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Point-of-Care Testing Abstracts From the 2019 American Association for Clinical Chemistry Annual Meeting 2019年美国临床化学协会年会上的即时检测摘要
Pub Date : 2020-06-01 DOI: 10.1097/poc.0000000000000206
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引用次数: 0
Analytical Evaluation of ABL90 Flex Plus Blood Gas Analyzer for Urea and Creatinine ABL90 Flex Plus血气分析仪尿素和肌酐的分析评价
Pub Date : 2020-06-01 DOI: 10.1097/POC.0000000000000200
Cristina Pizarro Sánchez, P. O. Sáez, P. Fernández-Calle, Marta Suescun Giménez, Ricardo Miguel Alonso Díaz, Erika Perez Zafra, Núria Estañ Capell, A. Buño Soto
Background Acute kidney injury is a common complication among hospitalized patients. The availability of creatinine and urea measurements as point-of-care testing provides an alternative strategy to monitor renal function and develop prevention strategies, especially in the emergency services, where reducing waiting times and rapid clinical decisions may be required. Objective The aim of this study was to evaluate if creatinine and urea measurements are interchangeable between ABL90 Flex Plus and three common central laboratory methods. Methods With a multicenter design, creatinine and urea were first analyzed by ABL90 Flex Plus and then by laboratory method: Dimension Vista 1500, Cobas c702, and Architect c16000 according to Clinical and Laboratory Standards Institute EP09-A3 protocol. All measurements were performed in duplicate. Results were evaluated using Passing-Bablok regression and Bland-Altman comparison. Interchangeability of patient results was verified at different clinical decision levels. Results Passing-Bablok regression between the 3 central laboratory methods and ABL90 Flex Plus showed correlation coefficients over 0.998 for creatinine and 0.994 for urea, and despite the presence of proportional and/or constant bias observed in the study, estimated difference was lower than the allowable difference (±15.6% for urea and ±8.9% for creatinine) at clinical decision levels in all cases. Conclusion Creatinine and urea measurements are interchangeable using ABL90 Flex Plus blood gas analyzer compared with 3 central laboratory methods, ensuring no impact on patient care using indistinctly any analyzer.
背景急性肾损伤是住院患者常见的并发症。肌酸酐和尿素测量作为护理点检测的可用性提供了监测肾功能和制定预防策略的替代策略,特别是在紧急服务中,可能需要减少等待时间和快速临床决策。目的:本研究的目的是评估ABL90 Flex Plus和三种常见的中心实验室方法之间的肌酐和尿素测量是否可互换。方法采用多中心设计,首先采用ABL90 Flex Plus检测肌酐和尿素,然后采用实验室方法:Dimension Vista 1500、Cobas c702和Architect c16000,按照临床与实验室标准协会EP09-A3方案进行检测。所有测量都是重复进行的。采用Passing-Bablok回归和Bland-Altman比较对结果进行评价。在不同的临床决策水平上验证了患者结果的互换性。结果3种中心实验室方法与ABL90 Flex Plus之间的passin - bablok回归显示肌酐和尿素的相关系数超过0.998和0.994,尽管在研究中观察到比例和/或恒定偏差,但在所有病例的临床决策水平上,估计差异低于允许差异(尿素±15.6%和肌酐±8.9%)。结论与3种中心实验室方法相比,ABL90 Flex Plus血气分析仪测定肌酐和尿素的方法具有可互换性,不影响患者的护理。
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引用次数: 0
Integrating Competence Assessment, Internal Quality Control, and External Quality Assurance in a Large Point-of-Care Testing Network 整合能力评估,内部质量控制,和外部质量保证在一个大型点护理测试网络
Pub Date : 2020-03-01 DOI: 10.1097/poc.0000000000000199
C. Martin, A. StJohn, T. Badrick
Abstract Point-of-care testing is widespread and requires a different form of quality control and quality assurance model to conventional laboratory testing because the types of error that occur are different. In many situations, the point-of-care instruments and operators are part of a broader organizational network. We have developed a different model for the provision of a quality framework for these situations. The quality of the instrument cartridges is checked centrally, and the quality assurance is wider in concept assessing the operator competence and instrument operation. Centralizing some of the quality control reduces errors and allows for greater confidence in the results.
