1
|
Jafri L, Ahmed S, Majid H, Ghani F, Pillay T, Khan AH, Siddiqui I, Shakeel S, Ahmed S, Azeem S, Khan A. A framework for implementing best laboratory practices for non-integrated point of care tests in low resource settings. EJIFCC 2023; 34:110-122. [PMID: 37455843 PMCID: PMC10349313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The method we respond to pandemics is still inadequate for dealing with the point of care testing (POCT) requirements of the next large epidemic. The proposed framework highlights the importance of having defined policies and procedures in place for non-integrated POCT to protect patient safety. In the absence of a pathology laboratory, this paradigm may help in the supply of diagnostic services to low-resource centers. A review of the literature was used to construct this POCT framework for non-integrated and/or unconnected devices. It also sought professional advice from the Chemical Pathology faculty, quality assurance laboratory experts and international POCT experts from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). Our concept presents a comprehensive integrated and networked approach to POCT with direct and indirect clinical laboratory supervision, particularly for outpatient and inpatient care in low-resource health care settings.
Collapse
Affiliation(s)
- Lena Jafri
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
- Corresponding member for Pakistan-IFCC Committee on Point of Care Testing
| | - Sibtain Ahmed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Hafsa Majid
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Farooq Ghani
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Tahir Pillay
- Department of Chemical Pathology, University of Pretoria, Pretoria, South Africa
- Chair, IFCC Communications and Publications Division
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Imran Siddiqui
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shahid Shakeel
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Shuja Ahmed
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Saba Azeem
- Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, Pakistan
| | - Adil Khan
- Point-of-Care Testing & Clinical Chemistry, Department of Pathology and Laboratory Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Chair, IFCC Committee on Point of Care Testing
| |
Collapse
|
2
|
Ahmed S, Jafri L, Majid H, Shakeel S, Ahmed S, Khan AH. Assessing Third-Year Medical Students' Perspective on Point of Care Testing Boot Camp: From Bench to Bedside. EJIFCC 2022; 33:252-261. [PMID: 36447803 PMCID: PMC9644088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Point-of-care testing (POCT), which is also known as bed side-testing, has been integrated into the healthcare system, offering faster results that can lead to improved patient outcomes. POCT was missing from the medical education curriculum in our institute. OBJECTIVES The primary objective of this study was to describe the development and introduce POCT training for medical students in a medical college in Pakistan.Secondary objectives were to evaluate student performance on POCT content and to assess the impact of POCT training via students' feedback. METHODOLOGY The boot camp experience was devised, directed, and facilitated by team constituting of Chemical Pathology faculty members, laboratory technologists and teaching assistants. The program included presentations, demonstrations of POCT instrument handling, supervised hands-on individual performance on glucometer using quality control specimens, competency assessment and sign off followed by interactive case-based discussions. A knowledge quiz via Kahoot was administered at the beginning and end of the experience and scores were compared statistically. Online evaluation and feedback were designed via virtual learning environment based on 10 questions regarding the program and methodology using on a five-point Likert Scale. Frequencies were generated and t-tests were employed to determine pre-post differences. RESULTS The boot camp was spread over 2 days and ran three hours each day with the third-year medical students class split into two groups (n=80). On knowledge evaluation, the mean group pre and post test scores were 45% and 95% respectively (p-value =< 0.05). On documented structured competency assessment form a score of 95 was achieved by 100% participants. Positive feedback of 4 or more was recorded on the Likert's scale by 100% respondents. CONCLUSION This POCT boot camp experience can be used by other institutions and can be applied at different times during the medical school curriculum and other professional education programs. This bootcamp will be helpful to educate medical students, postgraduate trainees and field workers working in rural areas and in low resource settings to deliver reliable POC tests results. Future research should examine these students' competence in achieving POCT skills when they enter in clinical practice.
