integrate POCT-testing into practice routines (e.g. time and personnel expenses). CONCLUSION Although participating German GPs generally perceive POCTs as useful diagnostic tools and numerous POCTs are available, several test-related and contextual factors contribute to the relatively low utilization of POCTs in primary care.
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Affiliation(s)
- Anni Matthes
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
- InfectoGnostics Research Campus Jena, Jena, Germany
| | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Sciences, Department for Health Services Research, Bremen University, Bremen, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Wuerzburg, Würzburg, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Robby Markwart
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany.
- InfectoGnostics Research Campus Jena, Jena, Germany.
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Kjær N, Plejdrup Hansen M, Schou Pedersen H, Bondo Christensen M, Huibers L. Development over time in point-of-care test use in Danish daytime and out-of-hours general practice: a register-based study. Scand J Prim Health Care 2023; 41:108-115. [PMID: 36939231 DOI: 10.1080/02813432.2023.2187667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE To describe the development over time of the use of C-reactive protein (CRP) and rapid streptococcal detection test (RADT) point-of-care tests (POCT) in Danish general practice and to explore associations between patient characteristics and POCT use (i.e. CRP and RADT). DESIGN AND SETTINGS A register-based study including all general practice clinic consultations in daytime and out-of-hours (OOH) settings in Denmark between 2003 and 2018. SUBJECTS All citizens who had at least one clinic consultation in daytime or OOH general practice within the study period. MAIN OUTCOME MEASURES We estimated the total and relative use of CRP and RADT POCTs and described the development over time. Crude and adjusted proportion ratios (PRs) were calculated to explore associations between patient characteristics and POCT use. RESULTS Overall, the relative use of CRP POCTs increased. At OOH, a steep increase was noticed around 2012. The relative use of RADT decreased. Patient age 40-59 years and existing comorbidity were significantly associated with a higher use of CRP testing in both settings. A significantly lower use of CRP testing was found for patients with higher educational level. We found a significantly higher use of RADT testing for patients aged 0-19 years and with higher household educational level, whereas comorbidity was associated with a lower use of RADT testing. CONCLUSION The use of CRP POCT increased over time, whereas the use of RADT POCT decreased. Perhaps the success of implementing CRP as a tool for reducing antibiotic use has reached it limit. Future studies should focus on how and when POCT are used most optimal.Key pointsCRP POC tests and RADT POCTs are frequently used diagnostic tools in general practice, both in daytime and in the out-of-hours setting.There was an increased use of CRP POCTs, particularly in out-of-hours general practice, whereas the use of RADT POCTs declined between 2003 and 2018.CRP POCTs were associated with age of 40-59 years and co-morbidity, while the use of RADT was mostly associated with younger age.
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Affiliation(s)
- Niels Kjær
- Research Unit for General Practice, Aarhus, Denmark
| | | | | | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Institute for Public Health, Aarhus University, Aarhus, Denmark
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11
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Dewez JE, Nijman RG, Fitchett EJA, Lynch R, de Groot R, van der Flier M, Philipsen R, Vreugdenhil H, Ettelt S, Yeung S. Adoption of C-reactive protein point-of-care tests for the management of acute childhood infections in primary care in the Netherlands and England: a comparative health systems analysis. BMC Health Serv Res 2023; 23:191. [PMID: 36823597 PMCID: PMC9947887 DOI: 10.1186/s12913-023-09065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 01/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The use of point of care (POC) tests varies across Europe, but research into what drives this variability is lacking. Focusing on CRP POC tests, we aimed to understand what factors contribute to high versus low adoption of the tests, and also to explore whether they are used in children. METHODS We used a comparative qualitative case study approach to explore the implementation of CRP POC tests in the Netherlands and England. These countries were selected because although they have similar primary healthcare systems, the availability of CRP POC tests in General Practices is very different, being very high in the former and rare in the latter. The study design and analysis were informed by the non-adoption, abandonment, spread, scale-up and sustainability (NASSS) framework. Data were collected through a review of documents and interviews with stakeholders. Documents were identified through a scoping literature review, search of websites, and stakeholder recommendation. Stakeholders were selected purposively initially, and then by snowballing. Data were analysed thematically. RESULTS Sixty-five documents were reviewed and 21 interviews were conducted. The difference in the availability of CRP POC tests is mainly because of differences at the wider national context level. In the two countries, early adopters of the tests advocated for their implementation through the generation of robust evidence and by engaging with all relevant stakeholders. This led to the inclusion of CRP POC tests in clinical guidelines in both countries. In the Netherlands, this mandated their reimbursement in accordance with Dutch regulations. Moreover, the prevailing better integration of health services enabled operational support from laboratories to GP practices. In England, the funding constraints of the National Health Service and the prioritization of alternative and less expensive antimicrobial stewardship interventions prevented the development of a reimbursement scheme. In addition, the lack of integration between health services limits the operational support to GP practices. In both countries, the availability of CRP POC tests for the management of children is a by-product of the test being available for adults. The tests are less used in children mainly because of concerns regarding their accuracy in this age-group. CONCLUSIONS The engagement of early adopters combined with a more favourable and receptive macro level environment, including the role of clinical guidelines and their developers in determining which interventions are reimbursed and the operational support from laboratories to GP practices, led to the greater adoption of the tests in the Netherlands. In both countries, CRP POC tests, when available, are less used less in children. Organisations considering introducing POC tests into primary care settings need to consider how their implementation fits into the wider health system context to ensure achievable plans.
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Affiliation(s)
- Juan Emmanuel Dewez
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruud G Nijman
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
| | | | - Rebecca Lynch
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Ronald de Groot
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Michiel van der Flier
- Paediatric Infectious diseases and Immunology, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
- Paediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ria Philipsen
- Section of Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Centre for Infectious Diseases, Radboud Institute for Molecular Life Sciences, Radboud UMC, Nijmegen, The Netherlands
| | - Harriet Vreugdenhil
- Utrecht General Practice Training Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefanie Ettelt
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Prognos AG, Basel, Switzerland
| | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
- Department of Paediatrics, St Mary's Imperial College Hospital NHS Trust, London, UK.
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12
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Phelan A, Broughan J, McCombe G, Collins C, Fawsitt R, O’Callaghan M, Quinlan D, Stanley F, Cullen W. Impact of enhancing GP access to diagnostic imaging: A scoping review. PLoS One 2023; 18:e0281461. [PMID: 36897853 PMCID: PMC10004541 DOI: 10.1371/journal.pone.0281461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/24/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. METHODS A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. CONCLUSION Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.
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Affiliation(s)
- Amy Phelan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - John Broughan
- Clinical Research Centre, School of Medicine, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Claire Collins
- Research, Policy and Information, Irish College of General Practitioners, Dublin, Ireland
| | - Ronan Fawsitt
- General Practice, Castle Gardens Medical Centre, Kilkenny, Ireland
- Primary Care Advisor, Ireland East Hospital Group, Dublin, Ireland
| | - Mike O’Callaghan
- Irish College of General Practitioners, ICGP, Dublin, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Fintan Stanley
- Irish College of General Practitioners, ICGP, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Ireland
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13
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Dewez JE, Pembrey L, Nijman RG, del Torso S, Grossman Z, Hadjipanayis A, Van Esso D, Lim E, Emonts M, Burns J, Gras-LeGuen C, Kohlfuerst D, Dornbusch HJ, Brengel-Pesce K, Mallet F, von Both U, Tsolia M, Eleftheriou I, Zavadska D, de Groot R, van der Flier M, Moll H, Hagedoorn N, Borensztajn D, Oostenbrink R, Kuijpers T, Pokorn M, Vincek K, Martinón-Torres F, Rivero I, Agyeman P, Carrol ED, Paulus S, Cunnington A, Herberg J, Levin M, Mujkić A, Geitmann K, Da Dalt L, Valiulis A, Lapatto R, Syridou G, Altorjai P, Torpiano P, Størdal K, Illy K, Mazur A, Spreitzer MV, Rios J, Wyder C, Romankevych I, Basmaci R, Ibanez-Mico S, Yeung S. Availability and use of rapid diagnostic tests for the management of acute childhood infections in Europe: A cross-sectional survey of paediatricians. PLoS One 2022; 17:e0275336. [PMID: 36538525 PMCID: PMC9767335 DOI: 10.1371/journal.pone.0275336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/14/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. METHODS AND FINDINGS A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95%CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. CONCLUSION There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.
