APPLICATION LEVELS OF PRINCIPLES OF POCT IMPLEMENTATION, MANAGEMENT, AND MAINTENANCE THROUGH THE PERCEPTIONS OF HEALTHCARE PROFESSIONALS AT A TERTIARY HOSPITAL IN UYO, AKWA STATE, NIGERIA

Background :The application of principles for the implementation,management, and maintenance of point-of-care (POC) testing systemservice is unclear in tertiary healthcare settings in Nigeria. Hence, thestudy assessed these principles through the perceptions of healthcareprofessionals (HCPs).Methods:The cross-sectional study was conducted among 300 HCPs inthe University of Uyo Teaching Hospital (UUTH), southern Nigeria,using a pre-tested self-administered questionnaire that assessed the majorprinciples for POC system service. The questionnaires assessed theimplementation principles (determination of healthcare need, presenceof POC Organizing and implementation committee, POC testing policy/accountability protocols, direct involvement of Health care Professionals(HCPs) and the training and certification of operators), the managementprinciples (establishment of quality assurance and audit policies,establishment of maintenance and inventory control policies,establishment of documentary protocols) and the maintenance principles(accreditation and/or regulation of POC testing systems/devices and thecentral laboratory's involvement in effecting all the principles).Categorical data were summarized in frequency and percentages andpresented in tables and figures.Results:Regarding implementation principles, most respondents affirmednot having determined the healthcare need, clinical/operational/economic benefits, performance requirements, clinical risks, and costsbefore deployment (63.3%), not having any POC organizing/implementation coordinating committee (83.3%), no POC testing policy/accountability protocols (96.7%), and no training/certification ofoperators for POC systems/devices in the hospital and/or theirdepartments/units (91.7%) (p<0.001). On the management principles, mostrespondents affirmed negatively to having established quality assurance/audit policies (83.3%), maintenance/inventory control policies (91.7%),and documentary protocols for POC systems/devices in the hospital and/or their department/unit (96.7%) (p<0.001). Concerning the maintenanceprinciples, most respondents affirmed to no accreditation/regulationpolicy (73.3%) and involvement of the central laboratory regarding thePOCT systems/devices within the hospital and/or their departments/units (78.4%) (p<0.001).Conclusion:The level of application of POC principles is low withinUUTH based on current findings. This highlights a critical gap in currentoperational practices, posing potential risks to the quality of patientdiagnostic data. Immediate development/implementation of targetedprograms and enhanced compliance protocols to address these deficienciesis recommended.

BackgroundEdmonton is in the midst of a syphilis outbreak occurring largely in high risk and hard-to-reach populations. Point of care (POC) testing for syphilis and HIV offers the opportunity for immediate and rapid access to testing, and in the case of syphilis, immediate treatment. POC syphilis tests have not been previously evaluated in clinical settings in Canada.MethodsSince 14 February 2011, treponemal syphilis (Bioline Syphilis 3.0) and HIV (INSTI HIV-1/HIV-2 Antibody Test) POC testing, using whole blood from a finger prick specimen, has been offered to outreach clients in Edmonton. POC results were compared to standard testing from simultaneously collected serum specimens. Baseline demographics, sexual and drug use risk behaviour information were collected. Age and gender were collected on individuals who refused POC testing. A descriptive analysis was performed on the characteristics and outcomes of participants and those who refused.ResultsAs of 15 April 2011, 146 individuals had been offered POC testing; 85.6% (n=125) consented. Among participants, 59.2% (74) were male [vs 66.7% (14) of non-participants, p=0.5)] and the median age was 29 yrs (IQR 24–36 yrs) [vs non-participants median age 29 yrs (IQR 25–45 yrs), p=0.2)]. The majority of participants (83.2%; 104) were heterosexual, 59.2% (69) were Aboriginal, and 30.4% (38) reported injection drug use. Among females, 62.7% (32) reported sex trade involvement, while among males, 21.6% (16) reported sex with a sex trade worker. Of 121 syphilis treponemal POC tests, 5 (4.1%) were positive, all in old treated cases of syphilis that were asymptomatic for infectious syphilis at the time of testing. Two syphilis POC (1.7%) tests were falsely negative when compared to the standard screening test (Architect Syphilis TP Microparticles, Abbott Laboratories, Illinois, USA); both were in individuals previously treated for syphilis. Of 123 HIV POC tests, 2 (1.6%) were reactive, both newly diagnosed cases as confirmed by GS HIV-1 Western Blot (BioRad Laboratories, California, USA); both were negative by syphilis POC tests.ConclusionPreliminary results from Edmonton suggest that POC testing for syphilis and HIV is well accepted among high-risk populations in outreach settings in Edmonton. This ongoing study will assess the utility of these tests in mitigating the further spread of both syphilis and HIV through POC testing, and in the case of syphilis, POC treatment.

