Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) – does it leverage any advantage in clinical decision making?

2017 ◽  
Vol 54 (7-8) ◽  
pp. 471-494 ◽  
Author(s):  
Christopher Florkowski ◽  
Andrew Don-Wauchope ◽  
Nuria Gimenez ◽  
Karina Rodriguez-Capote ◽  
Julien Wils ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Laboratory Medicine ◽  
Evidence Based ◽  
Point Of Care Testing

Point-of-Care Testing (DRAFT)

2018 ◽  
Author(s):  
Douglas E. Morgan
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Driving Forces ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Care Process ◽  
Point Of Care Testing ◽  
Subsequent Decrease

Point-of-care testing (POCT) is defined as medical diagnostic testing performed outside the clinical laboratory in close proximity to where the patient is receiving care. POCT is typically performed by non-laboratory personnel and the results are used for clinical decision making. When used appropriately, point-of-care testing (POCT) is a valuable resource during the rapid response system (RRS) activation. Advantages include shortened time between acquiring a sample from the patient and analysis of that sample and a subsequent decrease in time to clinical decision making. Disadvantages revolve largely around the cost of POCT. Driving forces behind the movement towards POCT include care process optimization, improvement of patient outcomes, changing regulatory requirements, and changes in the face of the workforce.

scholarly journals Microfluidic-based point-of-care testing for disease diagnosis

2019 ◽  
Vol 131 ◽  
pp. 01004 ◽  
Author(s):  
Ruixuan Wen
Keyword(s):  
Decision Making ◽  
Medical Diagnosis ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Disease Diagnosis ◽  
Rapid Diagnosis ◽  
Design Strategies ◽  
Point Of Care Testing ◽  
Precision Testing

The early detection of diseases is important to optimize clinical treatment. To meet the increasing requirement of rapid medical diagnosis, point-of-care testing (POCT) has drawn scientists’ great attention for its outstanding advantages including simple, efficient, inexpensive and instrument-independent. Recent advantages of microfluidic-based diagnosis have played an important role in the significant technological process of POCT, which can achieve rapid diagnosis and provide high precision testing results for correct clinical decision making. This review focuses on design strategies, detection targets and sensing mechanisms of recent microfluidic-based POCT for disease diagnosis. Further, we provide a perspective of the next generation of POCT devices and their future opportunities.

Using On-Line Medical Knowledge to Support Evidence-Based Practice

2011 ◽  
pp. 187-203
Author(s):  
Daniel L. Moody ◽  
Graeme G. Shanks
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Medical Knowledge ◽  
Clinical Decision ◽  
Evidence Based ◽  
On Line ◽  
Management Project

This paper describes a successful knowledge management project in one of Australia’s state health departments. The objective of the project was to provide medical staff with on-line access to the latest medical knowledge at the point of care in order to improve the quality of clinical decision making. We believe this represents an important case study from both a theoretical and practical viewpoint:

scholarly journals High-Value Consults: A Curriculum to Promote Point-of-Care, Evidence-Based Recommendations

2017 ◽  
Vol 9 (5) ◽  
pp. 640-644 ◽  
Author(s):  
Deepa Rani Nandiwada ◽  
Amar Kohli ◽  
Megan McNamara ◽  
Kenneth J. Smith ◽  
Shanta Zimmer ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
General Medicine ◽  
Clinical Decision ◽  
Evidence Based ◽  
Consultation Process ◽  
Teaching Point ◽  
Consult Process ◽  
Value Based Care

ABSTRACT Background  In an era when value-based care is paramount, teaching trainees to explicitly communicate the evidence behind recommendations fosters high-value care (HVC) in the consultation process. Objective  To implement an HVC consult curriculum highlighting the need for clear consult questions, evidence-based recommendations to improve consult teaching, clinical decision-making, and the educational value of consults. Methods  A pilot curriculum was implemented for residents on cardiology consult electives utilizing faculty and fellows as evidence-based medicine (EBM) coaches. The curriculum included an online module, an EBM teaching point template, EBM presentations on rounds, and “coach” feedback on notes. Results  A total of 15 residents and 4 fellows on cardiology consults participated, and 87% (13 of 15) of residents on consults felt the curriculum was educationally valuable. A total of 80% (72 of 90) of residents on general medicine rotations responded to the survey, and 25 of 72 residents (35%) had a consult with the EBM template. General medicine teams felt the EBM teaching points affected clinical decision-making (48%, 12 of 25) and favored dissemination of the curriculum (90%, 72 of 80). Checklist-guided chart review showed a 22% improvement in evidence-based summaries behind recommendations (7 of 36 precurriculum to 70 of 146 charts postcurriculum, P = .015). Conclusions  The HVC consult curriculum during a cardiology elective was perceived by residents to influence clinical decision-making and evidence-based recommendations, and was found to be educationally valuable on both parties in the consult process.