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Affiliation(s)
- Juan Emmanuel Dewez
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
| | - Lucy Pembrey
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ruud G. Nijman
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
- Research in European Paediatric Emergency Medicine (REPEM)
| | - Stefano del Torso
- ChildCare WorldWide, Padova, Italy
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
| | - Zachi Grossman
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Pediatric Clinic, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Adamos Hadjipanayis
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
- Medical School, European University Cyprus, Nicosia, Cyprus
| | - Diego Van Esso
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Primary Care Paediatrician, Health Care Centre Pere Grau, Barcelona, Spain
| | - Emma Lim
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marieke Emonts
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Great North Children’s Hospital, Paediatric Immunology, Infectious Diseases & Allergy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - James Burns
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christèle Gras-LeGuen
- Centre d’Investigation Clinique CIC1413, INSERM-Nantes University Hospital, Nantes, France
| | - Daniela Kohlfuerst
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Medical University of Graz, Graz, Austria
| | - Hans Jürgen Dornbusch
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Medical University of Graz, Graz, Austria
| | - Karen Brengel-Pesce
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- BioMérieux, Lyon, France
| | - Francois Mallet
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- BioMérieux, Lyon, France
| | - Ulrich von Both
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Maria Tsolia
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Irini Eleftheriou
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- P. and A. Kyriakou Children’s Hospital, Athens, Greece
| | - Dace Zavadska
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Children Clinical University Hospital, Riga, Latvia
| | - Ronald de Groot
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Michiel van der Flier
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henriëtte Moll
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Nienke Hagedoorn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Dorine Borensztajn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Rianne Oostenbrink
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Taco Kuijpers
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Marko Pokorn
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Katarina Vincek
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Federico Martinón-Torres
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Irene Rivero
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Philipp Agyeman
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Enitan D. Carrol
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Stéphane Paulus
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
| | - Aubrey Cunnington
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Jethro Herberg
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Michael Levin
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, United Kingdom
| | - Aida Mujkić
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia
| | - Karin Geitmann
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Primary Care Paediatrician, BVKJ, Hagen, Germany
| | - Liviana Da Dalt
- Research in European Paediatric Emergency Medicine (REPEM)
- Department of Woman’s and Child’s Health Padova University Hospital, Padua, Italy
| | - Arūnas Valiulis
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Vilnius University Medical Faculty, Institute of Clinical Medicine, Clinic of Children’s Diseases, Vilnius, Lithuania
| | - Risto Lapatto
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Department of Paediatrics, Helsinki University Hospital, Helsinki, Finland
| | - Garyfallia Syridou
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Attiko University Hospital, Chaidari, Greece
| | - Péter Altorjai
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Association of Hungarian Primary Care Paediatricians, Budapest, Hungary
| | - Paul Torpiano
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Department of Paediatrics and Adolescent Health at Mater Dei Hospital, Valletta, Malta
| | - Ketil Størdal
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Paediatric Research Institute, University of Oslo, Oslo, Norway
| | - Károly Illy
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Dutch Society of Paediatrics NVK, Utrecht, the Netherlands
| | - Artur Mazur
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Medical College of Rzeszow University, Rzeszów, Poland
| | - Mateja Vintar Spreitzer
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Zdravstveni dom Domžale, Slovenian Paediatric Society, Burnaby, Slovenia
| | - Joana Rios
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Hospital Beatriz Ângelo, Loures, Portugal
| | - Corinne Wyder
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Kinderärzte KurWerk, Burgdorf, Switzerland
| | - Ivanna Romankevych
- European Academy of Paediatrics Research in Ambulatory Settings network (EAPRASnet)
- Ukrainian Academy of Pediatric Specialties, Ukraine
| | - Romain Basmaci
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Service de Pédiatrie-Urgences, AP-HP, Hôpital Louis-Mourier, Colombes, France
| | | | - Shunmay Yeung
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Personalised Risk Assessment in Febrile Illness to Optimise Real-Life Management Across the European Union (PERFORM)
- Department of Paediatrics, St Mary’s Imperial College Hospital, London, United Kingdom
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14
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Blok GCGH, Nikkels ED, van der Lei J, Berger MY, Holtman GA. Added value of CRP to clinical features when assessing appendicitis in children. Eur J Gen Pract 2022; 28:95-101. [PMID: 35535699 PMCID: PMC9103685 DOI: 10.1080/13814788.2022.2067142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/10/2022] [Accepted: 04/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The diagnostic value of C-reactive protein (CRP) for appendicitis in children has not been evaluated in primary care. As biochemical responses and differential diagnoses vary with age, separate evaluation in children and adults is needed. OBJECTIVES To determine whether adding CRP to symptoms and signs improves the diagnosis of appendicitis in children with acute abdominal pain in primary care. METHODS A retrospective cohort study in Dutch general practice. Data was collected from the Integrated Primary Care Information database between 2010 and 2016. We included children aged 4-18 years, with no history of appendicitis, presenting with acute abdominal pain, and having a CRP test. Initial CRP levels were related to the specialist's diagnosis of appendicitis, and the test's characteristics were calculated for multiple cut-offs. The value of adding CRP to signs and symptoms was analysed by logistic regression. RESULTS We identified 1076 eligible children, among whom 203 were referred for specialist evaluation and 70 had appendicitis. The sensitivity and specificity of a CRP cut-off ≥10 mg/L were 0.87 (95%CI, 0.77-0.94) and 0.77 (95%CI, 0.74-0.79), respectively. When symptoms lasted > 48 h, this sensitivity increased to 1.00. Positive predictive values for CRP alone were low (0.18-0.38) for all cut-off values (6-100 mg/L). Adding CRP increased the area under the curve from 0.82 (95%CI, 0.78-0.87) to 0.88 (95%CI, 0.84-0.91), and decision curve analysis confirmed that its addition provided the highest net benefit. CONCLUSION CRP adds value to history and physical examination when diagnosing appendicitis in children presenting acute abdominal pain in primary care. Appendicitis is least likely if the CRP value is < 10 mg/L and symptoms have been present for > 48 h.
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Affiliation(s)
- Guus C. G. H. Blok
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eelke D. Nikkels
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjolein Y. Berger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gea A. Holtman
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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15
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Oehme R, Sandholzer-Yilmaz AS, Heise M, Frese T, Fankhaenel T. Utilization of point-of-care tests among general practitioners, a cross-sectional study. BMC PRIMARY CARE 2022; 23:41. [PMID: 35264103 PMCID: PMC8906527 DOI: 10.1186/s12875-022-01643-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/14/2022] [Indexed: 11/15/2022]
Abstract
Background Point-of-care testing (POCT) has numerous potential benefits to improve health care service, especially in resource-limited settings. We aim to identify which POC-tests (POCTs) of laboratory parameters are known, employed, and rated as useful by general practitioners (GPs). Methods A questionnaire with 27 POCTs was posted to a random selection of GPs (n = 451) in Saxony, Germany. Results A total of 208 GPs replied (response rate 46.1%). Out of 27 POCTs, each GP knew an average of 20.3 as laboratory parameters and 9.2 as POCTs. Urine test strips (99.0%), blood glucose test (98.1%), and Troponin I/T (86.4%) were the best-known, followed by INR/Quick (82.5%), Microalbumin (79.1%), and D-dimer (78.6%) POCTs. Yet, solely 0 to 13 POC tests were actually used (mean value 4.6). Urine test strips were employed most frequently (97.6%), followed by blood glucose test (94.7%), Troponin I/T (57.8%), Microalbumin (57.3%), and INR/Quick POCTs (41.7%). Heart fatty binding protein (H-FABP), Syphilis, Coeliac disease, and Malaria appeared as the least frequently used POCTs. The majority of the GPs declared 14 of the 27 POCTs to be useful. Discussion/conclusion The most recurrently employed POCTs are those for diagnosing or monitoring diabetes mellitus, ensued by POCTs addressing acute cardiovascular diseases (Troponin I/T, D-dimer) or monitoring the therapy of infectious diseases or the anticoagulant therapy. POCTs most often rated as useful by GPs are also widely known and frequently used. Nonetheless, the majority of GPs rate only a very limited number of POCTs as useful. Frequent concerns might be low economic benefit, over-reliance, and test accuracy coming along with the complex implementation of the tests requiring technical skills, accurate storage, and the correct interpretation of test results. Trial registration In accordance with the (Model) Professional Code for Physicians in Germany, neither human body materials nor data that can be assigned to a specific human being are used in our study. A declaration of no objection from the Ethics Committee of the Martin-Luther University Halle-Wittenberg (Medical Faculty) confirms no professional or ethical concerns due to completely anonymized data collection and analysis. Our study was therefore not registered in a corresponding registry. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01643-9.
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Research on point-of-care tests in outpatient care in Germany: A scoping review and definition of relevant endpoints in evaluation studies. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 174:1-10. [PMID: 36055890 DOI: 10.1016/j.zefq.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/14/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The fast turnaround time and user-friendliness of point-of-care tests (POCTs) offer a great potential to improve outpatient health care where clinical decisions have to be made during the physician-patient encounter and time resources are limited. The aim of this scoping review is to describe the extent and nature as well as gaps in German research activities on POCT in outpatient care. In addition, we define research endpoints that should be addressed in the comprehensive evaluation of POCTs targeted for outpatient care. METHODS We performed a scoping review with a systematic literature search in Medline (via PubMed), Scopus, Web of Science, Cochrane library and Google Scholar for German publications on POCT with relevance to German outpatient care published from January 2005 to November 2020. RESULTS Our literature search identified 2,200 unique records. After literature selection 117 articles were included in this scoping review. Just over half of the articles (67/117, 57.3%) were primary research studies with original data, while one third of all the studies (33.3%) were secondary research articles (e.g., review articles). The remaining articles were clinical recommendations / position papers (7/117, 6.0%) and other types of articles (3.4%). The majority of articles focused on POCT use in infectious diseases (44/117, 37.6%), diabetic syndromes (15.4%), cardiac disease (12.0%) or coagulopathies and thrombosis (10.3%), while the remaining articles did not specify the disease (13.7%) or investigated other diseases (11.1%). Similar to international studies, most primary research studies investigated the diagnostic performance of POCT (e.g., sensitivity, specificity). Evidence beyond diagnostic accuracy remains scarce, such as the impact on therapeutic decisions and practice routines, clinical effectiveness, and user perspectives. In line with this, interventional studies (such as RCTs) on the effectiveness of POCT use in German outpatient care are limited. We define six endpoint domains that should be addressed in the evaluation of POCTs targeted for outpatient care: (i) diagnostic performance, (ii) clinical performance, (iii) time and costs, (iv) impact on clinical routines / processes, (v) perspectives of medical professionals and patients, and (vi) broader aspects. CONCLUSION There is considerable research activity on POCTs targeted for use in outpatient care in Germany. Data on their potential benefits beyond diagnostic accuracy is often lacking and should be addressed in future POCT research studies.