Point of care (POC) testing in communities, home settings, and primary healthcare centers is believed to have tremendous potential in reducing delays in diagnosing and initiating treatment for diseases such as HIV, tuberculosis, syphilis, and malaria. Quick diagnosis and further management decisions completed in the same clinical encounter or at least the same day, while the patient waits, promise to overcome delays associated with conventional laboratory-based testing. However, the availability of cheap, simple, and rapid tests that can be conducted outside laboratories does not automatically ensure successful POC testing. In order to understand the new roles and challenges medical devices such as these encounter, we need to study how diagnostics are used at the POC and integrated into workflow and patient pathways. This chapter reviews selected results from a qualitative research project on barriers to POC testing in India and South Africa and discusses them comparatively. The project used semi-structured interviews and focus group discussions to examine diagnostic practices across major diseases and actors in homes, clinics, communities, hospitals, and laboratories in South Africa and India. In comparing selected results, it becomes clear that both countries have very different diagnostic eco-systems that provide very different conditions for POC testing. The chapter concludes by reflecting on how to take such insights into account when designing POC testing programs.

To predict COVID-19 disease severity within 10 days, distinguishing cases that will progress to moderate or severe versus mild, patient urinary L-type fatty acid-binding protein (L-FABP) was assayed within 4 days of receiving a diagnosis. The study also examined whether L-FABP point of care (POC) test is helpful in risk screening. Symptomatic subjects who tested positive for SARS-CoV-2 and were hospitalized were prospectively enrolled at the National Center for Global Health and Medicine (NCGM), Yamanashi Prefectural Central Hospital (YPCH), and Sinai Hospital in Maryland. The outcome of each case was evaluated 7 days after admission and the diagnostic performance of L-FABP was assessed. Subjects were treated for COVID-19 at public healthcare centers in Japan from January 31, 2020, to January 31, 2021, to NCGM, YPCH, and at Sinai Hospital in Baltimore, MD, during the same period. The primary outcome was to determine whether urinary L-FABP within 48 hours of admission can predict the patient's severity of COVID-19 1 week later. We obtained demographic data, information on clinical symptoms, radiographic images, and laboratory data. Diagnostic performance was assessed using receiver operating characteristic analysis. Of the 224 participants in the study, 173 initially had a mild form of COVID-19. The area under the curve (AUC) for a severe outcome was 93.5%. L-FABP POC risk prediction of a severe outcome had an AUC of 88.9%. Urinary L-FABP can predict patient risk of COVID-19 illness severity. L-FABP POC is implementable for patient management. (ClinicalTrials.gov number, NCT04681040).

IntroductionMortality from advanced HIV disease (AHD) remains high and current strategies to promptly test people eligible for AHD screening, are insufficient. Task sharing for point of care (POC) testing utilizing lay health workers (LHW) is recommended, however it is marginally practised in many countries. This study sought to describe the feasibility and testing outcomes of task-shared implementation of the AHD POC diagnostic tests utilizing LHW and professional health care workers (HCW).MethodsThis was a cross-sectional mixed-methods implementation study in seven primary and three secondary health facilities, in Mozambique and Democratic Republic of Congo (DRC). From March to November 2022, consenting HIV positive adults eligible for AHD screening, were offered Visitect CD4 lateral flow assay (LFA), and or subsequently urinary Mycobacterium tuberculosis lipoarabinomannan antigen (TB LAM) and cryptococcal antigen (CrAg) tests. The primary study outcome was the proportion of testers (LHW and HCW) who found it ‘easy’ to integrate the 3 POC tests within their routine work together with their opinions on the value of task shared AHD POC testing.ResultsA total of 1542 patients were screened for AHD by 35 LHW (34 counsellors, and 1 lay educator) and 45 professional HCW (28 nurses and 9 clinical officers and 8 doctors). In the study period, LHW conducted a median number of 27 [IQR: 16–34] Visitect CD4 LFA tests, whereas nurses, clinical officers together with doctors conducted 19 and 11 respectively. Visitect CD4 LFA increased CD4 testing by 10.7% in Munhava (Beira) and 22.9% in CHK (DRC), complementing existing CD4 testing instruments. Among testers who completed the feasibility survey, nearly sixty percent of testers (25/42; LHW in particular) found it easy to integrate AHD POC testing within their routine workflow.The prevalence of AHD was 39.2% (604/1542). A total of 34% (146/430) and 5.4% (22/407) of patients tested positive for urine TB LAM and plasma CrAg respectively. Of these, 82.2% (120/146) and 36.4% (8/22) had a documented therapeutic intervention. The median time for completing the Visitect CD4 LFA and conveying the results to the clinician was 59 minutes [IQR: 48–71].ConclusionTask-shared integrated testing for AHD at POC among LHW and professional HCW, is feasible and can improve access to AHD testing. However, as POC testing responsibilities become shared, documentation of testing activities could increase in complexity and can be easily fragmented, especially when there is limited supervision. Nevertheless, LHW are well suited for POC testing due to limited availability and higher clinical workload of other HCW.

