scholarly journals SARS-CoV-2 screening in patients in need of urgent inpatient treatment in the Emergency Department (ED) by digitally integrated point-of-care PCR: A clinical cohort study

2022 ◽  
Author(s):  
Martin Mockel ◽  
Myrto Bolanaki ◽  
Joerg Hofmann ◽  
Angela Stein ◽  
Jennifer Hitzek ◽  
...  
Keyword(s):  
Emergency Department ◽  
Inpatient Treatment ◽  
Point Of Care ◽  
Test Results ◽  
Central Laboratory ◽  
Clinical Cohort ◽  
Very High ◽  
Test Result ◽  
Performance Trial ◽  
Pcr Test

Patients in need of urgent inpatient treatment were recruited prospectively. A rapid point of care PCR test (POC-PCR; Liat) for SARS-CoV2 was conducted in the ED and a second PCR-test from the same swab was ordered in the central laboratory (CL-PCR). POC-PCR analyzers were digitally integrated in the laboratory information system. Overall, 160 ED patients were included. A valid POC-PCR-test result was available in 96.3% (n=154) of patients. N=16 patients tested positive for SARS-CoV-2 (10.0%). The POC PCR test results were available within 102 minutes (median, IQR: 56-211), which was significantly earlier compared to the CL PCR (811 minutes; IQR: 533-1289, p < 0.001). The diagnostic accuracy of the POC- PCR test was 100%. The implementation and digital LIS integration was successfully done. Staff satisfaction with the POC process was high. The POC-PCR testing in the emergency department is feasible and shows a very high diagnostic performance. Trial registration: DRKS00019207

Death and COVID-19 Anxiety in Home-Quarantined Individuals Aged 65 and Over During the Pandemic

2021 ◽  
pp. 003022282110598
Author(s):  
Hümeyra Aslaner ◽  
Betül Özen ◽  
Zeliha K. Erten ◽  
Mebrure Beyza Gökçek
Keyword(s):  
Polymerase Chain Reaction ◽  
Death Anxiety ◽  
Short Form ◽  
Anxiety Score ◽  
Test Results ◽  
Rt Pcr ◽  
Chain Reaction ◽  
Polymerase Chain ◽  
Test Result ◽  
Pcr Test

Urgent measures were taken for those at the age of 65 and over who were at the risk group all over the world due to the COVID-19 pandemic. It is known that many individuals at the age of 65 and over have experienced anxiety due to the uncertainties. This study aimed to determine the anxiety and death anxiety in individuals aged 65 and over who were isolation at home due to being diagnosed with COVID-19 or being in contact during the pandemic process. The study is descriptive and cross-sectional. It was performed with 656 home-quarantined individuals aged between 65–80 years with positive or negative real-time polymerase chain reaction (RT-PCR) test result. A form including questions about the death anxiety and the Coronavirus Anxiety Scale Short Form prepared by the researchers were administered to the individuals by phone call. Of the participants, 49.5% were male. Median COVID-19 anxiety score was 4 (0–18). Anxiety scores of the male and female participants were similar. Participants with negative polymerase chain reaction (PCR) results and those with death anxiety had higher COVID anxiety scores. Death anxiety has increased by 1.661 times in male gender, 1.983 times in RT-PCR positivity and 0.146 times in the presence of symptoms. Individuals with positive COVID-19 test results or those aged 65 and over who had death anxiety and negative COVID-19 test result but who were in home-isolation due to being a contact had higher anxiety score. For this reason, those with death anxiety can be supported in line with their religious beliefs to reduce anxiety. Those with negative PCR test results in quarantine can be adequately informed about the COVID-19.

Unpacking the black box: Empirical evidence to understand the human factor for effective rapid testing against SARS-CoV2

2021 ◽  
Author(s):  
Cornelia Betsch ◽  
Philipp Sprengholz ◽  
Regina Siegers ◽  
Sarah Eitze ◽  
Lars Korn ◽  
...  
Keyword(s):  
Social Life ◽  
Point Of Care ◽  
Test Results ◽  
Rapid Testing ◽  
Infection Rates ◽  
Cross Sectional ◽  
Home Tests ◽  
Data Collections ◽  
Willingness To Use ◽  
Test Result

SARS-CoV-2 rapid antigen point-of-care (PoC) and home tests are available to laypeople. This raises questions regarding the drivers and barriers of people’s willingness to use tests, their understanding of test results and the psychological and behavioural consequences of positive and negative test results. Four cross-sectional data collections, including survey items, open text answers and three experiments, were therefore conducted between December 2020 and March 2021, involving 4,026 German participants. The majority was willing to use PoC or home tests. People will be more likely to use tests when they are inexpensive and easy to use or when they are a necessary (given low infection rates) for obtaining access to public and social life. However, people urgently need information about what a test result means and how they should behave. Recommendations based on the present findings could make rapid testing a successful pillar of pandemic management.