摘要即时检测的应用十分广泛,由于发生的误差类型不同,因此需要一种不同于传统实验室检测的质量控制和质量保证模式。在许多情况下,护理点仪器和操作人员是更广泛的组织网络的一部分。我们开发了一种不同的模式,为这些情况提供高质量的框架。集中检查仪器墨盒的质量,在概念上更广泛地评价操作人员的能力和仪器的操作。集中一些质量控制可以减少错误,并允许对结果有更大的信心。
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引用次数: 1
Reliability of Point-of-Care International Normalized Ratio Measurements in Various Patient Populations 在不同患者群体中护理点国际标准化比率测量的可靠性
Pub Date : 2020-03-01 DOI: 10.1097/poc.0000000000000197
Kim Arline, C. Rodriguez, K. Sanchez
Purpose The aim of this study was to determine if the Coagsense point-of-care (POC) instrument provides more reliable international normalized ratio (INR) measurements than Coagucheck XS POC in comparison to the Stago laboratory instrument in different disease states. Methods This was a prospective study of outpatient warfarin patients comparing venous Stago INR to fingerstick INR on the Coagsense and Coagucheck XS POC meters. Patients were invited to study if they had an of INR 2.0 to 5.0 and had a medical history of antiphospholipid syndrome, hypercoagulable disorder, autoimmune condition, peripheral vascular disease, mechanical heart valve, atrial fibrillation, or deep vein thrombosis/pulmonary embolism/cerebrovascular accident history. Results Seventy-seven patients were enrolled. Coagsense correlated well (92% of INRs within 20% of Stago, 64% of INRs within 0.2 of Stago, overall INR bias of 0.1 or 4%). Six patients had greater than 20% POC INR bias, which could have resulted in 4 warfarin dosing errors. Coagucheck XS INRs correlated poorly (49% within 20% of Stago, 10% of INRs were within 0.2 of Stago, overall INR bias of 0.66 or 25.7%). Forty-one patients had greater than 20% POC INR bias in all diseases, which could have resulted in 28 warfarin dosing errors. The average Coagucheck XS INR bias (0.46–1.3 INR) increased with each 0.5 increase in laboratory INR, whereas Coagsense bias remained stable (0.1–0.25) as INR increased up to 4.3. Two patients correlated well on Coagucheck XS but not Coagsense. Conclusion Coagsense correlated better than Coagucheck XS and did not show increasing bias as INR increased. Both POC instruments had higher INR variability in 4 disease states (antiphospholipid syndrome, autoimmune, peripheral vascular disease, and hypercoagulable). Patient-specific laboratory correlations may be needed on each POC device.
目的本研究的目的是确定在不同疾病状态下,与Stago实验室仪器相比,凝血护理点(POC)仪器是否比Coagucheck XS POC提供更可靠的国际标准化比率(INR)测量。方法对门诊华法林患者进行前瞻性研究,比较静脉Stago INR和手指针刺INR在凝血仪和Coagucheck XS POC仪上的差异。如果患者的INR为2.0 - 5.0,并且有抗磷脂综合征、高凝障碍、自身免疫性疾病、外周血管疾病、机械心脏瓣膜、心房颤动或深静脉血栓形成/肺栓塞/脑血管意外病史,则邀请患者进行研究。结果共纳入77例患者。凝血相关良好(20% Stago内的INRs为92%,0.2 Stago内的INRs为64%,总体INR偏差为0.1或4%)。6例患者的POC INR偏差大于20%,这可能导致4个华法林剂量错误。Coagucheck XS INRs相关性较差(49%在Stago的20%范围内,10%的INRs在Stago的0.2范围内,总体INR偏差为0.66或25.7%)。41例患者在所有疾病中POC INR偏差大于20%,这可能导致28例华法林剂量错误。实验室INR每增加0.5,Coagucheck XS INR平均偏倚(0.46-1.3 INR)增加,而当INR增加到4.3时,凝固偏倚保持稳定(0.1-0.25)。两例患者的Coagucheck XS相关性良好,但凝血功能不相关。结论与Coagucheck XS的相关性较好,且不随INR的增加而增加偏倚。两种POC仪器在4种疾病状态(抗磷脂综合征、自身免疫、外周血管疾病和高凝)中都有更高的INR变异性。每个POC设备可能需要患者特定的实验室相关性。
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引用次数: 3
Optimizing Quality Practices in Point-of-Care Testing 优化护理点测试的质量实践
Pub Date : 2020-03-01 DOI: 10.1097/poc.0000000000000198
S. Sengupta, A. Handoo
Abstract With testing in health care becoming more decentralized to include the patient bedside, quality assurance in point-of-care testing (POCT) assumes immense significance in optimizing clinical outcomes. However, complex regulatory requirements, training of testing personnel, and implementation of a uniform quality policy in varied locations across the hospital pose the greatest challenges in achieving the desired result. Although 70 POCT instruments were being used across our hospital, there was no structured program in place. In accordance with the requirements of the Joint Commission (JCI) accreditation, efforts were made to bring the supervision of POCT under the supervision of the laboratory. Initial internal audits revealed absence of quality assurance policies, inadequate documentation, and lack of uniformity in POCT practices across the hospital. Standard operating procedures on uniform POCT practice, quality control, and critical values were formulated. Training of testing personnel was conducted. Internal quality control and proficiency testing programs were designed and implemented. Periodic evaluation revealed a paradigm shift in the attitude of the testing personnel and the treating physicians toward POCT. It helped in ensuring strict adherence to quality practices in POCT and increased confidence in the reported results. This impacted positive clinical outcomes. Although, on one hand, the implementation of a structured POCT program facilitated the accreditation by the Joint Commission, it also helped us achieve uniformity and a high level of quality in POCT across the hospital. A multidisciplinary organizational approach for POCT under the direct supervision of the laboratory improved the quality of patient care.
