Investigations and microscopy

2019 ◽  
pp. 63-80
Keyword(s):  
Nucleic Acid ◽  
Laboratory Testing ◽  
Trichomonas Vaginalis ◽  
Point Of Care ◽  
Rapid Test ◽  
The Other ◽  
Nucleic Acid Amplification ◽  
Blood Samples ◽  
Dark Ground ◽  
Point Of Care Tests

This chapter covers investigations and tests commonly used in sexual health. Some investigations can be performed on-site as the patient waits, such as urinalysis, pregnancy tests, and increasingly available point of care tests for infections such as HIV and, less commonly, the other blood-borne viruses, syphilis, Trichomonas vaginalis. On-site microscopy helps with diagnosis of genital candidiasis, bacterial vaginosis, N. gonorrhoeae infection, and T. vaginalis. Other investigations require sending samples away for laboratory testing of genital or ulcer swab, urine, or blood samples for STI and blood-borne viruses. This chapter explains the use of light and dark ground microscopy, near patient rapid test technologies, molecular methods such as nucleic acid amplification, culture and serology. Sensitivities and specificities of commonly available test kits are included.

scholarly journals Performance evaluation and acceptability of point-of-care Trichomonas vaginalis testing in adult female emergency department patients

2020 ◽  
Vol 31 (14) ◽  
pp. 1364-1372
Author(s):  
Yu-Hsiang Hsieh ◽  
Mitra K Lewis ◽  
Valentina G Viertel ◽  
Deanna Myer ◽  
Richard E Rothman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Adult Female ◽  
Trichomonas Vaginalis ◽  
Point Of Care ◽  
Rapid Test ◽  
Vaginal Swab ◽  
The Self ◽  
Nucleic Acid Amplification ◽  
Wet Mount ◽  
Self Testing

We evaluated the accuracy and perception of a patient self-administered, tablet-facilitated rapid Trichomonas vaginalis (TV) point-of-care (POC) test in adult female emergency department (ED) patients. ED patients undergoing gynecologic examination were eligible. Each consented participant self-collected a vaginal swab, performed a tablet-facilitated TV rapid test using the OSOM® Trichomonas Rapid Test, and completed pre- and post-test self-surveys. After the self-test, the clinician collected one standard-of-care (SOC) vaginal swab for wet-mount testing and two for research. The research coordinator performed the TV rapid test using the clinician-collected swab, and reported the results to the clinician and patient. If the self- and coordinator-performed results were discordant, a TV nucleic acid amplification test (NAAT) was performed in a clinical laboratory. A survey was later administered to providers to assess their perceptions of the utility of the POC TV test. Of the 136 participants, 134 (98.5%) completed self-testing; two had invalid results. Comparing coordinator-performed TV rapid test adjudicated with NAAT, the sensitivity and specificity of self-administered test was 96.0% and 100%, respectively. The wet mount had a sensitivity of 52.0% and specificity of 100%. TV detection increased from 9.6% with wet mount to 18.4% with the TV rapid test. Most women (82.0%) stated self-testing was “not at all hard” (versus 66.2% before testing, p < 0.001). Clinicians indicated the TV rapid test affected their clinical management in 48.5% of cases, including 82.6% of positive cases and 41.6% of negative cases. ED patients were able to reliably collect, perform, and interpret their own POC TV test using tablet instructions. Both participants and providers reported high levels of acceptability of POC TV testing, which nearly doubled rates of TV detection.

scholarly journals Diagnosis and Treatment of Vaginal Discharge Syndromes in Community Practice Settings

2020 ◽  
Author(s):  
Sharon L Hillier ◽  
Michele Austin ◽  
Ingrid Macio ◽  
Leslie A Meyn ◽  
David Badway ◽  
...  
Keyword(s):  
Trichomonas Vaginalis ◽  
Medical Center ◽  
Point Of Care ◽  
Nucleic Acid Amplification ◽  
Yeast Culture ◽  
Community Practice ◽  
University Of Pittsburgh ◽  
Inappropriate Treatment ◽  
Common Diagnosis ◽  
Point Of Care Tests

