scholarly journals Point-of-Care Assessment of Antiplatelet Agents in the Perioperative Period: A Review

2009 ◽  
Vol 37 (3) ◽  
pp. 354-369 ◽  
Author(s):  
N. M. Gibbs
Keyword(s):  
Platelet Function ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Perioperative Period ◽  
Cyclooxygenase Inhibitors ◽  
Antiplatelet Drug ◽  
Monitoring Therapy ◽  
Platelet Aggregometry ◽  
Care Assessment ◽  
The Impact

The aim of this paper was to review the strengths and limitations of current ‘point-of-care’ techniques for the detection of antiplatelet drug effects. The review was based on a Medline search for articles with key words related to “platelet function tests”, “point-of-care”, and “anaesthesia”, published in English between January 1996 and September 2008. It was found that global assessments of ‘haemostasis’, such as the standard thrombelastograph®, Sonoclot®, Clot Signature Analyser® and Hemodyne™, are not specific for platelet function and are essentially insensitive to cyclooxygenase inhibitors (aspirin, non-steroidal anti-inflammatory drugs) and P2Y12 antagonists (ticlopidine, clopidogrel). Global assessments of ‘platelet function’, such as the PFA-100® and PlateletWorks®, are more specific for platelet function, but also have limited sensitivity for cyclooxygenase inhibitors and P2Y12 antagonists. The newer devices developed specifically for the assessment of antiplatelet drugs, such as Platelet Mapping, the Impact™ Cone and Platelet Analyser and the VerifyNow®, are more promising, but are not as sensitive as laboratory platelet aggregometry. All three categories of devices detect GpIIb/IIIa antagonists (abciximab, tirofiban, eptfibatide) activity, but not all provide quantitative assessments for monitoring therapy. The limitations appeared to be related to the complexity of platelet function, the multiple pathways of platelet activation, the wide interpatient variability in platelet responses and the interdependence between platelets and other aspects of coagulation. The strengths and limitations of point-of-care devices should be appreciated before they are used to assist clinical decision-making in the perioperative period.

The impact and management of acquired platelet dysfunction

2011 ◽  
Vol 31 (01) ◽  
pp. 28-40 ◽  
Author(s):  
M. M. Rahman ◽  
H. Seidel ◽  
R. E. Scharf
Keyword(s):  
Platelet Function ◽  
Factor Viia ◽  
Ex Vivo ◽  
Point Of Care ◽  
Bleeding Complications ◽  
Platelet Dysfunction ◽  
Vascular Events ◽  
Platelet Aggregometry ◽  
Careful Clinical Examination ◽  
The Impact

SummaryPlatelet function can be abnormally increased, as in association with acute vascular events, or defective, as in a variety of clinical settings. Acquired platelet dysfunction may occur at any age and range in severity from mild to life-threatening haemorrhages. Diagnostic work-up of platelet disorders requires meticulous evaluation of medical history, specifically of any drugs interfering with platelet function, careful clinical examination and a staged laboratory protocol to assess the underlying platelet defect(s). To identify hyperactive platelets ex vivo, costly procedures may be required using flow cytometry and distict epitope-specific monoclonal antibodies. Currently, this approach can be recommended for research purposes only. Drugs represent the most common cause of platelet dysfunction in our overmedicated society. While aspirin, clopigogrel (more recently also prasugrel) and integrin αIIbβ3 (GPIIb-IIIa) receptor antagonists (ab-ciximab, eptifibatide and tirofiban) are well-known prototypes of antiplatelet drugs, other widely used agents (e.g. nonsteroidal anti-inflammatory drugs, antibiotics, serotonin reup-take inhibitors and volume expanders) can also impair platelet function and thus cause or aggravate hemorrhages. Identification of individual patients with pre-existing hemostatic defects remains crucial (i) to prevent bleeding complications, (ii) to manage symptoms adequately, (iii) to minimize the risk from invasive procedures, and (iv) to avoid unnecassary exposure to blood products. Screening for platelet dysfunction can be performed by point-of-care testing followed by platelet aggregometry in response to various agonists. While mild bleeding episodes due to antiplatelet therapy can be managed by withdrawal of the drug(s), severe hemorrhages may require immediate platelet transfusions. Apart from that, the prohemostatic armamentarium is limited to desmopressin, antifi-brinolytic agents, and recombinant factor VIIa.