Collapse
Affiliation(s)
- Sibtain Ahmed
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Lena Jafri
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan,Corresponding authors: Dr. Lena Jafri Chemical Pathology Department of Pathology and Laboratory Medicine Aga Khan University Karachi Pakistan Phone: 92-213-4861927 E-mail:
| | - Hafsa Majid
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Shahid Shakeel
- POCT, Clinical Laboratories, Aga Khan University, Karachi, Pakistan
| | - Shuja Ahmed
- POCT, Clinical Laboratories, Aga Khan University, Karachi, Pakistan
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
3
|
Shakeel S, Ahmed S, Jafri L, Ahmed S, Khan A. T116 Performance evaluation of a point-of-care testing program operational at 30 sites with six sigma metrics – Experience from a tertiary care hospital in Pakistan. Clin Chim Acta 2022. [DOI: 10.1016/j.cca.2022.04.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
4
|
Shakeel S, Finley C, Akhtar-Danesh G, Seow HY, Akhtar-Danesh N. Trends in survival based on treatment modality in patients with pancreatic cancer: a population-based study. Curr Oncol 2020; 27:e1-e8. [PMID: 32218662 PMCID: PMC7096205 DOI: 10.3747/co.27.5211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Pancreatic cancer (pcc) is one of the most lethal types of cancer, and surgery remains the optimal treatment modality for patients with resectable tumours. The objective of the present study was to examine and compare trends in the survival rate based on treatment modality in patients with pcc. Methods This population-based retrospective analysis included all patients with known-stage pcc in Ontario between 2007 and 2015. Flexible parametric models were used to conduct the survival analysis. Survival rates were calculated based on treatment modality, while adjusting for patient- and tumour-specific covariates. Results The study included 6437 patients. We found no noticeable improvement in survival for patients with stage iii or iv tumours; however, for stage i disease, the 1-, 2-, and 5-year survival rates increased over time to 81% from 51%, to 71% from 35%, and to 61% from 22% respectively. Most improvements were seen for surgical modalities, with 2-year survivals increasing to 89% from 65% for distal pancreatectomy (dp) without radiation (rt) or chemotherapy (ctx), to 65% from 37% for dp plus rt or ctx, to 60% from 44% for Whipple-only, and to 50% from 36% for Whipple plus rt or ctx. Lastly, 5-year survival improved to 81% from 52% for dp only, to 41% from 12% for dp plus rt or ctx, to 49% from 25% for Whipple-only, and to 26% from 12% for Whipple plus rt or ctx. Conclusions Most cases of pcc continue to be diagnosed at a late stage, with poor short-term and long-term prognoses. After adjustment for patient age, sex, and year of diagnosis, the survival for stage i tumours and for surgical modalities increased over time. Further research is needed to identify the reasons for improvement in survival during the study period.
Collapse
Affiliation(s)
- S Shakeel
- School of Medicine, University of Toronto, Toronto, ON
| | | | | | - H Y Seow
- Health Research Methods, Evidence, and Impact
- Oncology, McMaster University, Hamilton, ON
| | - N Akhtar-Danesh
- Health Research Methods, Evidence, and Impact
- School of Nursing, McMaster University, Hamilton, ON
| |
Collapse
|
5
|
Khan AH, Shakeel S, Hooda K, Siddiqui K, Jafri L. Best Practices in the Implementation of a Point of Care Testing Program: Experience From a Tertiary Care Hospital in a Developing Country. EJIFCC 2019; 30:288-302. [PMID: 31695586 PMCID: PMC6803771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Implementation of a structured Point of Care Test (POCT) program is challenging. Traditionally POCT was unregulated and the aim was to introduce a structured POCT program at our tertiary care hospital to ensure compliance with regulatory standards. The purpose of this article is to describe how a hospital in a developing country with limited resources has approached POCT program initiative. The benefits offered by such systems, including cost-effectiveness, robustness and the ability to generate reliable accurate POCT results in a short time, are appropriate to the clinical and social needs of the developing world.
Collapse
Affiliation(s)
- Aysha Habib Khan
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi, Pakistan
| | - Shahid Shakeel
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi, Pakistan
| | | | | | - Lena Jafri
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi, Pakistan,Corresponding author: Lena Jafri Section of Chemical Pathology Department of Pathology and Laboratory Medicine Aga Khan University (AKU) Karachi Pakistan E-mail:
| |
Collapse
|
6
|
Ahmed S, Jafri L, Raheem A, Shakeel S, Siddiqui I. Performance Evaluation of Cardiac Troponin I Assay: A Comparison Between the Point-of-care Testing Radiometer AQT90 FLEX and the Central Laboratory Siemens Advia Centaur Analyzer. Cureus 2019; 11:e4231. [PMID: 31123653 PMCID: PMC6510564 DOI: 10.7759/cureus.4231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background To validate the point of care testing (POCT) Trop-I analyzer and compare it with a central laboratory-based chemiluminescence immunoassay, in order to evaluate its performance for use in critical care areas. Moreover, for clinical decision-making, it is imperative to know the extent to which patient stratification will differ based on the analytic method being used. In particular, the aim of this study was to evaluate the analytical performance of the point-of-care analyzer and demonstrate the agreement with the central laboratory measurements in patients presenting to the emergency department (ED) with chest pain and suspected acute coronary syndrome (ACS). Methods This cross-sectional study was performed at the section of chemical pathology, department of pathology and laboratory medicine, the Aga Khan University (AKU), Karachi, from October to November 2017. Samples from patients and the quality control material of Trop-I were analyzed for imprecision, linearity, and method comparison on Advia Centaur (Siemens Diagnostics, CA, USA), and the AQT90 FLEX analyzer (Radiometer Medical ApS, Brønshøj, Denmark) with photometric detection at the section of chemical pathology, AKU. Statistical analysis was done using Microsoft Excel (Microsoft Corporation, Washington, United States) and EP Evaluator version 10.3.0.556 (Data Innovations, LLC, VT, US). Quantitative variables were represented in terms of mean ± SD. For precision, the computed SD was compared with allowable random error. Furthermore, Cohen’s kappa was applied to observe the agreement between the two methods. Results The Trop-I Precision study on the POCT analyzer showed a coefficient of variation (CV) of 2.4% using a pooled patient sample with a mean Trop-I of 2.15 ± 0.05 ng/ml. Three standards ranging from 0.034 to 1.316 ng/ml were run in triplicate to verify accuracy and linearity. The allowable systematic error (SEa) was 10.0%. The maximum deviation for a mean recovery from 100% was 4.1%. All three of the mean recoveries were accurate and within the allowable error limits. The results were linear with slope 1.04, intercept 0.0. On a method comparison, Trop-I showed good agreement, yielding a kappa value of 0.95. Conclusion This study has validated the performance of a POCT Trop-I assay against a central laboratory immunoassay and found acceptable results. POCT assays for cTnI should be implanted in emergency settings to ensure the fast triage of patients with chest pain, as well as timely diagnosis.