Introduction of molecular point-of-care testing for SARS-CoV-2 in a triage unit of a large maternity hospital: An evaluation of staff experiences.

Introduction/Objective Testing platforms to detect COVID-19 infection include antigen-based point of care (POC) testing and reverse transcriptase polymerase chain reaction (RT-PCR) to detect viral ribonucleic acid (RNA). RT-PCR, generally considered the gold standard for diagnosis of COVID-19 infection, is capable of being used for mass population screening but may be more expensive. Alternatively, antigen based POC testing can not only produce results rapidly (15 minutes on some assays) but also may be less expensive. This reduced cost provides an argument that it may be economical to use POC testing for mass surveillance in asymptomatic or mildly symptomatic patients while reserving the more expensive gold standard RT-PCR testing for sensitivity for hospitalized and more significantly at risk or ill patients. However, cost modeling between the two modalities for mass screening is sparse, particularly for studies including the Veteran Affairs system that may have different costs from the general community retail pricing. Methods/Case Report Cost information reviewed at the regional VAMC included costs for the Alinity-m SARS-CoV-2 RT-PCR assay (Abbott, Chicago IL), the Cepheid Xpert-Xpress-CoV-2-Flu-RSV-Plus RT-PCR assay (Cepheid, Sunnyvale CA), and the BinaxNOW POC antigen-based assay (Abbott, Chicago IL). The median cost of RT-PCR testing in the community was obtained from the Peterson-KFF Health System Tracker. Publicly available quoted prices for selected POC assays in the community were reviewed for comparison. Results (if a Case Study enter NA) Test costs at the regional VAMC was $28.34 (Alinity-m), $68 (Cepheid), and $5 (BinaxNOW). These costs did not include technologist time or standard laboratory consumables that would be part of the standard overhead costs of running the laboratory. The median community RT-PCR assay price per the Peterson- KFF Health System Tracker was $148, and the Abbott’s quoted BinaxNOW price was $25. POC testing cost was 82% less than the cheapest RT-PCR assay available at the regional VAMC. This trend in being significantly cheaper holds true in the community whereby BinaxNOW testing was 83% cheaper. Publicly available quoted prices from other selected POC assays confirm this trend. Conclusion For a mass surveillance screening program, the use of POC assays would result in significant cost savings.

BackgroundPoint of Care (POC) diagnostics are an essential component of modern medicine and are employed in a variety of clinical disciplines to improve patient outcomes and provider efficiency. Despite these benefits, there are aspects of POC testing which may still hold room for improvement. In the present study, a group of healthcare professionals familiar with different facets of blood-based POC testing provided their perspectives on the benefits and challenges of POC testing within their respective fields.Materials and methodsThe study was conducted from April to June 2019, in Colorado, United States of America. Five healthcare professionals, each working in a distinct field (anesthesiology, nursing, emergency medicine, trauma surgery, and POC management) were interviewed. Results from each of the interviews were transcribed as qualitative perspectives on POC diagnostics.DiscussionThe general consensus among participants in this study is that POC testing is tremendously beneficial, providing rapid test results, increased access to diagnostics, and improvements in hospital efficiency. However, significant challenges remain in blood-based POC diagnostics, particularly in maintaining sample quality, due to the fact that devices used for sample acquisition and handling are not designed for POC. This raises the possibility for interferents like hemolysis to occur, which may alter diagnostic results. Errors in POC diagnostics, whether due to sample, operator, or instrument error, may cause providers to lose confidence in the test. This lack of confidence can lead to duplicate testing and delayed patient diagnoses.ConclusionThe perspectives presented in this study suggest there is a significant need for improvement in the pre-analytical phase of POC testing, and that current practice employs specimen collection technology not designed for POC. Therefore, one hypothesis is that the introduction of a collection device designed specifically for POC could reduce pre-analytical errors, standardize sample quality, improve efficiency, and further benefit patient care.

ObjectivesWe aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current...

BackgroundLittle is known about clinicians’ perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them.MethodTo explore clinicians’ perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams.We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsThe clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were “appropriate” and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients’ homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families.ConclusionClinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.

Background: In sub-Saharan Africa, gonococcal and chlamydial infections are usually managed using the syndromic approach. However, many infections are asymptomatic in women, and the syndromic algorithm has poor sensitivity and...