scholarly journals Early Multi-organ Point-of-Care Ultrasound Evaluation of Respiratory Distress During SARS-CoV-2 Outbreak: Case Report

2020 ◽  
Vol 4 (2) ◽  
Author(s):  
Robert Farrow ◽  
Graham Becherer-Bailey ◽  
Daniel Mantuani ◽  
Arun Nagdev
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Respiratory Distress ◽  
Clinical Decision Making ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Case Series ◽  
Disease Process ◽  
Point Of Care Ultrasound ◽  
Care Assessment

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several case series from Italy and China have highlighted the lung ultrasound findings of this disease process and may demonstrate its clinical utility during the current pandemic. Case Report: We present a case of a COVID-19 patient who presented to the emergency department twice within a 24-hour period with rapidly progressing illness. A multi-organ point-of-care ultrasound (POCUS) evaluation was used on the return visit and assisted clinical decision-making. Discussion: A multi-organ POCUS exam allows for quick assessment of acute dyspnea in the emergency department. As the lung involvement of COVID-19 is primarily a peripheral process it is readily identifiable via lung ultrasound. We believe that when applied efficiently and safely a POCUS exam can reduce clinical uncertainty and potentially limit the use of other imaging modalities when treating patients with COVID-19. Conclusion: This case highlights the utility of an early multiorgan point-of-care assessment for patients presenting with moderate respiratory distress during the severe SARS-CoV-2 pandemic.

scholarly journals Point-of-care assessment of platelet function in the peri-operative period

Anaesthesia ◽  
2008 ◽  
Vol 63 (2) ◽  
pp. 217-217 ◽  
Author(s):  
C. N. Melikian ◽  
K. James ◽  
S. V. Mallett
Keyword(s):  
Platelet Function ◽  
Point Of Care ◽  
Care Assessment

scholarly journals Perception and Usage of Point of Care Devices: A Cross-sectional Study Targeting Residents and Trainers in Oman

2021 ◽  
Vol 36 (1) ◽  
pp. e213-e213
Author(s):  
Amna Al Harrasi ◽  
Laila Mohammed Al Mbeihsi ◽  
Abdulhakeem Al Rawahi ◽  
Mohammed Al Shafaee
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Cross Sectional Study ◽  
Mobile Technologies ◽  
Handheld Devices ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Impact

Objectives: The use of mobile technologies and handheld computers by physicians has increased worldwide. However, there are limited studies globally regarding training physicians on the use of such devices in clinical practice. In addition, no studies have been conducted previously in Oman addressing this issue among postgraduate medical trainees and trainers. The present study explores the practice and perception of resident doctors and trainers towards the use of mobile technologies and handheld devices in healthcare settings in Oman. Methods: This cross-sectional study was conducted using a validated questionnaire disseminated via email to all residents and trainers in five major training programs of the Oman Medical Specialty Board (OMSB). The questionnaire explored three main areas; perception, usage, and perceived barriers of handheld devices. Results: Overall, 61.4% of the residents and 28.3% of the trainers responded to the questionnaire. Both types of participants agreed that the use of such devices positively affects clinical decision-making. In total, 98.8% of the participating residents and 86.7% of the trainers frequently used handheld devices. Both OMSB residents and trainers agreed that lack of time, training, and applications were the most common factors limiting the use of these devices. Participants emphasized the need for constructive training regarding the use of handheld devices as healthcare resources. Conclusions: Point-of-care devices are positively perceived and frequently used by OMSB trainees and trainers. However, constructive training on the effective usage of these devices in clinical decision-making is needed. Further future studies to evaluate the impact of using such devices in patient care should be conducted.