Collapse
Affiliation(s)
- Sibtain Ahmed
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Lena Jafri
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| | - Ahmed Raheem
- Pathology, Aga Khan University Hospital, Karachi, PAK
| | - Shahid Shakeel
- Pathology & Laboratory Medicine, Aga Khan University, Karachi, PAK
| | - Imran Siddiqui
- Pathology & Laboratory Medicine, Aga Khan University Hospital, Karachi, PAK
| |
Collapse
|
7
|
Laine A, Iyengar P, Westover K, Christie A, Smith I, Shakeel S, Attia A, Villaruz L, Gerber D, Chen Y, Spigel D, Socinski M, Choy H. P3.08-004 Phase I/II Trial of Nab-Paclitaxel or Paclitaxel Plus Carboplatin with Concurrent Radiation for Inoperable Stage IIIA/B NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
8
|
Jafri L, Khan AH, Ghani F, Shakeel S, Raheem A, Siddiqui I. Error identification in a high-volume clinical chemistry laboratory: Five-year experience. Scandinavian Journal of Clinical and Laboratory Investigation 2015; 75:296-300. [DOI: 10.3109/00365513.2015.1010175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
9
|
Shakeel S, Mubarak M, Kazi JI. Frequency and clinicopathological correlations of histopathological variants of pediatric idiopathic focal segmental glomerulosclerosis. Indian J Nephrol 2014; 24:148-53. [PMID: 25120291 PMCID: PMC4127833 DOI: 10.4103/0971-4065.132003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There is no information on the frequency and clinicopathological correlations of the histopathological variants of primary focal segmental glomerulosclerosis (FSGS) in children presenting with idiopathic nephrotic syndrome (INS) in Pakistan. All consecutive children (≤17 years) who presented with INS, and in whom the histological diagnosis of FSGS was made on renal biopsies, were included in this prospective study. Their clinical, laboratory, and histopathological features at the time of presentation were noted from the case files and the biopsy reports for analysis and clinicopathological correlations. Out of 138 children, 93 (67.4%) were males and 45 (32.6%) were females. The mean age was 8.95 ± 4.14 (range: 1.5-17) years. All had NS, with steroid dependant NS (SDNS) in 45 (32.6%) and steroid resistant NS (SRNS) in 93 (67.4%) cases. Renal dysfunction at the time of presentation was found in six (4.3%) children. Global glomerulosclerosis was found in 68 (49.3%) cases. The mean number of glomeruli involved by segmental scarring was 2.98 ± 2.44. FSGS, not otherwise specified (NOS) was the most prevalent variant, comprising 89.1% of all cases. Collapsing variant comprised 8%, tip variant 1.4%, perihilar 0.7%, and cellular 0.7%. Hyaline arteriolosclerosis was found in 13 (9.4%) cases. Mild interstitial fibrosis/tubular atrophy was found in 95 (68.6%) cases, moderate in 18 (13%), and severe in two (1.4%) cases. In conclusion, FSGS, NOS variant was the highly prevalent variant, while collapsing type was also found in small but significant number of cases. Remaining three variants were distinctly rare in our children.
Collapse
Affiliation(s)
- S Shakeel
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - M Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - J I Kazi
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| |
Collapse
|
10
|
Arshad B, Shehzad W, Malik S, Shakeel S, Raza A. PP-043 Staphylococcus epidermidis contains ampicillin resistant gene. Int J Infect Dis 2011. [DOI: 10.1016/s1201-9712(11)60196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|