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Lingervelder D, Koffijberg H, Emery JD, Fennessy P, Price CP, van Marwijk H, Eide TB, Sandberg S, Cals JW, Derksen JT, Kusters R, IJzerman MJ. How to Realize the Benefits of Point-of-Care Testing at the General Practice: A Comparison of Four High-Income Countries. Int J Health Policy Manag 2022; 11:2248-2260. [PMID: 34814677 PMCID: PMC9808289 DOI: 10.34172/ijhpm.2021.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations. METHODS The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country. RESULTS The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support. CONCLUSION Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Fennessy
- Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, Australia
| | - Christopher P. Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Torunn B. Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Jochen W.L. Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | | | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Maarten J. IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Cancer Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Yonel Z, Kuningas K, Sharma P, Dutton M, Jalal Z, Cockwell P, Webber J, Narendran P, Dietrich T, Chapple ILC. Concordance of three point of care testing devices with clinical chemistry laboratory standard assays and patient-reported outcomes of blood sampling methods. BMC Med Inform Decis Mak 2022; 22:248. [PMID: 36138408 PMCID: PMC9493167 DOI: 10.1186/s12911-022-01999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Point of care testing (POCT) devices have been developed to facilitate immediate results with the potential to aid screening for new disease and enable patients to self-monitor their disease. Non-communicable diseases (NCDs) are the major cause of mortality globally and are increasing in prevalence as the population ages. Allied health care professionals (AHPs) are skilled in undertaking risk assessment and delivering preventative advice, providing opportunities to access large proportions of the population who may not visit their doctor, within non-traditional community settings. There is evidence of high levels of support from public, patients and health professionals for engaging AHPs in risk-targeted early case detection of certain NCDs. Thus, POCT devices offer a potential alternative to traditional venous blood collection, as novel care pathways for increasing early case detection and access to preventative care. The objectives of this study were to: (i) determine the concordance of the specific POCT devices with laboratory-based standard assays employed within clinical biochemistry laboratories. (ii) compare the sampling experience of both methods via patient-reported experiences. Methods A prospective, two-centre study was undertaken involving 158 participants who provided informed consent. Venous blood was collected for traditional assays of HbA1c, creatinine/ estimated Glomerular-Filtration-Rate (eGFR) and vitamin-D. Capillary blood was collected by finger prick test and also assayed for the same biochemical indices (Nova StatSensor (creatinine/eGFR); Siemens DCA-Vantage (HbA1C); CityAssays (vitamin-D)). All users were provided with device training. Participants reported any discomfort experienced by each simultaneously applied method (randomised in order) via a 100 mm Visual-Analogue-Scale. Results Results for each POCT device and the laboratory standard were analysed by Bland-Altman plots to determine assay concordance. POCT devices demonstrated good concordance with laboratory testing, with at least 95% of all samples being within two standard deviations, for each of the devices tested. The majority of participants reported less discomfort with POCT than venepuncture, with the average reported discomfort being 17/100 mm less for POCT compared to venous blood sample collection on the visual analogue scale. Conclusions The POCT devices demonstrated acceptable concordance with laboratory-based assays, and patients reported lower levels of discomfort compared to traditional means of blood collection. This study demonstrates the potential of using these devices as acceptable methods for opportunistic testing of “at-risk” individuals within non-traditional community care settings.
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Affiliation(s)
- Z Yonel
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK.
| | - K Kuningas
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Sharma
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - M Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - Z Jalal
- School of Pharmacy, University of Birmingham, Birmingham, UK
| | - P Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - J Webber
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - P Narendran
- Diabetes Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - T Dietrich
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
| | - I L C Chapple
- The Periodontal Research Group, School of Dentistry, University of Birmingham, 5 Mill Pool Way, Birmingham, B5 7EG, UK
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Dixon S, Fanshawe TR, Mwandigha L, Edwards G, Turner PJ, Glogowska M, Gillespie MM, Blair D, Hayward GN. The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation. Antibiotics (Basel) 2022; 11:antibiotics11081008. [PMID: 35892398 PMCID: PMC9332095 DOI: 10.3390/antibiotics11081008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Improving prescribing antibiotics appropriately for respiratory infections in primary care is an antimicrobial stewardship priority. There is limited evidence to support interventions to reduce prescribing antibiotics in out-of-hours (OOH) primary care. Herein, we report a service innovation where point-of-care C-Reactive Protein (CRP) machines were introduced to three out-of-hours primary care clinical bases in England from August 2018-December 2019, which were compared with four control bases that did not have point-of-care CRP testing. We undertook a mixed-method evaluation, including a comparative interrupted time series analysis to compare monthly antibiotic prescription rates between bases with CRP machines and those without, an analysis of the number of and reasons for the tests performed, and qualitative interviews with clinicians. Antibiotic prescription rates declined during follow-up, but with no clear difference between the two groups of out-of-hours practices. A single base contributed 217 of the 248 CRP tests performed. Clinicians reported that the tests supported decision making and communication about not prescribing antibiotics, where having 'objective' numbers were helpful in navigating non-prescribing decisions and highlighted the challenges of training a fluctuant staff group and practical concerns about using the CRP machine. Service improvements to reduce prescribing antibiotics in out-of-hours primary care need to be developed with an understanding of the needs and context of this service.
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Affiliation(s)
- Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
- Correspondence:
| | - Thomas R. Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
| | - Lazaro Mwandigha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
| | - George Edwards
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
| | - Philip J. Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
| | - Marjorie M. Gillespie
- Practice Plus Group, Hawker House, 5–6 Napier Court, Napier Road, Reading, Berkshire RG1 8BW, UK;
| | - Duncan Blair
- Queen Elizabeth Memorial Health Centre, St Michaels Avenue, Tidworth Garrison SP9 7EA, UK;
| | - Gail N. Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK; (T.R.F.); (L.M.); (G.E.); (P.J.T.); (M.G.); (G.N.H.)
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Smits M, Hopstaken R, Terhaag L, de Kort G, Giesen P. Early experiences with quality-assured HbA1c and professional glucose point-of-care testing in general practice: a cross-sectional observational study among patients, nurses and doctors. BMC Nurs 2022; 21:183. [PMID: 35804341 PMCID: PMC9263435 DOI: 10.1186/s12912-022-00969-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Point-of-care testing (POCT) is increasingly used in primary care. The rapid availability of the test result during the patient encounter increases the potential for patients and care providers to make a direct and joint decision on disease management. Our aim was to get insight into the first experiences of patients and healthcare professionals after introducing quality-controlled HbA1c and professional glucose POCT in diabetes care in their own general practices. Methods A cross-sectional observational study using paper questionnaires for patients, nurses and general practitioners (GPs) in 13 general practices in the Netherlands. HbA1c and professional glucose POCT was introduced after training and under day-to-day quality control. Patients filled in the questionnaire immediately after the test; nurses and GPs after a minimum period of three months from the starting date. Descriptive data analyses were performed. Results A total of 1551 fingerstick blood POC tests were performed (1126 HbA1c; 425 Glucose). For HbA1c POCT, 84 patients, 29 nurses and 11 GPs filled in the questionnaires. For professional glucose POCT, 30 patients, 17 nurses and 8 GPs responded. Response rates varied between 24 and 56%. Patients, nurses and GPs were generally (very) satisfied with the novel POC tests. Patients were most positive about the location (in the GPs’ office) and execution of the POC test (by their own nurse), and the speed of the test result. Almost all nurses indicated to have sufficient knowledge and skills to perform the test. Both nurses and GPs had confidence in the test results and indicated they experienced a higher patient satisfaction than with regular blood tests. Perceived disadvantages were the time required to regularly calibrate the devices and the extension of the consultation time because of the test. Patients, nurses and GPs generally expressed they wanted to continue performing these POC tests in routine diabetes care. Conclusions Patients, nurses and GPs expressed (very) positive first experiences after introducing HbA1c and professional glucose testing on two high-quality POCT devices in their own general practices. Further research, with a random selection procedure of practices and patients and in other regions and countries, is recommended to confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00969-0.
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Affiliation(s)
- Marleen Smits
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, P.O Box 9101, 160 IQ healthcare, HB, 6500, Nijmegen, The Netherlands.
| | - Rogier Hopstaken
- Star-shl Diagnostic Centers, Etten-Leur, the Netherlands.,General Practice Hapert en Hoogeloon, Hapert, the Netherlands
| | - Lusan Terhaag
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, P.O Box 9101, 160 IQ healthcare, HB, 6500, Nijmegen, The Netherlands
| | - Gijs de Kort
- Star-shl Diagnostic Centers, Etten-Leur, the Netherlands
| | - Paul Giesen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, P.O Box 9101, 160 IQ healthcare, HB, 6500, Nijmegen, The Netherlands
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Jędrzak A, Kuznowicz M, Rębiś T, Jesionowski T. Portable glucose biosensor based on polynorepinephrine@magnetite nanomaterial integrated with a smartphone analyzer for point-of-care application. Bioelectrochemistry 2022; 145:108071. [DOI: 10.1016/j.bioelechem.2022.108071] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/31/2021] [Accepted: 01/14/2022] [Indexed: 01/08/2023]
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Martínez-González NA, Plate A, Jäger L, Senn O, Neuner-Jehle S. The Role of Point-of-Care C-Reactive Protein Testing in Antibiotic Prescribing for Respiratory Tract Infections: A Survey among Swiss General Practitioners. Antibiotics (Basel) 2022; 11:543. [PMID: 35625187 PMCID: PMC9137646 DOI: 10.3390/antibiotics11050543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023] Open
Abstract
Understanding the decision-making strategies of general practitioners (GPs) could help reduce suboptimal antibiotic prescribing. Respiratory tract infections (RTIs) are the most common reason for inappropriate antibiotic prescribing in primary care, a key driver of antibiotic resistance (ABR). We conducted a nationwide prospective web-based survey to explore: (1) The role of C-reactive protein (CRP) point-of-care testing (POCT) on antibiotic prescribing decision-making for RTIs using case vignettes; and (2) the knowledge, attitudes and barriers/facilitators of antibiotic prescribing using deductive analysis. Most GPs (92-98%) selected CRP-POCT alone or combined with other diagnostics. GPs would use lower CRP cut-offs to guide prescribing for (more) severe RTIs than for uncomplicated RTIs. Intermediate CRP ranges were significantly wider for uncomplicated than for (more) severe RTIs (p = 0.001). Amoxicillin/clavulanic acid was the most frequently recommended antibiotic across all RTI case scenarios (65-87%). Faced with intermediate CRP results, GPs preferred 3-5-day follow-up to delayed prescribing or other clinical approaches. Patient pressure, diagnostic uncertainty, fear of complications and lack of ABR understanding were the most GP-reported barriers to appropriate antibiotic prescribing. Stewardship interventions considering CRP-POCT and the barriers and facilitators to appropriate prescribing could guide antibiotic prescribing decisions at the point of care.