scholarly journals Evaluation of a Point-of-Care Ultrasound (POCUS) training course for Regional Anesthesiologists – A Single Institution’s Experience

2020 ◽  
Vol 1 (2) ◽  
pp. 1-7
Author(s):  
Alex K. Saltzman ◽  
Thuyvan H. Luu ◽  
Nicole Brunetti ◽  
James D. Beckman ◽  
Mary J. Hargett ◽  
...  
Keyword(s):  
Decision Making ◽  
Regional Anesthesia ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Left Ventricular ◽  
P Value ◽  
Point Of Care Ultrasound ◽  
Training Course ◽  
The Impact

Background and Objectives: Point-of-care ultrasound (POCUS) in the form of focused cardiac ultrasound (FOCUS) is a powerful clinical tool for anesthesiologists to supplement bedside evaluation and optimize cardiopulmonary resuscitation in the perioperative setting. However, few courses are available to train physicians. At Hospital for Special Surgery (HSS), from March of 2013 to May of 2016, nine basic Focused Assessed Transthoracic Echocardiography (FATE) training courses were held. A large percentage of the participants were practicing regional anesthesiologists or trainees in fellowship for regional anesthesia and acute pain. In this study, a survey was used to assess clinical utilization as well as potential barriers to use for regional anesthesiologists. Methods: Following IRB approval, 183 past participants of the basic FATE training course were contacted weekly from November 22nd, 2016, through January 3rd, 2017, via email and sent a maximum 40-item electronic survey hosted on REDCap. Responses were analyzed by a blinded statistician. Results: 92 participants responded (50%), and 65 of the 92 (70.7%) indicated they had regional anesthesiology training or practice regional anesthesia regularly. Of the total number of respondents, 50% (95% CI: 40.3%, 59.8%; P-value = 0.001) have used FOCUS to guide clinical decision making. Of the regional anesthesiologists, 27 (45.8%) have used FOCUS to guide clinical decision making with left ventricular function assessment (40.7%) and hypovolemia (39.0%) being the most common reasons. Regional anesthesiologists utilized FOCUS in the following settings: preoperatively (44.6%), intraoperatively (41.5%), postoperatively (41.5%), and in the Intensive Care Unit (40.0%). Limitations were due to lack of opportunities (52.3%), resources (36.9%), and comfort with performance (30.8%). 84.4% agreed that basic FOCUS training should be a required part of anesthesia residents or fellows’ curriculum. Conclusions: This study is the first formal evaluation of the impact of the implementation of a FOCUS training course on regional anesthesiologists’ current practice. Nearly 50% of regional anesthesiologists used FOCUS to guide clinical decision-making following formal training. The limitations to the use of FOCUS were a lack of relevant opportunities and resources. This evaluation of clinical use following training provides insight into how FOCUS is used by regional anesthesiologists and the limitations to implementation in the perioperative setting.

scholarly journals Point-of-care platelet function tests: relevance to arterial thrombosis and opportunities for improvement

2020 ◽  
Author(s):  
Diana A. Gorog ◽  
Richard C. Becker
Keyword(s):  
Platelet Aggregation ◽  
Platelet Function ◽  
Arterial Thrombosis ◽  
Point Of Care ◽  
Laboratory Research ◽  
Platelet Function Tests ◽  
Function Tests ◽  
Antiplatelet Medication ◽  
Platelet Aggregometry