scholarly journals Point-of-care testing for bacterial infection in diabetic foot ulcers: a prospective cohort study

2020 ◽  
Vol 29 (11) ◽  
pp. 649-657
Author(s):  
Leon Jonker ◽  
Danielle Smith ◽  
Emma Mark ◽  
Jose Schutter ◽  
Sarah Thornthwaite ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Wound Infection ◽  
Diabetic Foot ◽  
Host Response ◽  
Point Of Care ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Test Results ◽  
Infection Detection ◽  
Test Result

Objective: To appraise the performance of a new point-of-care wound infection detection kit in diabetic foot ulcers (DFUs), using clinician opinion as the primary comparator. The proprietary swab-based chromatic Glycologic (Glycologic Ltd., UK) detection kit used in this study is designed to detect host response to pathogenic levels of bacteria in wounds. Method: In high-risk podiatry clinics, patients with DFUs were recruited and infection detection kit test results compared with initial clinician opinion. Chi-squared tests, principal component analysis (PCA) and multiple regression analysis were performed to determine which variables were possibly associated with infection. The variables considered were patients' wound parameters, wider vascular comorbidity and demographics. Results: A total of 136 patients, providing 383 wound swabs, were included in the study. Total agreement in terms of DFU wound assessment for infection—between podiatrists' clinical opinion and Glycologic kit test result—was observed in 79% of cases (301/383). For 56 of the 349 negative infection detection kit test results (16%), podiatrists identified a ‘possible’ or ‘definite’ infection. Conversely, in 14 of the 307 cases (4.6%) where podiatrists deemed the wound ‘not infected’, the infection detection kit test showed a colour change. Regression analysis and PCA showed that clinical signs of wound infection, namely erythema, purulence and odour, were all significantly associated with both a positive clinical opinion and infection detection kit test result. However, in the case of the infection detection kit, a patient's number of lesions and vascular comorbidities were also significantly correlated with a positive test result. Conclusion: A host response to critical pathological levels of bioburden in a wound—as detected with the infection detection kit—may partly be determined by an individual patient's (vascular) health and therefore be person-specific. Further research is indicated to determine the relationship between an infection detection kit test result and the microbiological status of the wound.

scholarly journals Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Breanna Wright ◽  
Alyse Lennox ◽  
Mark L. Graber ◽  
Peter Bragge
Keyword(s):  
Diagnostic Test ◽  
Point Of Care ◽  
Patient Perspectives ◽  
Audit And Feedback ◽  
Rapid Review ◽  
Test Results ◽  
Multiple Perspectives ◽  
Communication Breakdown ◽  
Closing The Loop ◽  
Test Result

Abstract Background Communication failures involving test results contribute to issues of patient harm and sentinel events. This article aims to synthesise review evidence, practice insights and patient perspectives addressing problems encountered in the communication of diagnostic test results. Methods The rapid review identified ten systematic reviews and four narrative reviews. Five practitioner interviews identified insights into interventions and implementation, and a citizen panel with 15 participants explored the patient viewpoint. Results The rapid review provided support for the role of technology to ensure effective communication; behavioural interventions such as audit and feedback could be effective in changing clinician behaviour; and point-of-care tests (bedside testing) eliminate the communication breakdown problem altogether. The practice interviews highlighted transparency, and clarifying the lines of responsibility as central to improving test result communication. Enabling better information sharing, implementing adequate planning and utilising technology were also identified in the practice interviews as viable strategies to improve test result communication. The citizen panel highlighted technology as critical to improving communication of test results to both health professionals and patients. Patients also highlighted the importance of having different ways of accessing test results, which is particularly pertinent when ensuring suitability for vulnerable populations. Conclusions This paper draws together multiple perspectives on the problem of failures in diagnostic test results communication to inform appropriate interventions. Across the three studies, technology was identified as the most feasible option for closing the loop on test result communication. However, the importance of clear, consistent communication and more streamlined processes were also key elements that emerged. Review registration The protocol for the rapid review was registered with PROSPERO CRD42018093316.

scholarly journals Impact of point-of-care testing on patients' length of stay in a large emergency department

1996 ◽  
Vol 42 (5) ◽  
pp. 711-717 ◽  
Author(s):  
C A Parvin ◽  
S F Lo ◽  
S M Deuser ◽  
L G Weaver ◽  
L M Lewis ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Point Of Care ◽  
Control Period ◽  
Experimental Period ◽  
Central Laboratory ◽  
Point Of Care Testing ◽  
Acceptable Accuracy ◽  
Patient Interview ◽  
Combined Control

Abstract We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the two control periods) had at least one Na, K, Cl, BUN, or Gluc test ordered from the ED. However, no decrease in ED LOS was observed in the tested patients during the experimental period. Median LOS during the experimental period was 209 min vs 201 min for the combined control periods. Stratifying patients by presenting condition (chest pain, trauma, etc.), discharge/admit status, or presence/absence of other central laboratory tests did not reveal a decrease in patient LOS for any patient subgroup during the experimental period. From these observations, we consider it unlikely that routine use of a hand-held POCT device in a large ED such as ours is sufficient by itself to impact ED patient LOS.