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Affiliation(s)
- Nahara Anani Martínez-González
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, CH-6002 Lucerne, Switzerland
| | - Andreas Plate
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Levy Jäger
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich and University Hospital of Zurich, Pestalozzistrasse 24, CH-8091 Zurich, Switzerland; (A.P.); (L.J.); (O.S.); (S.N.-J.)
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Davies S, Hu Y, Jiang N, Montelongo Y, Richardson A, Blyth J, Yetisen AK. Reversible photonic hydrogel sensors via holographic interference lithography. Biosens Bioelectron 2022; 207:114206. [PMID: 35339821 DOI: 10.1016/j.bios.2022.114206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/08/2022] [Accepted: 03/19/2022] [Indexed: 02/02/2023]
Abstract
Continuous monitoring of physiological conditions and biomarkers via optical holographic sensors is an area of growing interest to facilitate the expansion of personalised medicine. Here, a facile laser-induced dual polymerization method is developed to fabricate holographic hydrogel sensors for the continuous and reversible colorimetric determination of pH variations over a physiological range in serum (pH 7-9). Readout parameters simulated through a Finite-difference time-domain Yee's algorithm retrieve the spectral response through expansion. Laser lithography of holographic hydrogel sensor fabrication is achieved via a single 355 nm laser pulse to initiate polymerization of ultrafine hydrogel fringes. Eliminating the requirement for complex processing of toxic components and streamlining the synthetic procedure provides a simpler route to mass production. Optimised pH-responsive hydrogels contain amine bearing functional co-monomers demonstrating reversible Bragg wavelength shifts of 172 nm across the entire visible wavelength range with pH variation from 7.0 to 9.0 upon illumination with broadband light. Photolithographic recording of information shows the ability to convey detailed information to users for qualitative identification of pH. Holographic sensor reversibility over 20 cycles showed minimal variation in replay wavelength supporting reliable and consistent readout, with optimised sensors showing rapid response times of <5 min. The developed sensors demonstrate the application to continuous monitoring in biological fluids, withstanding interference from electrolytes, saccharides, and proteins colorimetrically identifying bovine serum pH over a physiological range. The holographic sensors benefit point-of-care pH analysis of biological analytes which could be applied to the identification of blood gas disorders and wound regeneration monitoring through colorimetric readouts.
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Affiliation(s)
- Samuel Davies
- Department of Chemical Engineering, Imperial College London, London, SW7 2BU, UK
| | - Yubing Hu
- Department of Chemical Engineering, Imperial College London, London, SW7 2BU, UK.
| | - Nan Jiang
- West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, 610041, China.
| | - Yunuen Montelongo
- Department of Engineering Science, University of Oxford, Oxford, OX1 3PJ, UK
| | - Andreas Richardson
- Department of Chemical Engineering, Imperial College London, London, SW7 2BU, UK
| | - Jeff Blyth
- Department of Chemical Engineering, Imperial College London, London, SW7 2BU, UK
| | - Ali K Yetisen
- Department of Chemical Engineering, Imperial College London, London, SW7 2BU, UK
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Verbakel JYJ, De Burghgraeve T, Van den Bruel A, Coenen S, Anthierens S, Joly L, Laenen A, Luyten J, De Sutter A. Antibiotic prescribing rate after optimal near-patient C-reactive protein testing in acutely ill children presenting to ambulatory care (ARON project): protocol for a cluster-randomized pragmatic trial. BMJ Open 2022; 12:e058912. [PMID: 34980633 PMCID: PMC8724812 DOI: 10.1136/bmjopen-2021-058912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Children become ill quite often, mainly because of infections, most of which can be managed in the community. Many children are prescribed antibiotics which contributes to antimicrobial resistance and reinforces health-seeking behaviour. Point-of-care C reactive protein (POC CRP) testing, prescription guidance and safety-netting advice can help safely reduce antibiotic prescribing to acutely ill children in ambulatory care as well as save costs at a systems level. METHODS AND ANALYSIS The ARON (Antibiotic prescribing Rate after Optimal Near-patient testing in acutely ill children in ambulatory care) trial is a pragmatic cluster randomized controlled superiority trial with a nested process evaluation and will assess the clinical and cost effectiveness of a diagnostic algorithm, which includes a standardised clinical assessment, a POC CRP test, and safety-netting advice, in acutely ill children aged 6 months to 12 years presenting to ambulatory care. The primary outcome is antibiotic prescribing at the index consultation; secondary outcomes include clinical recovery, reconsultation, referral/admission to hospital, additional testing, mortality and patient satisfaction. We aim to recruit a total sample size of 6111 patients. All outcomes will be analysed according to the intent-to-treat approach. We will use a mixed-effect logistic regression analysis to account for the clustering at practice level. ETHICS AND DISSEMINATION The study will be conducted in compliance with the principles of the Declaration of Helsinki (current version), the principles of Good Clinical Practice and in accordance with all applicable regulatory requirements. Ethics approval for this study was obtained on 10 November 2020 from the Ethics Committee Research of University Hospitals Leuven under reference S62005. We will ensure that the findings of the study will be disseminated to relevant stakeholders other than the scientific world including the public, healthcare providers and policy-makers. The process evaluation that is part of this trial may provide a basis for an implementation strategy. If our intervention proves to be clinically and cost-effective, it will be essential to educate physicians about introducing the diagnostic algorithm including POC CRP testing and safety-netting advice in their daily practice. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT04470518. Protocol V.2.0 date 2 October 2020. (Pre-results).
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Affiliation(s)
- Jan Yvan Jos Verbakel
- Department of Public Health and Primary Care, Academic Centre for General Practice, EPI-Centre, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tine De Burghgraeve
- Department of Public Health and Primary Care, Academic Centre for General Practice, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, Academic Centre for General Practice, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Samuel Coenen
- Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Wilrijk, Belgium
- Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine & Population Health (FAMPOP), University of Antwerp, Wilrijk, Belgium
- Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Louise Joly
- Research Unit Primary Care and Health, Department of General Practice, Department of Clinical Sciences, University of Liege, Liege, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Jeroen Luyten
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Department of Family Medicine & Health Policy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Chu H, Liu C, Liu J, Yang J, Li Y, Zhang X. Recent advances and challenges of biosensing in point-of-care molecular diagnosis. SENSORS AND ACTUATORS. B, CHEMICAL 2021; 348:130708. [PMID: 34511726 PMCID: PMC8424413 DOI: 10.1016/j.snb.2021.130708] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 05/07/2023]
Abstract
Molecular diagnosis, which plays a major role in infectious disease screening with successful understanding of the human genome, has attracted more attention because of the outbreak of COVID-19 recently. Since point-of-care testing (POCT) can expand the application of molecular diagnosis with the benefit of rapid reply, low cost, and working in decentralized environments, many researchers and commercial institutions have dedicated tremendous effort and enthusiasm to POCT-based biosensing for molecular diagnosis. In this review, we firstly summarize the state-of-the-art techniques and the construction of biosensing systems for POC molecular diagnosis. Then, the application scenarios of POCT-based biosensing for molecular diagnosis were also reviewed. Finally, several challenges and perspectives of POC biosensing for molecular diagnosis are discussed. This review is expected to help researchers deepen comprehension and make progresses in POCT-based biosensing field for molecular diagnosis applications.