Abstract Studies using whole blood platelet aggregometry as a laboratory research tool, provided important insights into the mechanism and modulators of platelet aggregation. Subsequently, a number of point-of-care (POC) platelet function tests (PFTs) were developed for clinical use, based on the concept that an individual’s thrombotic profile could be assessed in vitro by assessing the response to stimulation of platelet aggregation by specific, usually solo agonists such as adenosine diphosphate (ADP), collagen and thrombin. However, adjusting antiplatelet medication in order to improve the results of such POC PFTs has not translated into a meaningful reduction in cardiovascular events, which may be attributable to important differences between the POC PFT techniques and in vivo conditions, including patient-to-patient variability. Important limitations of most tests include the use of citrate-anticoagulated blood. Citrate directly and irreversibly diminishes platelet function and even after recalcification, it may result in altered platelet aggregation in response to ADP, epinephrine or collagen, and interfere with thrombin generation from activated platelets. Furthermore, most tests do not employ flowing blood and therefore do not assess the effect of high shear forces on platelets that initiate, propagate and stabilize arterial thrombi. Finally, the effect of endogenous thrombolysis, due to fibrinolysis and dislodgement, which ultimately determines the outcome of a thrombotic stimulus, is mostly not assessed. In order to accurately reflect an individual’s predisposition to arterial thrombosis, future tests of thrombotic status which overcome these limitations should be used, to improve cardiovascular risk prediction and to guide pharmacotherapy.

scholarly journals Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing

2018 ◽  
Vol 71 (12) ◽  
pp. 1065-1071 ◽  
Author(s):  
Thomas R Fanshawe ◽  
José M Ordóñez-Mena ◽  
Philip J Turner ◽  
Ann Van den Bruel ◽  
Brian Shine ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
General Practice ◽  
Laboratory Test ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Hierarchical Cluster ◽  
Full Blood Count ◽  
Function Tests ◽  
The Impact ◽  
Test Request

AimsThe demand for test requests from general practice to laboratory services remains high. Tests performed at the point of care could reduce turnaround time and speed up clinical decision making. Replicating laboratory testing in the community would require panels of tests to be performed simultaneously, which is now approaching technological feasibility. We assessed frequencies and combinations of test requests from community settings to inform the potential future development of multiplex point-of-care panels.MethodsWe assessed all laboratory test requests made from general practice in Oxfordshire, UK, from January 2014 to March 2017. We summarised test request frequency overall and in combination, using heatmaps and hierarchical cluster analysis. Results are also presented by age/sex subgroups. We further assessed patterns of tests requested within 7 and 14 days after an initial test request.Results11 763 473 test requests were made for 413 073 individuals (28% age >65). Of more than 500 test types, 62 were requested at least 5000 times, most commonly renal function tests (approximately 296 000/year), full blood count (278 000/year) and liver function tests (237 000/year). Cluster analysis additionally identified a clear grouping of tests commonly used to investigate anaemia. Follow-up test frequency was much lower than the frequency of multiple tests ordered at initial presentation.ConclusionsThe current high volume of single and combination test requests highlights an opportunity for reliable multiplex point-of-care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.

scholarly journals The impact of mobile technologies on new graduate nurses’ perceived self-efficacy and clinical decision making: A report from a longitudinal study in Western Canada

2017 ◽  
Vol 6 (6) ◽  
pp. 28
Author(s):  
Monique Sedgwick ◽  
Olu Awosoga ◽  
Lance Grigg
Keyword(s):  
Decision Making ◽  
Self Efficacy ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
Mobile Technologies ◽  
Steady Increase ◽  
Pertinent Data ◽  
The Impact ◽  
Over Time

Healthcare environments require practitioners to competently and independently collect pertinent data, select appropriate key resources, prioritize information, solve problems, and make sound clinical decisions. The steady increase of health-related information implies a need for useful, practical Information and Communication Technology (ICT) tools that easily provide nurses’ access to accurate evidence-based information. The purpose of this study was to explore the impact of using mobile technologies at the point of care on new graduates’ perceived clinical decision making ability and associated level of self-efficacy over time. A longitudinal quasi-experimental pre-test/post-test design was used. A trend in the findings of this small study suggests that over time, using mobile technologies at the point of care did not enhance the participants’ perceived clinical decision making ability or self-efficacy in clinical decision making. Notwithstanding, the use of mobile technologies in the practice setting is wide spread. It, however, may be that the transition from student to graduate nurse is a significant enough event that seriously limits the useful influence of mobile devices and their associated applications on clinical decision making ability and self-efficacy.

