scholarly journals An Overview of Emerging Point-of-Care Tests for Differentiating Bacterial and Viral Infections

2021 ◽  
Vol 1 (12) ◽  
Author(s):  
Sinwan Basharat ◽  
Jennifer Horton
Keyword(s):  
Health Care ◽  
Antibiotic Stewardship ◽  
Viral Infections ◽  
Point Of Care ◽  
Health Concern ◽  
Antibiotic Prescribing ◽  
Suspected Infection ◽  
Diagnostic Uncertainty ◽  
Health Technologies ◽  
Point Of Care Tests

Antimicrobial resistance is an important health concern in Canada and around the world. Although resistance arises naturally, the overuse of antibiotics, among many other behavioural, social, and economic drivers, contributes to the emergence of resistance patterns. Within health care settings, diagnostic uncertainty, a situation in which it is uncertain whether a suspected infection is due to a bacterial, viral, or other microorganism, is a regarded as a key driver that contributes to overuse of antibiotics. In these situations, antibiotics may be prescribed although the infection is viral. Emerging health technologies that can help reduce diagnostic uncertainty of acute infections at the point of care may help reduce the unnecessary use of antibiotics. If these point-of-care diagnostic devices demonstrate clinical benefit and cost-effectiveness for health systems, they may complement other interventions as part of antibiotic stewardship programs. This Horizon Scan provides an overview of new and emerging point-of-care tests that help differentiate bacterial and viral infections. Although rapid tests for identifying specific pathogens have existed for decades, these emerging tests aim to assess a wider range of possible pathogens and help inform treatment decisions. Different types of emerging devices, such as rapid molecular tests and immunoassays, are described including how they work and information about their capabilities that may influence their potential use. The report also describes the evidence about the diagnostic accuracy of certain tests and their effect on reducing antibiotic prescribing. Considerations are provided about where tests might be beneficial, such as primary care settings, and the emerging evidence base for their feasibility and acceptability. The emerging evidence suggests that point-of-care tests could be effective tools as part of antibiotic stewardship programs, but further studies assessing specific devices in randomized controlled trials are recommended by researchers and health technology assessment agencies. Monitoring the continued development of devices and the testing landscape, especially in post-pandemic health care, will be important for decision-makers.

scholarly journals Point-of-Care Mobile Application to Guide Health Care Professionals in Conducting Substance Use Screening and Intervention: A Mixed-Methods User Experience Study

ACI Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e1-e12
Author(s):  
Megan O'Grady ◽  
Sandeep Kapoor ◽  
Evan Gilmer ◽  
Charles Neighbors ◽  
Joseph Conigliaro ◽  
...  
Keyword(s):  
Health Care ◽  
Substance Use ◽  
Mixed Methods ◽  
User Experience ◽  
Point Of Care ◽  
Health Care Settings ◽  
Health Technologies ◽  
Patient Interactions ◽  
System Usability Scale ◽  
Substance Use Services

Background Well-documented barriers have limited the widespread, sustained adoption of screening and intervention for substance use problems in health care settings. mHealth applications may address provider-related barriers; however, there is limited research on development and user experience of such applications. Objective This user experience study examines a provider-focused point-of-care app for substance use screening and intervention in health care settings. Method This mixed-methods study included think-aloud tasks, task success ratings, semistructured interviews, and usability questionnaires (e.g., System Usability Scale [SUS]) to examine user experience among 12 health coaches who provide substance use services in emergency department and primary care settings. Results The average rate of successful task completion was 94% and the mean SUS score was 76 out of 100. Qualitative data suggested the app enhanced participants' capability to complete tasks efficiently and effectively. Participants reported being satisfied with the app's features, content, screen layout, and navigation and felt it was easy to learn and could benefit patient interactions. Despite overwhelmingly positive user experience reports, there were some concerns that the app could negatively affect patient interactions due to reductions in eye contact and ability to build rapport. Conclusion Using the “Fit between Individuals, Task, and Technology” framework to guide interpretation, overall results indicate acceptable user experience and usability for this provider-focused point-of-care mobile app for substance use screening and intervention as well as favorable potential for adoption by health care practitioners. Such mobile health technologies may help to address well-known challenges related to implementing substance use services in health care settings.

scholarly journals Diagnostic performance and clinical feasibility of a point-of-care test for respiratory viral infections in primary health care

2017 ◽  
Vol 34 (5) ◽  
pp. 558-563 ◽  
Author(s):  
Andrea H L Bruning ◽  
Wilhelmina B de Kruijf ◽  
Henk C P M van Weert ◽  
Wim L M Willems ◽  
Menno D de Jong ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Diagnostic Performance ◽  
Viral Infections ◽  
Point Of Care ◽  
Point Of Care Test ◽  
Primary Health ◽  
Respiratory Viral Infections