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Affiliation(s)
- Hongwei Chu
- Shenzhen Key Laboratory of Flexible Printed Electronics Technology, School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen, Guangdong 518055, China
| | - Conghui Liu
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, Guangdong 518060, China
| | - Jinsen Liu
- Shenzhen ENCO Instrument Co., Ltd, Shenzhen 518000, China
| | - Jiao Yang
- Shenzhen Key Laboratory of Flexible Printed Electronics Technology, School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen, Guangdong 518055, China
| | - Yingchun Li
- Shenzhen Key Laboratory of Flexible Printed Electronics Technology, School of Science, Harbin Institute of Technology (Shenzhen), Shenzhen, Guangdong 518055, China
| | - Xueji Zhang
- College of Chemistry and Environmental Engineering, Shenzhen University, Shenzhen, Guangdong 518060, China
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Derckx RT, Rinsma S, Dukers-Muijrers NHTM, Ab E, van Bergen J, de Bont E, Hoebe CJPA, Cals JWL. Feasibility of anorectal chlamydia testing in women: a cross-sectional survey among general practitioners. Fam Pract 2021; 38:724-730. [PMID: 34173649 DOI: 10.1093/fampra/cmab036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Anorectal Chlamydia trachomatis (CT) may be clinically relevant for women in general practice. Although anorectal CT testing in this setting may prevent underdiagnosis and undertreatment, its feasibility is questioned as GPs currently rarely order anorectal CT tests, for yet unknown reasons. OBJECTIVE To explore the feasibility of anorectal CT testing in women in general practice. METHODS GPs across the Netherlands were invited directly (n = 1481) and by snowball sampling (n = 330) to join an online cross-sectional survey that asked about the acceptability of and barriers for (standard) anorectal testing in women during CT-related consultations. Data were analysed with univariable and multivariable logistic regression models. RESULTS The questionnaire was opened by 514 respondents (28%, 514/1811) and 394 fully completed it. GPs' acceptability of anorectal testing by either self-sampling or provider-sampling was high (86%). Twenty-eight percent of GPs felt neutral, and 43% felt accepting towards standard anorectal testing. Nevertheless, 40% of GPs had never tested for anorectal CT in women, which was associated with a reported difficulty in asking about anal sex (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 1.21-7.80), infrequency of anal sexual history taking (OR: 11.50, 95% CI: 6.39-20.72), low frequency of urogenital CT testing (OR 3.44, 95%-CI: 1.86-6.38) and with practicing in a non-urban area (OR: 2.27, 95% CI: 1.48-3.48). Acceptability of anorectal testing was not associated with the studied factors. CONCLUSION This quantitative survey shows that anorectal CT testing is feasible based on its acceptability, but is likely hindered by a lower awareness of (anorectal) CT in GPs.
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Affiliation(s)
- Raissa T Derckx
- Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - Sygriet Rinsma
- Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, AA Heerlen, The Netherlands.,Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands.,Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - Elisabeth Ab
- Academic General Practitioners practice Groningen, University Medical Center Groningen, GZ Groningen, The Netherlands
| | - Jan van Bergen
- Department of General Practice, Amsterdam University Medical Centre location AMC, 1105AZ Amsterdam, The Netherlands.,Soa Aids Nederland, AX Amsterdam, The Netherlands
| | - Eefje de Bont
- Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, AA Heerlen, The Netherlands.,Department of Social Medicine and Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of General Practice, Care and Public Health Research Institute (CAPHRI), Maastricht University, MD Maastricht, The Netherlands
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Regan B, O'Kennedy R, Collins D. Advances in point-of-care testing for cardiovascular diseases. Adv Clin Chem 2021; 104:1-70. [PMID: 34462053 DOI: 10.1016/bs.acc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Point-of-care testing (POCT) is a specific format of diagnostic testing that is conducted without accompanying infrastructure or sophisticated instrumentation. Traditionally, such rapid sample-to-answer assays provide inferior analytical performances to their laboratory counterparts when measuring cardiac biomarkers. Hence, their potentially broad applicability is somewhat bound by their inability to detect clinically relevant concentrations of cardiac troponin (cTn) in the early stages of myocardial injury. However, the continuous refinement of biorecognition elements, the optimization of detection techniques, and the fabrication of tailored fluid handling systems to manage the sensing process has stimulated the production of commercial assays that can support accelerated diagnostic pathways. This review will present the latest commercial POC assays and examine their impact on clinical decision-making. The individual elements that constitute POC assays will be explored, with an emphasis on aspects that contribute to economically feasible and highly sensitive assays. Furthermore, the prospect of POCT imparting a greater influence on early interventions for medium to high-risk individuals and the potential to re-shape the paradigm of cardiovascular risk assessments will be discussed.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin, Ireland.
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin, Ireland
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Ansems S, Berger M, Rheenen PV, Vermeulen K, Beugel G, Couwenberg M, Holtman G. Effect of faecal calprotectin testing on referrals for children with chronic gastrointestinal symptoms in primary care: study protocol for a cluster randomised controlled trial. BMJ Open 2021; 11:e045444. [PMID: 34301652 PMCID: PMC8311316 DOI: 10.1136/bmjopen-2020-045444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Children with chronic gastrointestinal symptoms are frequently seen in primary care, yet general practitioners (GPs) often experience challenges distinguishing functional gastrointestinal disorders (FGID) from organic disorders. We, therefore, aim to evaluate whether a test strategy that includes point-of-care testing (POCT) for faecal calprotectin (FCal) can reduce the referral rate to paediatric specialist care among children with chronic gastrointestinal symptoms. The study findings will contribute to improving the recommendations on FCal use among children in primary care. METHODS AND ANALYSIS In this pragmatic cluster randomised controlled trial, we will randomise general practices into intervention and control groups. The intervention group will use FCal-POCT when indicated, after completing online training about its indication, interpretation and follow-up as well as communicating an FGID diagnosis. The control group will test and treat according to Dutch GP guidelines, which advise against FCal testing in children. GPs will include children aged 4-18 years presenting to primary care with chronic diarrhoea and/or recurrent abdominal pain. The primary outcome will be the referral rate for children with chronic gastrointestinal symptoms within 6 months after the initial assessment. Secondary outcomes will be evaluated by questionnaires completed at baseline and at 3- and 6-month follow-up. These outcomes will include parental satisfaction and concerns, gastrointestinal symptoms, impact of symptoms on daily function, quality of life, proportion of children with paediatrician-diagnosed FGID referred to secondary care, health service use and healthcare costs. A sample size calculation indicates that we need to recruit 158 GP practices to recruit 406 children. ETHICS AND DISSEMINATION The Medical Research Ethics Committee (MREC) of the University Medical Center Groningen (The Netherlands) approved this study (MREC number: 201900309). The study results will be made available to patients, GPs, paediatricians and laboratories via peer-reviewed publications and in presentations at (inter)national conferences. TRIAL REGISTRATION NUMBER The Netherlands Trial Register: NL7690 (Pre-results).
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Affiliation(s)
- Sophie Ansems
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marjolein Berger
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Patrick van Rheenen
- Paediatric Gastroenterology, University Medical Centre Groningen Beatrix Childrens Hospital, Groningen, The Netherlands
| | - Karin Vermeulen
- Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gina Beugel
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maria Couwenberg
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gea Holtman
- General Practice and Elderly Care Medicine, University Medical Centre Groningen, Groningen, The Netherlands
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Huddy JR, Ni MZ, Barlow J, Hanna GB. Qualitative analysis of stakeholder interviews to identify the barriers and facilitators to the adoption of point-of-care diagnostic tests in the UK. BMJ Open 2021; 11:e042944. [PMID: 33849848 PMCID: PMC8051412 DOI: 10.1136/bmjopen-2020-042944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/21/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study investigated the barriers and facilitators to the adoption of point-of-care tests (POCTs). DESIGN Qualitative study incorporating a constant comparative analysis of stakeholder responses to a series of interviews undertaken to design the Point-of-Care Key Evidence Tool. SETTING The study was conducted in relation to POCTs used in all aspects of healthcare. PARTICIPANTS Forty-three stakeholders were interviewed including clinicians (incorporating laboratory staff and members of trust POCT committees), commissioners, industry, regulators and patients. RESULTS Thematic analysis highlighted 32 barriers in six themes and 28 facilitators in eight themes to the adoption of POCTs. Six themes were common to both barriers and facilitators (clinical, cultural, evidence, design and quality assurance, financial and organisational) and two themes contained facilitators alone (patient factors and other (non-financial) resource use). CONCLUSIONS Findings from this study demonstrate the complex motivations of stakeholders in the adoption of POCT. Most themes were common to both barriers and facilitators suggesting that good device design, stakeholder engagement and appropriate evidence provision can increase the likelihood of a POCT device adoption. However, it is important to realise that while the majority of identified barriers may be perceived or mitigated some may be absolute and if identified early in device development further investment should be carefully considered.
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Affiliation(s)
- Jeremy R Huddy
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melody Zhifang Ni
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - James Barlow
- Imperial College Business School, Imperial College London, London, UK
| | - George B Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
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Lenters-Westra E, English E. Are hemoglobin A 1c point-of-care analyzers fit for purpose? The story continues. Clin Chem Lab Med 2021; 59:765-774. [PMID: 33128524 DOI: 10.1515/cclm-2020-1308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/20/2020] [Indexed: 07/24/2024]
Abstract
OBJECTIVES Point-of-care (POC) analyzers are playing an increasingly important role in diabetes management but it is essential that we know the performance of these analyzers in order to make appropriate clinical decisions. Whilst there is a growing body of evidence around the more well-known analyzers, there are many 'new kids on the block' with new features, such as displaying the presence of potential Hb-variants, which do not yet have a proven track record. METHODS The study is a comprehensive analytical and usability study of six POC analyzers for HbA1c using Clinical and Laboratory Standards Institute (CLSI) protocols, international quality targets and certified International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Glycohemoglobin Standardization Program (NGSP) Secondary Reference Measurement Procedures (SRMP). The study includes precision (EP-5 and EP-15), trueness (EP-9), linearity (EP-6), sample commutability (fresh, frozen and lyophilized), interference of Hb-variants (fresh and frozen samples). RESULTS Only two of the six analyzers performed to acceptable levels over the range of performance criteria. Hb-variant interference, imprecision or variability between lot numbers are still poor in four of the analyzers. CONCLUSIONS This unique and comprehensive study shows that out of six POC analyzers studied only two (The Lab 001 and Cobas B101) met international quality criteria (IFCC and NGSP), two (A1Care and Innovastar) were borderline and two (QuikReadgo and Allegro) were unacceptable. It is essential that the scientific and clinical community are equipped with this knowledge in order to make sound decisions on the use of these analyzers.