Point-of-care monitoring of oral anticoagulation therapy in children

2009 ◽  
Vol 102 (07) ◽  
pp. 159-165 ◽  
Author(s):  
Anthea Greenway ◽  
Robyn Summerhayes ◽  
Fiona Newall ◽  
Janet Burgess ◽  
Lydia DeRosa ◽  
...  
Keyword(s):  
Prothrombin Time ◽  
Oral Anticoagulation ◽  
Gold Standard ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Anticoagulation Therapy ◽  
Clinical Decision ◽  
Gold Standard Reference ◽  
Coaguchek Xs ◽  
The Impact

SummaryPoint-of-care (POC) monitoring of oral anticoagulation has been widely adopted in both paediatric and adult patients. A new POC system, the CoaguChek XS® has recently been developed to measure the international normalised ratio (INR) and may offer significant advantages. The CoaguChek XS® utilises a new method of electrochemical clot detection based on thrombin generation. This system has not been previously evaluated in children with reference to the laboratory gold standard, the prothrombin time using reference thromboplastin. It was the objective to compare values obtained by the CoaguChek XS® system with both the venous INR and the gold standard for anticoagulant monitoring, prothrombin time with reference thromboplastin (rTF/95).To evaluate the impact of testing using the Coagu-Chek XS® on clinical anticoagulant dosing decisions. Fifty paired venous INR and capillary CoaguChek XS® results were obtained from 31 children (aged up to 16 years).The laboratory gold standard, a manual prothrombin time with reference thromboplastin (rTF/95) was additionally performed on 26 samples. Correlation between the CoaguChek XS® result and the venous INR was r= 0.810. Agreement between the CoaguChek XS result and the reference INR was shown to be higher (r=0.95), in the subset analysed by this method. Correlation between the venous INR and reference INR was r=0.90. Despite changes to the methodology of testing with the CoaguChek XS® POC monitoring system, the accuracy of this method when compared with both the venous INR and gold standard reference INR was satisfactory. This resulted in infrequent changes to clinical decision making regarding anticoagulation

scholarly journals Assessment of the Impact of Rapid Point-of-Care CD4 Testing in Primary Healthcare Clinic Settings: A Survey Study of Client and Provider Perspectives

Diagnostics ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 81 ◽  
Author(s):  
Shabashini Reddy ◽  
Andrew Gibbs ◽  
Elizabeth Spooner ◽  
Noluthando Ngomane ◽  
Tarylee Reddy ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Clinical Management ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Survey Study ◽  
Time Saving ◽  
Provider Perspectives ◽  
The Impact ◽  
Cd4 Testing

Background: The high burden of disease in South Africa presents challenges to public health services. Point-of-care (POC) technologies have the potential to address these gaps and improve healthcare systems. This study ascertained the acceptability and impact of POC CD4 testing on patients’ health and clinical management. Methods: We conducted a qualitative survey study with patients (n = 642) and healthcare providers (n = 13) at the Lancers Road (experienced POC) and Chesterville (non-experienced POC) primary healthcare (PHC) clinics from September 2015 to June 2016. Results: Patients (99%) at Lancers and Chesterville PHCs were positive about POC CD4 testing, identifying benefits: No loss/delay of test results (6.4%), cost/time saving (19.5%), and no anxiety (5.1%), and 58.2% were ready to initiate treatment. Significantly more patients at Chesterville than Lancers Road PHC felt POC would provide rapid clinical decision making (64.7% vs. 48.1%; p < 0.0001) and better clinic accessibility (40.4% vs. 24.7%; p < 0.0001) respectively. Healthcare providers thought same-day CD4 results would impact: Clinical management (46.2%), patient readiness (46.2%), and adherence (23.0%), and would reduce follow-up visits (7.7%), while 38.5% were concerned that further tests and training (15.4%) were required before antiretroviral therapy (ART) initiation. Conclusion: The high acceptability of POC CD4 testing and the immediate health, structural, and clinical management benefits necessitates POC implementation studies.

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