scholarly journals Evidence-based Laboratory Medicine: Supporting Decision-Making

2000 ◽  
Vol 46 (8) ◽  
pp. 1041-1050 ◽  
Author(s):  
Christopher P Price
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Evidence Base ◽  
Laboratory Medicine ◽  
Experimental Methodology ◽  
Evidence Based ◽  
Test Procedures ◽  
Specific Test ◽  
Explicit Statement

Abstract There is an implicit acceptance that an evidence-based culture underpins the practice of laboratory medicine, in part because it is perceived as the scientific foundation of medicine. However, several reviews of specific test procedures or technologies have shown that the evidence base is limited and in many cases flawed. One of the key deficiencies in the scientific literature on diagnostic tests often is the absence of an explicit statement of the clinical need, i.e., the clinical or operational question that the use of the test is seeking to answer. Several reviews of the literature on specific procedures have also demonstrated that the experimental methodology used is flawed with, in some cases, significant bias being introduced. Despite these limitations it is recognized that a more evidence-based approach will help in the education and training of health professionals, in the creation of a research agenda, in the production of guidelines, in the support of clinical decision-making, and in resource allocation. Furthermore, as knowledge and technologies continue to be developed, an evidence-based strategy will be critical to harnessing these developments.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

POCT errors can lead to false potassium results

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Antonio Buño ◽  
Paloma Oliver
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Point Of Care ◽  
Clinical Intervention ◽  
Clinical Decision ◽  
Whole Process ◽  
Severe Hyperkalemia ◽  
Wrong Diagnosis ◽  
Critical Patients

Abstract Point-of-care-testing (POCT) facilitates rapid availability of results that allows prompt clinical decision making. These results must be reliable and the whole process must not compromise its quality. Blood gas analyzers are one of the most used methods for POCT tests in Emergency Departments (ED) and in critical patients. Whole blood is the preferred sample, and we must be aware that hemolysis can occur. These devices cannot detect the presence of hemolysis in the sample, and because of the characteristics of the sample, we cannot visually detect it either. Hemolysis can alter the result of different parameters, including potassium with abnormal high results or masking low levels (hypokalemia) when reporting normal concentrations. Severe hyperkalemia is associated with the risk of potentially fatal cardiac arrhythmia and demands emergency clinical intervention. Hemolysis can be considered the most frequent cause of pseudohyperkalemia (spurious hyperkalemia) or pseudonormokalemia and can be accompanied by a wrong diagnosis and an ensuing inappropriate clinical decision making. A complete review of the potential causes of falsely elevated potassium concentrations in blood is presented in this article. POCT programs properly led and organized by the clinical laboratory can help to prevent errors and their impact on patient care.

HEALTH TECHNOLOGY ASSESSMENT AND CLINICAL DECISION MAKING:

1999 ◽  
Vol 15 (3) ◽  
pp. 585-592 ◽  
Author(s):  
Alicia Granados
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Technology Assessment ◽  
Case Studies ◽  
Technology Assessment ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Health Technology ◽  
Evidence Based ◽  
Systematic Process

This paper examines the rationality of the concepts underlying evidence—based medicineand health technology assessment (HTA), which are part of a new current aimed at promoting the use of the results of scientific studies for decision making in health care. It describes the different approaches and purposes of this worldwide movement, in relation to clinical decision making, through a summarized set of specific HTA case studies from Catalonia, Spain. The examples illustrate how the systematic process of HTA can help in several types of uncertainties related to clinical decision making.

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