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Affiliation(s)
- Erna Lenters-Westra
- Isala, Department of Clinical Chemistry, Zwolle, The Netherlands
- European Reference Laboratory for Glycohemoglobin, Location Zwolle, Isala, The Netherlands
| | - Emma English
- University of East Anglia, Faculty of Medicine and Health, Norwich Research Park, Norwich, UK
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Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2021; 41:543-603. [PMID: 31504429 DOI: 10.1093/eurheartj/ehz405] [Citation(s) in RCA: 2137] [Impact Index Per Article: 712.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Saliba-Gustafsson EA, Nyberg A, Borg MA, Rosales-Klintz S, Stålsby Lundborg C. Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PLoS One 2021; 16:e0246782. [PMID: 33571265 PMCID: PMC7877739 DOI: 10.1371/journal.pone.0246782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta. METHODS Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour. FINDINGS We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed. CONCLUSION This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment. TRIAL REGISTRATION NUMBER NCT03218930; https://clinicaltrials.gov/ct2/show/NCT03218930.
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Affiliation(s)
- Erika A. Saliba-Gustafsson
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Nyberg
- Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Michael A. Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Senia Rosales-Klintz
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Unit of Surveillance and Response Support (SRS), European Centre for Disease Prevention and Control, Solna, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
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Development and Validation of the COVID-NoLab and COVID-SimpleLab Risk Scores for Prognosis in 6 US Health Systems. J Am Board Fam Med 2021; 34:S127-S135. [PMID: 33622827 PMCID: PMC8343954 DOI: 10.3122/jabfm.2021.s1.200464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/19/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Develop and validate simple risk scores based on initial clinical data and no or minimal laboratory testing to predict mortality in hospitalized adults with COVID-19. METHODS We gathered clinical and initial laboratory variables on consecutive inpatients with COVID-19 who had either died or been discharged alive at 6 US health centers. Logistic regression was used to develop a predictive model using no laboratory values (COVID-NoLab) and one adding tests available in many outpatient settings (COVID-SimpleLab). The models were converted to point scores and their accuracy evaluated in an internal validation group. RESULTS We identified 1340 adult inpatients with complete data for nonlaboratory parameters and 741 with complete data for white blood cell (WBC) count, differential, c-reactive protein (CRP), and serum creatinine. The COVID-NoLab risk score includes age, respiratory rate, and oxygen saturation and identified risk groups with 0.8%, 11.4%, and 40.4% mortality in the validation group (AUROCC = 0.803). The COVID-SimpleLab score includes age, respiratory rate, oxygen saturation, WBC, CRP, serum creatinine, and comorbid asthma and identified risk groups with 1.0%, 9.1%, and 29.3% mortality in the validation group (AUROCC = 0.833). CONCLUSIONS Because they use simple, readily available predictors, developed risk scores have potential applicability in the outpatient setting but require prospective validation before use.
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Holm A, Siersma V, Cordoba GC. Diagnosis of urinary tract infection based on symptoms: how are likelihood ratios affected by age? a diagnostic accuracy study. BMJ Open 2021; 11:e039871. [PMID: 33419902 PMCID: PMC7798711 DOI: 10.1136/bmjopen-2020-039871] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the impact of age on the diagnostic properties of typical symptoms of urinary tract infection (UTI) in women presenting in general practice with symptoms suggestive of UTI with significant bacteriuria as the reference standard. DESIGN Diagnostic accuracy study. SETTING General practice, Copenhagen, Denmark. PARTICIPANTS Adult 15 years or older. Women presenting in general practice with symptoms suggestive of UTI where urine was collected for investigation. PRIMARY AND SECONDARY OUTCOME MEASURES Accuracy of four symptoms of UTI (dysuria, frequency, urge and abdominal pain) in six different age groups. RESULTS 90 practices included 1178 adult women. The prevalence of bacteriuria varied between 30% in women aged 30-44 years and 67% in women aged 75-89 years. The likelihood ratios for dysuria varied between age groups with the best performance in women aged 15-29 (positive likelihood ratio (pLR): 1.62 (1.30-1.94), negative likelihood ratio (nLR): 0.36 (0.19-0.54)) and women aged 30-44 (pLR: 1.74 (1.30-2.17), nLR: 0.48 (0.27-0.68)). CIs included or approximated one for the remaining symptoms in most age groups. When symptoms were combined to calculate post-test probabilities, the combined effect of the varying prevalence of bacteriuria and the varying diagnostic values resulted in a large variation of the post-test probabilities between age groups. CONCLUSIONS The diagnostic value of symptoms of UTI as well as the prevalence of bacteriuria in women presenting to general practice with suspected UTI vary between age groups with considerable clinical implications. Diagnostic studies should take demographics such as age into consideration. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT02698332.
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Affiliation(s)
- Anne Holm
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Gloria Cristina Cordoba
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
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Kalecki J, Iskierko Z, Cieplak M, Sharma PS. Oriented Immobilization of Protein Templates: A New Trend in Surface Imprinting. ACS Sens 2020; 5:3710-3720. [PMID: 33225686 PMCID: PMC7771019 DOI: 10.1021/acssensors.0c01634] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/06/2020] [Indexed: 12/18/2022]
Abstract
In this Review, we have summarized recent trends in protein template imprinting. We emphasized a new trend in surface imprinting, namely, oriented protein immobilization. Site-directed proteins were assembled through specially selected functionalities. These efforts resulted in a preferably oriented homogeneous protein construct with decreased protein conformation changes during imprinting. Moreover, the maximum functionality for protein recognition was utilized. Various strategies were exploited for oriented protein immobilization, including covalent immobilization through a boronic acid group, metal coordinating center, and aptamer-based immobilization. Moreover, we have discussed the involvement of semicovalent as well as covalent imprinting. Interestingly, these approaches provided additional recognition sites in the molecular cavities imprinted. Therefore, these molecular cavities were highly selective, and the binding kinetics was improved.
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Affiliation(s)
- Jakub Kalecki
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Zofia Iskierko
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Maciej Cieplak
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
| | - Piyush S. Sharma
- Institute of Physical Chemistry, Polish Academy of Sciences, Kasprzaka 44/52, 01-224 Warsaw, Poland
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Development of a point-of-care technology for bacterial identification in milk. Talanta 2020; 219:121223. [DOI: 10.1016/j.talanta.2020.121223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/20/2022]
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Hong D, Jo EJ, Kim K, Song MB, Kim MG. Ru(bpy) 32+ -Loaded Mesoporous Silica Nanoparticles as Electrochemiluminescent Probes of a Lateral Flow Immunosensor for Highly Sensitive and Quantitative Detection of Troponin I. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2004535. [PMID: 33048467 DOI: 10.1002/smll.202004535] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Indexed: 05/14/2023]
Abstract
The lateral flow immunosensor (LFI) is a widely used diagnostic tool for biomarker detection; however, its sensitivity is often insufficient for analyzing targets at low concentrations. Here, an electrochemiluminescent LFI (ECL-LFI) is developed for highly sensitive detection of troponin I (TnI) using Ru(bpy)32+ -loaded mesoporous silica nanoparticles (RMSNs). A large amount of Ru(bpy)32+ is successfully loaded into the mesoporous silica nanoparticles with excellent loading capacity and shows strong ECL signals in reaction to tripropylamine. Antibody-immobilized RMSNs are applied to detect TnI by fluorescence and ECL analysis after a sandwich immunoassay on the ECL-LFI strip. The ECL-LFI enables the highly sensitive detection of TnI-spiked human serum within 20 min at femtomolar levels (≈0.81 pg mL-1 ) and with a wide dynamic range (0.001-100 ng mL-1 ), significantly outperforming conventional fluorescence detection (>3 orders of magnitude). Furthermore, TnI concentrations in 35 clinical serum samples across a low range (0.01-48.31 ng mL-1 ) are successfully quantified with an excellent linear correlation (R2 = 0.9915) using a clinical immunoassay analyzer. These results demonstrate the efficacy of this system as a high-performance sensing strategy capable of capitalizing on future point-of-care testing markets for biomolecule detection.
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Affiliation(s)
- Donggu Hong
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science & Technology (GIST), 123 Cheomdan-gwagiro, Gwangju, 61005, Republic of Korea
| | - Eun-Jung Jo
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science & Technology (GIST), 123 Cheomdan-gwagiro, Gwangju, 61005, Republic of Korea
| | - Kihyeun Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science & Technology (GIST), 123 Cheomdan-gwagiro, Gwangju, 61005, Republic of Korea
| | - Mun-Beom Song
- INGIbio Co. Ltd., R&D Center, Gwangju Institute of Science & Technology (GIST), 206, APRI, 123 Cheomdan-gwagiro, Gwangju, 61005, Republic of Korea
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science & Technology (GIST), 123 Cheomdan-gwagiro, Gwangju, 61005, Republic of Korea
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Louw S, Mayne ALH, Wan YO, Mayne E. Validation of the Mission Point-of-care device for haemoglobin measurement. Int J Lab Hematol 2020; 43:e9-e11. [PMID: 33010106 DOI: 10.1111/ijlh.13332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Susan Louw
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Anthony Leland Hamilton Mayne
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Yuen On Wan
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
| | - Elizabeth Mayne
- Department of Immunology, Faculty of Health Sciences, University of Witwatersrand and National Health Laboratory Service, Johannesburg, South Africa
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Frank O, Stocks N, Del Mar C. Does point-of-care testing in general practice for leucocyte and differential count change use of antimicrobial medicines? A pilot study. Aust J Prim Health 2020; 26:358-361. [PMID: 32972510 DOI: 10.1071/py20115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022]
Abstract
Diagnostic uncertainty when considering prescription of antimicrobials ('antibiotics') in primary care contributes to the major problem of microbial resistance. We conducted a feasibility evaluation of rapid testing for leucocyte and differential count in two urban general practices, surveying the GPs online and interviewing them. GPs reported that the machines were easy to use, the test results influenced their care and they would adopt the system if costs were off-set. Feasibility, acceptability and perceived benefit justify a randomised trial to test the effect on antibiotic prescribing rates and quality of care, with an economic evaluation to inform the cost-benefit.