随着医疗保健测试变得更加分散,包括患者床边,在护理点测试(POCT)的质量保证在优化临床结果具有巨大的意义。然而,复杂的法规要求、测试人员的培训以及在医院不同地点实施统一的质量政策,对实现预期结果构成了最大的挑战。尽管整个医院使用了70台POCT设备,但并没有一个结构化的程序。根据联合委员会(JCI)认可的要求,努力将POCT的监督置于实验室的监督之下。最初的内部审计发现缺乏质量保证政策,文件不足,以及整个医院POCT实践缺乏一致性。制定了统一POCT实践、质量控制和临界值的标准操作程序。对检测人员进行培训。设计并实施了内部质量控制和能力测试程序。定期评估显示,测试人员和治疗医生对POCT的态度发生了范式转变。它有助于确保严格遵守POCT的质量做法,并增加对报告结果的信心。这影响了积极的临床结果。虽然,一方面,结构化POCT项目的实施促进了联合委员会的认证,但它也帮助我们在整个医院实现了POCT的统一性和高质量。在实验室的直接监督下,POCT的多学科组织方法提高了患者护理的质量。
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引用次数: 0
The Status of Point-of-Care Testing and Coordinators in Vietnam 越南护理点检测和协调员的现状
Pub Date : 2020-03-01 DOI: 10.1097/poc.0000000000000196
Thuy Nguyen, G. Kost
Supplemental digital content is available in the text. Objectives The goals of this study were as follows: (a) to enhance point-of-care testing (POCT) and improve standards of care throughout Vietnam; (b) to educate point-of-care (POC) coordinators who provide leadership, oversight, and quality assurance; and (c) to promote international dialog and knowledge of POCT in limited-resource settings. Methods Needs assessment of 16 provincial hospitals, 2 each randomly chosen from the 8 geographic regions of Vietnam, was performed. In Ho Chi Minh City, 10 referral, 5 provincial, and 7 district hospitals, and 8 community medical stations were surveyed. Emergency and intensive care unit nurses and doctors, and laboratorian were respondents. Results Glucose meters and blood gas analyzers were the most frequent POC devices in the 16 provincial hospitals. Cardiac biomarker, coagulation, and human immunodeficiency tests were the highest needs. Biomedical engineers managed locations and quality. Point-of-care coordinators were deficient. Generally, hospitals with POCT had no laboratory oversight. Users performed POCT without internal or external quality control (QC). In Ho Chi Minh City, coagulation and cardiac biomarker tests were most desired. Conclusions Clinicians were poorly informed about the availability of urgent, emergency department, and bedside POC tests. No provincial hospitals surveyed offered cardiac biomarker testing, despite the high prevalence of acute coronary syndromes. Challenges to the implementation of POCT comprise: (a) the quality assurance burden for non laboratory personnel; (b) limited human resources to support POCT programs, including virtually total absence of POC coordinators; and (c) no national POCT policy and guidelines. To rectify these deficiencies, we recommend fundamental education at all levels, promotion of POC coordinator user groups, heightened awareness of available POCT, and vigorous international exchanges to enhanced standards of care in Vietnam.