Two-Tier Lyme Disease Serology Test Results Can Vary According to the Specific First-Tier Test Used

2019 ◽  
Vol 9 (2) ◽  
pp. 128-133 ◽  
Author(s):  
Alexandra B Maulden ◽  
Aris C Garro ◽  
Fran Balamuth ◽  
Michael N Levas ◽  
Jonathan E Bennett ◽  
...  
Keyword(s):  
Emergency Department ◽  
Lyme Disease ◽  
Serum Sample ◽  
Erythema Migrans ◽  
Clinical Suspicion ◽  
Test Results ◽  
Number Of Children ◽  
High Clinical Suspicion ◽  
Serology Test ◽  
Test Result

Abstract Background Variability in 2-tier Lyme disease test results according to the specific first-tier enzyme immunoassay (EIA) in children has not been examined rigorously. In this study, we compared paired results of clinical 2-tier Lyme disease tests to those of the C6 peptide EIA followed by supplemental immunoblotting (C6 2-tier test). Methods We performed a prospective cohort study of children aged ≥1 to ≤21 years who were undergoing evaluation for Lyme disease in the emergency department at 1 of 6 centers located in regions in which Lyme disease is endemic. The clinical first-tier test and a C6 EIA were performed on the same serum sample with supplemental immunoblotting if the first-tier test result was either positive or equivocal. We compared the results of the paired clinical and C6 2-tier Lyme disease test results using the McNemar test. Results Of the 1714 children enrolled, we collected a research serum sample from 1584 (92.4%). The clinical 2-tier EIA result was positive in 316 (19.9%) children, and the C6 2-tier test result was positive or equivocal in 295 (18.6%) children. The clinical and C6 2-tier test results disagreed more often than they would have by chance alone (P = .002). Of the 39 children with either a positive clinical or C6 2-tier test result alone, 2 children had an erythema migrans (EM) lesion, and 29 had symptoms compatible with early disseminated Lyme disease. Conclusions Two-tier Lyme disease test results differed for a substantial number of children on the basis of the specific first-tier test used. In children for whom there is a high clinical suspicion for Lyme disease and who have an initially negative test result, clinicians should consider retesting for Lyme disease.

Implementation of a Point-of-Care Satellite Laboratory in the Emergency Department of an Academic Medical Center

2003 ◽  
Vol 127 (4) ◽  
pp. 456-460 ◽  
Author(s):  
Elizabeth Lee-Lewandrowski ◽  
Daniel Corboy ◽  
Kent Lewandrowski ◽  
Julia Sinclair ◽  
Steven McDermot ◽  
...  
Keyword(s):  
Emergency Department ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Test Accuracy ◽  
Central Laboratory ◽  
Urine Dipstick ◽  
Academic Medical ◽  
Clinician Satisfaction ◽  
Satisfaction Surveys

Abstract Context.—Emergency department (ED) overcrowding has reached crisis proportions in the United States. Many hospitals are seeking to identify process reengineering efforts to reduce crowding and ED patient length of stay (LOS). Objectives.—To investigate the impact of a point-of-care testing (POCT) satellite laboratory in the ED of a large academic medical center. Setting.—The ED of the Massachusetts General Hospital, Boston, Mass. Design and Outcome Measures.—Evaluation of physician satisfaction, turnaround time (TAT), and ED LOS before and after implementation of a POCT laboratory. ED LOS was measured by patient chart audits. TAT was assessed by manual and computer audits. Clinician satisfaction surveys measured satisfaction with test TAT and test accuracy. Results.—Blood glucose, urine human chorionic gonadotropin, urine dipstick, creatine kinase–MB, and troponin tests were performed in the ED POCT laboratory. Test TAT declined an average of 87% after the institution of POCT. The ED LOS decreased for patients who received pregnancy testing, urine dipstick, and cardiac markers. Although these differences were not significant for individual tests, when the tests were combined, the decreased LOS was, on average, 41.3 minutes (P = .006). Clinician satisfaction surveys documented equivalent satisfaction with test accuracy between the central laboratory and the POCT laboratory. These surveys also documented dissatisfaction with central laboratory TAT and increased satisfaction with TAT of the POCT program (P &lt; .001). Conclusions.—The POCT satellite laboratory decreased test TAT and decreased ED LOS. There was excellent satisfaction with test accuracy and TAT.

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