Creation of State Antibiogram and Subsequent Launch of Public Health–Coordinated Antibiotic Stewardship in New Hampshire

2021 ◽  
pp. 003335492199577
Author(s):  
Hannah M. Leeman ◽  
Benjamin P. Chan ◽  
Carly R. Zimmermann ◽  
Elizabeth A. Talbot ◽  
Michael S. Calderwood ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
New Hampshire ◽  
Health Care Providers ◽  
Antibiotic Stewardship ◽  
Antibiotic Susceptibility ◽  
Advisory Group ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Tract Infections

Background An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services’ Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Methods Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. Results All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care–associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. Conclusions The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health–clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.

scholarly journals Exploring Primary Care Clinicians’ Views about How Best to Implement a Potential Trial around Point-of-Care Tests for Common Infections in South Africa

Diagnostics ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2100
Author(s):  
Alice Epps ◽  
Charlotte Albury ◽  
Oliver Van Hecke
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Point Of Care ◽  
Feasibility Trial ◽  
Antibiotic Prescribing ◽  
Western Cape ◽  
Middle Income ◽  
Primary Care Clinicians ◽  
Point Of Care Tests ◽  
Common Infections

Optimisation of antibiotic prescribing is critical to combat antimicrobial resistance. Point-of-care tests (POCTs) for common infections could be a valuable tool to achieve this in primary care. Currently, their use has primarily been studied in high-income countries. Trials in low-and-middle-income countries face challenges unique to their setting. This study aims to explore the barriers and facilitators for a future trial of POCTs for common infections in South Africa. Twenty-three primary care clinicians in the Western Cape Metropole were interviewed. Interview transcripts were analysed using thematic analysis. We identified three key themes. These themes focused on clinicians’ views about proposed trial design and novel POCTs, clinicians’ perspectives about trial set-up, and specific trial procedures. Participants were overall positive about the proposed trial and POCTs. Potential issues centred around the limited space and technology available and participant retention to follow-up. Additionally, impact on clinic workload was an important consideration. These insights will be invaluable in informing the design of a feasibility trial of POCTs in this setting.

scholarly journals Co-Developing an Antibiotic Stewardship Tool for Dentistry: Shared Decision-Making for Adults with Toothache or Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1345
Author(s):  
Wendy Thompson ◽  
Jonathan Sandoe ◽  
Sue Pavitt ◽  
Tanya Walsh ◽  
Lucie Byrne-Davis
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Behaviour Change ◽  
Antibiotic Stewardship ◽  
Point Of Care ◽  
Ethnographic Study ◽  
Behaviour Change Techniques ◽  
Antibiotic Prescribing ◽  
Think Aloud ◽  
Shared Decision

Dentistry is responsible for around 10% of antibiotic prescribing across global healthcare, with up to 80% representing inappropriate use. Facilitating shared decision-making has been shown to optimise antibiotic prescribing (antibiotic stewardship) in primary medical care. Our aim was to co-develop a shared decision-making antibiotic stewardship tool for dentistry. Dentists, patients and other stakeholders prioritised factors to include in the new tool, based on previous research (a systematic review and ethnographic study) about dentists’ decision-making during urgent appointments. Candidate behaviour-change techniques were identified using the Behaviour Change Wheel and selected based on suitability for a shared decision-making approach. A ‘think aloud’ study helped fine-tune the tool design and Crystal Marking ensured clarity of messaging. The resulting paper-based worksheet for use at point-of-care incorporated various behaviour change techniques, such as: ’information about (and salience of) health consequences’, ‘prompts and cues’, ‘restructuring the physical (and social) environment’ and ‘credible sources’. The think aloud study confirmed the tool’s acceptability to dentists and patients, and resulted in the title: ‘Step-by-step guide to fixing your toothache.’ Further testing will be necessary to evaluate its efficacy at safely reducing dental antibiotic prescribing during urgent dental appointments in England and, with translation, to other dental contexts globally.

scholarly journals Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044510
Author(s):  
Edmond Li ◽  
Juan Emmanuel Dewez ◽  
Queena Luu ◽  
Marieke Emonts ◽  
Ian Maconochie ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Clinical Decision ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Point Of Care Tests ◽  
University Teaching Hospitals ◽  
Doctors And Nurses

ObjectivesThe use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers’ views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.Study designQualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.SettingTwo university teaching hospitals in London and Newcastle.Participants24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).ResultsThere were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1–2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.ConclusionIn this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.

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