补充的数字内容可在文本中找到。本研究的目的如下:(a)加强护理点检测(POCT)并提高整个越南的护理标准;(b)教育提供领导、监督和质量保证的护理点协调员;(c)在资源有限的环境中促进POCT的国际对话和知识。方法对越南8个省区随机抽取的16家省级医院(各2家)进行需求评估。在胡志明市,调查了10家转诊医院、5家省级医院、7家区级医院和8家社区医疗站。受访者为急诊和重症监护病房的护士和医生,以及化验员。结果血糖仪和血气分析仪是16家省级医院最常用的POC设备。心脏生物标志物、凝血和人类免疫缺陷测试是最需要的。生物医学工程师负责管理地点和质量。缺乏护理点协调员。一般来说,有POCT的医院没有实验室监督。用户在没有内部或外部质量控制(QC)的情况下进行POCT。在胡志明市,最需要的是凝血和心脏生物标志物检测。结论临床医生对急诊、急诊科和床边POC检测的可用性知之甚少。尽管急性冠状动脉综合征的发病率很高,但接受调查的省级医院没有提供心脏生物标志物检测。POCT实施面临的挑战包括:(a)非实验室人员的质量保证负担;(b)支持POCT项目的人力资源有限,包括几乎完全没有POC协调员;(c)没有国家POCT政策和指导方针。为了纠正这些缺陷,我们建议在各级开展基础教育,促进POC协调员用户群体,提高对现有POCT的认识,并积极开展国际交流,以提高越南的护理标准。
{"title":"The Status of Point-of-Care Testing and Coordinators in Vietnam","authors":"Thuy Nguyen, G. Kost","doi":"10.1097/poc.0000000000000196","DOIUrl":"https://doi.org/10.1097/poc.0000000000000196","url":null,"abstract":"Supplemental digital content is available in the text. Objectives The goals of this study were as follows: (a) to enhance point-of-care testing (POCT) and improve standards of care throughout Vietnam; (b) to educate point-of-care (POC) coordinators who provide leadership, oversight, and quality assurance; and (c) to promote international dialog and knowledge of POCT in limited-resource settings. Methods Needs assessment of 16 provincial hospitals, 2 each randomly chosen from the 8 geographic regions of Vietnam, was performed. In Ho Chi Minh City, 10 referral, 5 provincial, and 7 district hospitals, and 8 community medical stations were surveyed. Emergency and intensive care unit nurses and doctors, and laboratorian were respondents. Results Glucose meters and blood gas analyzers were the most frequent POC devices in the 16 provincial hospitals. Cardiac biomarker, coagulation, and human immunodeficiency tests were the highest needs. Biomedical engineers managed locations and quality. Point-of-care coordinators were deficient. Generally, hospitals with POCT had no laboratory oversight. Users performed POCT without internal or external quality control (QC). In Ho Chi Minh City, coagulation and cardiac biomarker tests were most desired. Conclusions Clinicians were poorly informed about the availability of urgent, emergency department, and bedside POC tests. No provincial hospitals surveyed offered cardiac biomarker testing, despite the high prevalence of acute coronary syndromes. Challenges to the implementation of POCT comprise: (a) the quality assurance burden for non laboratory personnel; (b) limited human resources to support POCT programs, including virtually total absence of POC coordinators; and (c) no national POCT policy and guidelines. To rectify these deficiencies, we recommend fundamental education at all levels, promotion of POC coordinator user groups, heightened awareness of available POCT, and vigorous international exchanges to enhanced standards of care in Vietnam.","PeriodicalId":20262,"journal":{"name":"Point of Care: The Journal of Near-Patient Testing & Technology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80731523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
AACC Presents: 27th International CPOCT Symposium The Role of Point-of-Care Testing in a Value-Based Healthcare Landscape AACC介绍:第27届国际CPOCT专题讨论会:护理点测试在基于价值的医疗保健领域的作用
Pub Date : 2019-12-01 DOI: 10.1097/poc.0000000000000195
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引用次数: 0
Usability of IBDoc, a Novel Fecal Calprotectin Home-Based Rapid Test in Clinical Practice 新型粪钙保护蛋白家庭快速检测方法IBDoc的临床应用
Pub Date : 2019-09-01 DOI: 10.1097/POC.0000000000000192
M. Røer, M. Småstuen, A. Røseth
Abstract The aim of this study was to examine sustained usability and adherence to a fecal calprotectin (FC) home-based rapid test in an inflammatory bowel disease (IBD) monitoring program in clinical practice. Methods In total, 59 consecutive IBD outpatients were recruited. The participants were asked to measure FC with a home-based rapid test, IBDoc, every second month for a period of 14 months. At start and termination of this time period, they were invited to answer a questionnaire concerning the IBDoc device. The participants were also asked to deliver one stool sample for FC to be analyzed with enzyme-linked immunosorbent assay and analyze the same sample with the home-based FC test at start and termination. Results In total, one-third (34%) of the participants were adherent to the IBDoc program. No patient characteristics were significantly associated with being adherent. The home-based test correlated well with enzyme-linked immunosorbent assay method (Spearman rank correlation coefficient was 0.92, P < 0.001 and 0.74, P < 0.001, at study start and termination, respectively). After having used the IBDoc for over a year, all except for 1 of the 36 participants answering the follow-up questionnaire completely agreed with the statement “I would like to use IBDoc in the future.” Conclusions We found a low adherence to home-based FC measurements every second month for a period of 14 months. Nevertheless, all but 1 of the 36 participants who answered the follow-up questionnaire were interested in continuing using the IBDoc test.