Abstract Background Although vaginal symptoms are common, diagnosis of bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and Trichomonas vaginalis (TV) is not standardized. Diagnostic approaches and appropriateness of treatment were evaluated for women with symptoms of vaginitis who were seeking care at community practice sites. Methods Three hundred three symptomatic women, across 8 University of Pittsburgh Medical Center–affiliated clinics, were evaluated per standard office-based practice. Four of 5 vaginal swabs (1 cryopreserved) were collected for a US Food and Drug Administration–authorized nucleic acid amplification test (NAAT) for vaginitis/vaginosis diagnosis; Nugent scoring (BV); yeast culture (VVC); and a second NAAT (for TV). Two hundred ninety women had evaluable samples. Medical record extraction facilitated verification of treatments prescribed within 7 days of the index visit and return visit frequency within 90 days. Results Women had a mean age of 29.4 ± 6.5 years, 90% were not pregnant, 79% were of white race, and 38% reported vaginitis treatment within the past month. Point-of-care tests, including vaginal pH (15%), potassium hydroxide/whiff (21%), and wet mount microscopy (17%), were rarely performed. Of the 170 women having a laboratory-diagnosed cause of vaginitis, 81 (47%) received 1 or more inappropriate prescriptions. Of the 120 women without BV, TV, or VVC, 41 (34%) were prescribed antibiotics and/or antifungals. Among women without infectious vaginitis, return visits for vaginitis symptoms were more common among women treated empirically compared to those not receiving treatment (9/41 vs 5/79, P = .02). Conclusions Within a community practice setting, 42% of women having vaginitis symptoms received inappropriate treatment. Women without infections who received empiric treatment were more likely have recurrent visits within 90 days. Clinical Trials Registration NCT03151928.

scholarly journals »Point-of-Care« D-Dimer Testing

2010 ◽  
Vol 29 (4) ◽  
pp. 282-287 ◽  
Author(s):  
Jovan Antović
Keyword(s):  
Primary Care ◽  
Venous Thromboembolism ◽  
Emergency Departments ◽  
Laboratory Testing ◽  
Point Of Care ◽  
Turnaround Time ◽  
The Other ◽  
Clinical Conditions ◽  
D Dimer ◽  
Laboratory Assay

»Point-of-Care« D-Dimer TestingD-dimer testing is efficient in the exclusion of venous thromboembolism (VTE). D-dimer laboratory assays are predominantly performed in centralised laboratories in intra-hospital settings although most patients with suspected VTE are presented in primary care. On the other hand decreasing turnaround time for laboratory testing may significantly improve efficacy in emergency departments. Therefore an introduction of a rapid, easy to perform point of care (POC) assay for the identification of D-dimer may offer improvement in diagnostics flow of VTE both in primary care and emergency departments while it could also improve our diagnostic possibilities in some other severe clinical conditions (e.g. disseminated intra-vascular coagulation (DIC) and aortic aneurism (AA)) associated with increased D-dimer. Several POC D-dimer assays have been evaluated and majority of them have met the criteria for rapid and safe exclusion of VTE. In our hands three assays (Stratus, Pathfast and Cardiac) have the laboratory performance profile comparable with our routine D-dimer laboratory assay (Tinaqaunt).

scholarly journals Rapid electrostatic DNA enrichment for sensitive detection of Trichomonas vaginalis in clinical urinary samples

2020 ◽  
Vol 12 (8) ◽  
pp. 1085-1093
Author(s):  
Justin M. Rosenbohm ◽  
James M. Robson ◽  
Rishabh Singh ◽  
Rose Lee ◽  
Jane Y. Zhang ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Trichomonas Vaginalis ◽  
Nucleic Acid Amplification ◽  
Urine Samples ◽  
Sensitive Detection ◽  
Isothermal Nucleic Acid Amplification

Rapid electrostatic enrichment of DNA from urine samples for improved isothermal nucleic acid amplification-based detection of Trichomonas vaginalis.

scholarly journals Is There a Role of Using a Rapid Finger Prick Antibody Test in Screening for Celiac Disease in Children?

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Kristina Baraba Dekanić ◽  
Ivona Butorac Ahel ◽  
Lucija Ružman ◽  
Jasmina Dolinšek ◽  
Jernej Dolinšek ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Point Of Care ◽  
Tissue Transglutaminase ◽  
Rapid Test ◽  
Antibody Test ◽  
First Grade ◽  
Iga Deficiency ◽  
Iga Antibodies ◽  
Point Of Care Tests