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Affiliation(s)
- Oliver Frank
- Oakden Medical Centre, 132-134 Fosters Road, Hillcrest, SA 5086, Australia; and Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; and Corresponding author.
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Level 4, Building 5, Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, Qld 4226, Australia
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Hansen GT. Point-of-Care Testing in Microbiology: A Mechanism for Improving Patient Outcomes. Clin Chem 2020; 66:124-137. [PMID: 31811002 DOI: 10.1373/clinchem.2019.304782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/15/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasingly, demands for improved health and quality of life conflict with the realities of delivering healthcare in an environment of higher expenditures, adherence to test utilization, and patient-centered experience. Patient-centered care is commonly identified as a goal of healthcare delivery, and yet healthcare systems struggle with delivery of care to patients, often failing to identify the seriously ill and capitalize on the predictive qualities of diagnostic testing. Point-of-care (POC) testing provides access to rapid diagnosis and predictive value key to realizing patient outcomes. An evaluation of cost-effective models and the clinical impact of POC testing for clinical microbiology is needed. CONTENT Accurate and rapid diagnostics have the potential to affect healthcare decisions to a degree well out of proportion to their cost. Contemporary healthcare models increasingly view POC testing as a mechanism for efficient deployment of healthcare. POC testing can deliver rapid diagnosis in environments where testing results can be used to direct management during patient visits and in areas where centralized laboratory testing may limit access to care. Nucleic acid assays, designed for POC testing, can match, or exceed, the sensitivity of conventional laboratory-based testing, eliminating the need for confirmation testing. Here, the goals of POC testing for microbiology, applications, and technologies, as well as outcomes and value propositions, are discussed. SUMMARY The combination of rapid reporting, an increasing array of organisms capable of causing disease, actionable resulting, and improved patient outcomes is key in the evolution of POC testing in clinical microbiology.
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Affiliation(s)
- Glen T Hansen
- Microbiology and Molecular Diagnostics, Hennepin County Medical Center, Department of Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN.,Department of Pathology & Laboratory Medicine University of Minnesota, School of Medicine.,Department of Medicine, Infectious Diseases, University of Minnesota School of Medicine, Minneapolis, MN
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Avent ML, Cosgrove SE, Price-Haywood EG, van Driel ML. Antimicrobial stewardship in the primary care setting: from dream to reality? BMC FAMILY PRACTICE 2020; 21:134. [PMID: 32641063 PMCID: PMC7346425 DOI: 10.1186/s12875-020-01191-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 06/15/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Clinicians who work in primary care are potentially the most influential healthcare professionals to address the problem of antibiotic resistance because this is where most antibiotics are prescribed. Despite a number of evidence based interventions targeting the management of community infections, the inappropriate antibiotic prescribing rates remain high. DISCUSSION The question is how can appropriate prescribing of antibiotics through the use of Antimicrobial Stewardship (AMS) programs be successfully implemented in primary care. We discuss that a top-down approach utilising a combination of strategies to ensure the sustainable implementation and uptake of AMS interventions in the community is necessary to support clinicians and ensure a robust implementation of AMS in primary care. Specifically, we recommend a national accreditation standard linked to the framework of Core Elements of Outpatient Antibiotic Stewardship, supported by resources to fund the implementation of AMS interventions that are connected to quality improvement initiatives. This article debates how this can be achieved. The paper highlights that in order to support the sustainable uptake of AMS programs in primary care, an approach similar to the hospital and post-acute care settings needs to be adopted, utilising a combination of behavioural and regulatory processes supported by sustainable funding. Without these strategies the problem of inappropriate antibiotic prescribing will not be adequately addressed in the community and the successful implementation and uptake of AMS programs will remain a dream.
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Affiliation(s)
- M L Avent
- Statewide Antimicrobial Stewardship Program, Queensland Health, Brisbane, Australia.
- UQ Centre for Clinical Research (UQCCR), The University of Queensland, Brisbane, Australia.
| | - S E Cosgrove
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - E G Price-Haywood
- Ochsner Health System, Center for Outcomes and Health Services Research, New Orleans, Louisiana, USA
- Ochnser Clinical School, The University of Queensland, New Orleans, Louisiana, USA
| | - M L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Schneider JE, Boehme C, Borisch B, Dittrich S. Application of a simple point-of-care test to reduce UK healthcare costs and adverse events in outpatient acute respiratory infections. J Med Econ 2020; 23:673-682. [PMID: 32259465 DOI: 10.1080/13696998.2020.1736872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Acute respiratory infection (ARI) accounts for over two-thirds of total antibiotic prescriptions although most are caused by viruses that do not benefit from antibiotics. Most antibiotics are prescribed in the outpatients setting. Antibiotic overuse leads to antibiotic-related adverse events (AEs), inclusive of secondary infections, resistance, and increased costs. Point-of-care tests (POCT) may reduce unnecessary antibiotics. A cost analysis was performed to assess diagnostic POCT options to identify patients with an ARI that may benefit from antibiotics in a United Kingdom (UK) outpatient setting.Methods: Healthcare savings were estimated using a budget impact analysis based on UK National Institute for Health and Care Excellence (NICE) data and direct costs (antibiotics, AEs, POCTs) derived from published literature. Otitis media, sinusitis, pharyngitis and bronchitis were considered the most common ARIs. Antibiotic-related AE costs were calculated using re-consultation costs for anaphylaxis, Stevens-Johnson syndrome, allergies/diarrhea/nausea, C. difficile infection (CDI). Potential cost-savings from POCTs was assessed by evaluating NICE guideline-referenced POCTs (CRP, FebriDx, Sarasota, FL) as well as a target product profile (TPP).Results: Fifty-percent (7,718,283) of ARI consultations resulted in antibiotics while guideline-based prescribing suggest appropriate antibiotic prescriptions are warranted 9% (1,444,877) of ARI consultations. Direct antibiotic costs for actual ARI consultations associated with antibiotics was £24,003,866 vs. £4,493,568 for guideline-based, "appropriate" antibiotic prescriptions. Antibiotic-related AEs and re-consultations for actual vs. appropriate prescribing totaled £302,496,486 vs. £63,854,269. ARI prescribing plus AE costs totaled £326,729,943 annually without the use of delayed prescribing practices or POCT while the addition of delayed prescribing plus POCT totaled £60,114,564-£78,148,933 depending on the POCT.Conclusions: Adding POCT to outpatient triage of ARI can reduce unnecessary antibiotics and antibiotic-related AEs, resulting in substantial cost savings. Further, near patient diagnostic testing can benefit health systems and patients by avoiding exposure to unnecessary drugs, side effects and antibiotic resistant pathogens.Key points for decision makersMany patients are unnecessarily treated with antibiotics for respiratory infections.Antibiotic misuse leads to unnecessary adverse events, secondary infections, re-consultations, antimicrobial resistance and increased costs.Point-of-care diagnostic tests used to guide antibiotic prescriptions will avoid unnecessary adverse health effects and expenses.
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Affiliation(s)
| | - Catharina Boehme
- FIND (Foundation for Innovative New Diagnostic), Geneva, Switzerland
| | - Bettina Borisch
- Institute for Global Health, University Geneva, Geneva, Switzerland
| | - Sabine Dittrich
- FIND (Foundation for Innovative New Diagnostic), Geneva, Switzerland
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Patel H, Sun H, Hussain AN, Vakde T. Advances in the Diagnosis of Venous Thromboembolism: A Literature Review. Diagnostics (Basel) 2020; 10:E365. [PMID: 32498355 PMCID: PMC7345080 DOI: 10.3390/diagnostics10060365] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 12/14/2022] Open
Abstract
The incidence of venous thromboembolism (VTE), including lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) is increasing. The increase in suspicion for VTE has lowered the threshold for performing imaging studies to confirm diagnosis of VTE. However, only 20% of suspected cases have a confirmed diagnosis of VTE. Development of pulmonary embolism rule-out criteria (PERC) and update in pre-test probability have changed the paradigm of ruling-out patient with low index of suspicion. The D-dimer test in conjunction to the pre-test probability has been utilized in VTE diagnosis. The age appropriate D-dimer cutoff and inclusion of YEARS algorithm (signs of the DVT, hemoptysis and whether PE is the likely diagnosis) for the D-dimer cutoff have been recent updates in the evaluation of suspected PE. Multi-detector computed tomography pulmonary angiography (CTPA) and compression ultrasound (CUS) are the preferred imaging modality to diagnose PE and DVT respectively. The VTE diagnostic algorithm do differ in pregnant individuals. The prerequisite of avoiding excessive radiation has recruited planar ventilation-perfusion (V/Q) scan as preferred in pregnant patients to evaluate for PE. The modification of CUS protocol with addition of the Valsalva maneuver should be performed while evaluating DVT in pregnant individual.
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Affiliation(s)
- Harish Patel
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Haozhe Sun
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Ali N. Hussain
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
| | - Trupti Vakde
- Department of Medicine, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic affiliate of Icahn School of Medicine, Bronx, NY 10457, USA; (H.S.); (A.N.H.); (T.V.)