本研究的目的是在临床实践中检查在炎症性肠病(IBD)监测项目中粪便钙保护蛋白(FC)家庭快速检测的持续可用性和依从性。方法共招募59例连续IBD门诊患者。参与者被要求在14个月的时间里,每两个月用基于家庭的快速测试IBDoc来测量FC。在这段时间的开始和结束时,他们被邀请回答一份关于IBDoc装置的问卷。参与者还被要求提供一份粪便样本进行FC分析,用酶联免疫吸附法分析,并在开始和结束时用家庭FC测试分析同一样本。结果:总共有三分之一(34%)的参与者坚持IBDoc计划。没有患者特征与依从性显著相关。家庭检测与酶联免疫吸附法相关性良好(在研究开始和结束时,Spearman秩相关系数分别为0.92,P < 0.001和0.74,P < 0.001)。在使用IBDoc一年多后,36名回答随访问卷的参与者中,除了1人之外,其余的人都完全同意“我想在未来使用IBDoc”的说法。结论:我们发现,在14个月的时间里,每两个月进行一次家庭FC测量的依从性很低。然而,在36名回答了后续问卷的参与者中,除了1人之外,其他人都对继续使用IBDoc测试感兴趣。
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引用次数: 3
Beyond Price and Functionality 超越价格和功能
Pub Date : 2019-09-01 DOI: 10.1097/POC.0000000000000194
Becky Clarke
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引用次数: 0
The Creation of Point-of-Careology 心理学点的产生
Pub Date : 2019-09-01 DOI: 10.1097/POC.0000000000000191
Xiguang Liu, Xiangzhi Zhu, G. Kost, John Liu, Jing Huang, Xin Liu
Goals The objectives of this study were to improve awareness of point-of-care testing as a new medical field, to solidify relationships among point-of-care professionals and other medical disciplines, and to identify potential for advancing medical applications, economic benefits, and patient impact through timely decision-making for evidence-based medicine. Methods Literature review, comprehensive analysis, focused analysis, inductive logic, general summary of international outcomes, and comparative advances that improve point-of-care impact in China and other countries in need of rapid response were performed in this study. Results The creation of point-of-careology comprised the following: (a) introduction of its research and practical scope, (b) appropriate definition of this new field, (c) description of the range of applications, and (d) identification of relationships with other disciplines. Conclusions Point-of-care testing now is being written into a professional textbook in medical schools in China. Point-of-careology is the outcome of evolution in intelligent diagnostics. Notable achievements in critical care medicine, emergency response, and general practice have resulted from the implementation of point-of-care testing over the past 4 decades. As a new discipline, point-of-careology will contribute to key medical areas, such as disaster preparedness and public health, which we explore. The creation of this new specialty is justified by trends in modern medicine with improved service to the public and by parallel technological advances that empower health care providers at sites of need to deliver complete care cycles quickly and effectively.
本研究的目的是提高人们对护理点检测作为一个新的医学领域的认识,巩固护理点专业人员与其他医学学科之间的关系,并通过及时决策来确定推进医疗应用、经济效益和患者影响的潜力。方法采用文献综述、综合分析、重点分析、归纳逻辑、国际成果综述、中国和其他需要快速反应的国家在提高医疗点影响方面的比较进展。研究点学的创建包括以下内容:(a)对其研究和实践范围的介绍,(b)对这一新领域的适当定义,(c)对应用范围的描述,以及(d)确定与其他学科的关系。结论:目前,中国的医学院校正在将即时检测写入专业教材。诊断点是智能诊断进化的结果。在过去的40年里,在重症监护医学、应急反应和全科实践中,由于实施了即时检测,取得了显著的成就。作为一门新兴学科,护理点学将为我们正在探索的灾难准备和公共卫生等关键医学领域做出贡献。现代医学的发展趋势改善了对公众的服务,同时技术的进步使医疗保健提供者能够在需要的地方快速有效地提供完整的护理周期,这证明了创建这一新专业的合理性。
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引用次数: 6
期刊
Point of Care: The Journal of Near-Patient Testing & Technology
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