Introduction. Celiac disease (CD) is an autoimmune disease triggered by gluten in genetically predisposed individuals. Despite the increasing prevalence of CD, many patients remain undiagnosed. Standard serology tests are expensive and invasive, so several point-of-care tests (POC) for CD have been developed. We aimed to determine the prevalence of CD in first-grade pupils in Primorje-Gorski Kotar County, Croatia, using a POC test. Methods. A Biocard celiac test that detects IgA antibodies to tissue transglutaminase in whole blood was used to screen for celiac disease in healthy first-grade children born in 2011 and 2012 who consumed gluten without restrictions. Results. 1478 children were tested, and none of them were tested positive with a rapid test. In 10 children (0,6%), IgA deficiency has been suspected; only 4 of them agreed to be tested further for total IgA, anti-tTG, and anti-DGP antibodies. IgA deficiency was confirmed in 3 patients, and in all 4 children, CD has been excluded. Conclusion. Our results have not confirmed the usefulness of the POC test in screening the general population of first-grade schoolchildren. Further research is needed to establish the true epidemiology of CD in Primorje-Gorski Kotar County and to confirm the value of the rapid test in comparison with standard antibody CD testing.

Long-term dry storage of enzyme-based reagents for isothermal nucleic acid amplification in a porous matrix for use in point-of-care diagnostic devices

The Analyst ◽  
2020 ◽  
Vol 145 (21) ◽  
pp. 6875-6886 ◽  
Author(s):  
Sujatha Kumar ◽  
Ryan Gallagher ◽  
Josh Bishop ◽  
Enos Kline ◽  
Joshua Buser ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Glass Fiber ◽  
Point Of Care ◽  
Porous Matrix ◽  
Isothermal Amplification ◽  
Nucleic Acid Amplification ◽  
Isothermal Nucleic Acid Amplification ◽  
Dry Storage

Long-term dry storage of enzyme-based isothermal amplification reagents in glass fiber porous matrix for use in point-of-care devices.

scholarly journals 2158. Cost-Effectiveness and Budget Impact of a Point-of-Care Nucleic Acid Amplification Test for Diagnosis of Group A Streptococcal Pharyngitis in the United States

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S732-S732
Author(s):  
James Karichu ◽  
Mindy Cheng ◽  
Joanna Sickler ◽  
Julie Munakata ◽  
S Pinar Bilir ◽  
...  
Keyword(s):  
United States ◽  
Cost Effectiveness ◽  
Nucleic Acid ◽  
Budget Impact ◽  
Point Of Care ◽  
Cost Savings ◽  
The United States ◽  
Nucleic Acid Amplification ◽  
Sensitivity Analyses ◽  
Group A

Abstract Background Group A streptococcal (GAS) pharyngitis is common in the United States (US). Each year, approximately 12 million people seek medical care for pharyngitis, accounting for ~2% of ambulatory care visits. The gold standard method for diagnosing GAS is culture. However, because culture is time intensive, rapid antigen detection tests (RADTs), with or without culture confirmation, are commonly used. Although RADTs provide results quickly, test sensitivity has been shown to be sub-optimal, which can lead to inappropriate treatment decisions. Recently, highly sensitive point-of-care nucleic acid amplification tests (POC NAAT), such as the cobas® Liat® System, have emerged. The objective of this study was to evaluate the cost-effectiveness (CE) and budget impact (BI) of adopting POC NAAT compared with RADT+culture confirmation to diagnose GAS pharyngitis from the US third-party payer perspective. Methods A decision-tree economic model was developed in Microsoft Excel to quantify costs and clinical outcomes associated with POC NAAT and RADT+culture over a one-year period. All model inputs were derived from published literature and public databases. Model outputs included costs and clinical effects measured as quality-adjusted life days (QALDs) lost. One-way and probabilistic sensitivity analyses were performed to assess the impact of uncertainty on results. Results CE analysis showed that POC NAAT would cost $44 per patient compared with $78 with RADT+ culture. POC NAAT was associated with fewer QALDs lost relative to RADT+ culture. Therefore, POC NAAT may be considered the “dominant” strategy (i.e., lower costs and higher effectiveness). Findings were robust in sensitivity analyses. BI analysis showed that adopting POC NAAT for diagnosis of GAS could yield cost-savings of 0.3% vs. current budget over 3 years. This is due to savings associated with testing, GAS-related complications, antibiotic treatment and treatment-associated complication costs. Conclusion Results suggest that adopting POC NAAT to diagnose GAS would be considered cost-effective and yield cost-savings for US payers relative to RADT+culture. Access to POC NAAT would be important to optimize appropriate GAS diagnosis and treatment decisions. Disclosures All authors: No reported disclosures.

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