- Division of the Pulmonary and Critical Care, BronxCare Hospital Center a Clinical Affiliate of Mt Sinai Health Systems and Academic Affiliate of Icahn School of Medicine, Bronx, NY 10457, USA
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Albasri A, Van den Bruel A, Hayward G, McManus RJ, Sheppard JP, Verbakel JYJ. Impact of point-of-care tests in community pharmacies: a systematic review and meta-analysis. BMJ Open 2020; 10:e034298. [PMID: 32414821 PMCID: PMC7232628 DOI: 10.1136/bmjopen-2019-034298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/27/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To summarise the literature regarding the use of point-of-care test (POCT) in pharmacies versus control/usual care. DESIGN AND SETTING Systematic review and random-effects meta-analysis in community pharmacy. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, Embase, ClinicalTrial.gov and Web of Science databases were searched. ELIGIBILITY CRITERIA Articles were included if they: involved a POCT conducted by a community pharmacist, member of pharmacy staff or local equivalent; measured a clinically relevant outcome for example, clinical parameter monitoring. No clinical condition or language limits were set. PATIENT AND PUBLIC INVOLVEMENT No patient involvement. DATA EXTRACTION AND SYNTHESIS Data were independently extracted by two members of the review team to capture changes in clinical care that resulted from the use of the POCTs. The methodological quality of included studies was assessed, using the Cochrane Risk of Bias tool and Newcastle-Ottawa scale. RESULTS Thirteen of the 1584 articles found were included in the meta-analyses. Studies covered four therapeutic areas: targeted anti-malarial therapy (n=3 studies), glycated haemoglobin (HbA1c) in diabetes (n=2 studies), lipid control (n=3 studies) and international normalised ratio (INR) control in patients taking warfarin (n=5 studies). POCT in pharmacies reduced the risk of receiving antimalarial treatment when not clinically indicated (risk ratio 0.34, 95% CI 0.31 to 0.37). Lipid and HbA1c control appeared largely unaffected by pharmacy POCTs, and the impact on INR time-in-therapeutic-range was inconclusive. CONCLUSIONS Only 4 out of 13 included studies used a gold-standard randomised controlled trial (RCT) design, limiting our ability to conclusively determine the clinical utility of POCT conducted in pharmacies. Further RCTs are needed, particularly in areas such as upper respiratory tract infections, which have gathered momentum among service commissioners in recent years. PROSPERO REGISTRATION NUMBER CRD42017048578.
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Affiliation(s)
- Ali Albasri
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ann Van den Bruel
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - James Peter Sheppard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Yvan Jos Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Academic Centre for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
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Goyder C, Tan PS, Verbakel J, Ananthakumar T, Lee JJ, Hayward G, Turner PJ, Van Den Bruel A. Impact of point-of-care panel tests in ambulatory care: a systematic review and meta-analysis. BMJ Open 2020; 10:e032132. [PMID: 32111610 PMCID: PMC7050348 DOI: 10.1136/bmjopen-2019-032132] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 11/22/2019] [Accepted: 02/03/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This article summarises all the available evidence on the impact of introducing blood-based point-of-care panel testing (POCT) in ambulatory care on patient outcomes and healthcare processes. DESIGN Systematic review and meta-analysis of randomised-controlled trials and before-after studies. DATA SOURCES Ovid Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL, Database of Abstracts of Reviews and Effects, Science Citation Index from inception to 22 October 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Included studies were based in ambulatory care and compared POCT with laboratory testing. The primary outcome was the time to decision regarding disposition that is, admission/referral termed disposition decision (DD) time. Secondary outcomes included length of stay (LOS) at the ambulatory care unit/practice and mortality. RESULTS 19 562 patients from nine studies were included in the review, eight of these were randomised-controlled trials, and one was a before-after study. All the studies were based in either emergency departments or the ambulance service; no studies were from primary care settings. General panel tests performed at the POCT resulted in DDs being made 40 min faster (95% CI -42.2 to -36.6, I2=0%) compared with the group receiving usual care, including central laboratory testing. This in turn resulted in a reduction in LOS for patients who were subsequently discharged by 34 min (95% CI -63.7 to -5.16). No significant difference in mortality was reported. DISCUSSION Although statistical and clinical heterogeneity is evident and only a small number of studies were included in the meta-analysis, our results suggest that POCTs might lead to faster discharge decisions. Future research should be performed in primary care and identify how POCTs can contribute meaningful changes to patient care rather than focusing on healthcare processes. PROSPERO REGISTRATION NUMBER CRD42016035426.
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Affiliation(s)
- Clare Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Pui San Tan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Jan Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Thanusha Ananthakumar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Joseph J Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxon, UK
| | - Ann Van Den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Barais M, Fossard E, Dany A, Montier T, Stolper E, Van Royen P. Accuracy of the general practitioner's sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study. BMJ Open 2020; 10:e034348. [PMID: 32075841 PMCID: PMC7044836 DOI: 10.1136/bmjopen-2019-034348] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Dyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner's (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs' sense of alarm when confronted with dyspnoea and chest pain. DESIGN AND SETTINGS Prospective observational study in general practice. PARTICIPANTS Patients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation. PRIMARY OUTCOME MEASURES Life-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks. RESULTS 25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77). CONCLUSIONS Where the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds. TRIAL REGISTRATION NUMBER NCT02932982.
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Affiliation(s)
- Marie Barais
- Department of General Practice, EA 7479 SPURBO, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, Bretagne, France
| | - Emilie Fossard
- Department of General Practice, EA 7479 SPURBO, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, Bretagne, France
| | - Antoine Dany
- Department of Public Health, EA 7479 SPURBO, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, Bretagne, France
| | - Tristan Montier
- Inserm UMR1078, Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, Bretagne, France
| | - Erik Stolper
- CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
- Department of Primary and Interdisciplinary Care, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
| | - Paul Van Royen
- Department of Primary and Interdisciplinary Care, University of Antwerp Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
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Hayward G, Dixon S, Garland S, Glogowska M, Hunt H, Lasserson D. Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement. BMJ Open 2020; 10:e033428. [PMID: 31948989 PMCID: PMC7045021 DOI: 10.1136/bmjopen-2019-033428] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service. DESIGN A mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews. SETTING Out-of-hours primary care. PARTICIPANTS All patients requiring home visits from the service during the implementation period. INTERVENTIONS The i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation. PRIMARY AND SECONDARY OUTCOME MEASURES The proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests. RESULTS i-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage. CONCLUSIONS POC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.
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Affiliation(s)
- Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sharon Dixon
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sophie Garland
- Urgent and Ambulatory Care, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen Hunt
- Urgent and Ambulatory Care, Oxford Health NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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Lei R, Huo R, Mohan C. Current and emerging trends in point-of-care urinalysis tests. Expert Rev Mol Diagn 2020; 20:69-84. [PMID: 31795785 PMCID: PMC7365142 DOI: 10.1080/14737159.2020.1699063] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023]
Abstract
Introduction: The development of point-of-care testing (POCT) has made clinical diagnostics available, affordable, rapid, and easy to use since the 1990s.The significance of this platform rests on its potential to empower patients to monitor their own health status more frequently, in the convenience of their home, so that diseases can be diagnosed at the earliest possible time-point. Recent advances have expanded traditional formats such as qualitative or semi-quantitative dipsticks and lateral flow immunoassays to newer platforms such as microfluidics and paper-based assays where signals can be measured quantitatively using handheld devices.Areas covered: This review discusses: (1) working principles and operating mechanisms of both existing and emerging POCT platforms, (2) urine analytes measured using POCT in comparison to the laboratory or clinical 'gold standard,' and (3) limitations of existing POCT and expectations of emerging POCT in urinalysis.Expert opinion: Currently, a variety of biological samples such as urine, saliva, serum, plasma, and other fluids can be applied to POCT for quick diagnosis, especially in resource-limited settings. Emerging platforms will increasingly empower individuals to monitor their health status through frequent urine analysis even from their homes. The impact of these emerging technologies on healthcare is likely to be transformative.
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Affiliation(s)
- Rongwei Lei
- Department of Biomedical Engineering, University of Houston, Houston, TX
| | - Rannon Huo
- Department of Biomedical Engineering, University of Houston, Houston, TX
| | - Chandra Mohan
- Department of Biomedical Engineering, University of Houston, Houston, TX
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Wu AHB, Sellers J. XW-100: First FDA CLIA-Waived CBC Analyzer Designed for Physician Office Use. J Appl Lab Med 2019; 3:839-846. [PMID: 31639758 DOI: 10.1373/jalm.2018.027383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/08/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The XW-100 hematology analyzer (Sysmex America) is the first complete blood count (CBC) instrument waived by the US Food and Drug Administration. This analyzer also tests for a 3-part white blood cell count differential. METHODS The XW-100 analyzer was evaluated for preanalytical specimen variables including the need for mixing, specimen storage conditions, freeze-thaw cycles, the effect of under filling of tubes, precision, linearity, carryover, limits of the blank, detection, and quantification and interferences from common and CBC-specific substances. The clinical study examined 586 blood samples from 6 CLIA-waived clinical sites and 6 paired moderately complex sites. The point-of-care sites had different medical specialties and were using inexperienced operators. The results of 8 measurements and 4 calculated parameters were compared to a moderately complex point-of-care hematology analyzer (pocH-100i, Sysmex). RESULTS The precision was <6% for all analytics, and there was no carryover noted. Samples containing interfering substances were appropriately flagged or suppressed by the instrument. The correlation to the predicate analyzer was highly concordant, producing near unity slope and intercept and minimal bias. Delays from sample collection to testing resulted in decreased performance. The percentage of samples inside the allowable error was >98.8% for all parameters studied. CONCLUSION This CLIA-waived hematology analyzer produces acceptable results and can be used in offices and clinics.
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Affiliation(s)
- Alan H B Wu
- Department of Laboratory Medicine, University of California, San Francisco, CA;
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