We present here some of our experience of angiocardiography; it deals exclusively with children and infants as a result of our working in a children's hospital.*When a careful clinical examination, electrocardiograms, X rays, and the simple laboratory tests do not make the diagnosis certain, we have two principal procedures: heart catheterization with study of the pressures and gas content from samples obtained in different chambers of the heart, and in addition, angiocardiography.Although the first procedure is of great value, it is very difficult to perform on young children because of their small veins and lack of co-operation.On the contrary, angiocardiography is simple and harmless as far as our experience shows.Although the extensive and careful study Taussig made of the clinical and radiological picture of the different congenital heart malformations means a very great aid to diagnosis, we still believe that, especially in infants, angiocardiography can be a great help.At this early age diagnosis is difficult because the heart has not acquired its typical form and the physical and electrocardiographic signs are not yet clearly evident.It is also at this stage that the angiocardiograms are clearest as is illustrated by some of the pictures shown here.Therefore, we consider angiocardiography essential in diagnosing congenital heart diseases in infants, and certainly of great help even if not essential in older children. HISTORICALThe first attempt was made by Forssmann in 1929; after introducing a rubber catheter as far as the right auricle, by way of a vein in his own arm, he made a trial at visualization by injecting some opaque material and taking X rays.After this, Moniz, Carvalho, and Lima in 1932; Conte and Costa in 1933; Ravina, Sourire, and Benzaquen in 1932; and Ameuille et al. in 1936 made several attempts to visualize the right cavities of the heart and mainly the pulmonary arteries in animals and men, all more or less following Forss- mann's technique.In 1933, Reboult and Racine visualized very distinctly in dogs the right and left cavities of the heart, the aorta, and the coronary arteries, by introducing a needle directly into the heart and injecting a radio-opaque substance.In 1937, Castellanos, Pereiras, and Garcia from Havana, Cuba, obtained for the first time a good visualization of the right side of the heart, pulmonary artery, and its branches in living children, after injecting perabrodil 35 per cent directly into a vein of the arm.They were the first to use the term " angiocardiography " which has become classical, and they pointed out the simplicity of the method and its value in the diagnosis of congenital heart disease.Shortly afterwards, Robb and Steinberg, 1938 and 1939, in New York, used for the first time 70 per cent diodrast and a mechanical cassette changer, thus obtaining good visualization of the left side and aorta as well as the right.They used this procedure successfully on adults, which Castellanos, Pereiras, and Garcia had been unable to do, because of the lack of an adequate contrast * When one of the authors (R. K.) was in England recently, the editor was interested seeing his clear and striking angiocardiograms and suggested that he might submit a paper on the subject for publication in the B.H.

BackgroundHeightened pressures on hospitals and Emergency Medical Services (EMS) due to growing demand and staff shortages have led to prolonged ambulance response times and delays in handing over the care of EMS patients on arrival at an Emergency Department. These delays jeopardise patient safety and staff wellbeing. Point of care (POC) tests in EMS have been proposed to facilitate effective on-scene decision-making, reduced conveyance, improved clinical outcomes, enhanced system efficiency and patient experience. Despite an acceleration in POC testing during the Covid-19 pandemic, limited evidence exists for integrating POC tests into routine EMS practice. The aim of this research was to explore the impact, benefits, barriers, and facilitators of POC testing in United Kingdom (UK) EMS, alongside factors influencing future research on POC testing implementation.MethodsConvenience and snowballing sample techniques were used to recruit a diverse stakeholder group, including patient and public participants, for online semi-structured interviews between June and July 2023. Interviews were recorded, transcribed verbatim and thematically analysed using the framework method. The codes were pre-selected using the outcomes of a prior stakeholder event and double coded by the research team.ResultsA total of 25 participants took part in semi-structured interviews. Whilst most participants identified clear potential benefits associated with the implementation of further POC tests within UK EMS, barriers that need to be considered in future research were also highlighted. Three themes were identified: enhancing patient care and system efficiency through POC testing; navigating implementation challenges: balancing barriers and facilitators for successful implementation; building the foundations: key considerations for future research.ConclusionsOur study indicates that although the adoption of further POC testing was viewed positively, with substantial potential for impact, it will be essential to carefully address the barriers identified, along with insights from prior research, to overcome the associated challenges effectively.

BackgroundHeightened pressures on hospitals and Emergency Medical Services (EMS) due to growing demand and staff shortages have led to prolonged ambulance response times and delays in handing over the care...

Heightened pressures on hospitals and Emergency Medical Services (EMS) due to growing demand and staff shortages have led to prolonged ambulance response times and delays in handing over the care of EMS patients on arrival at an Emergency Department. These delays jeopardise patient safety and staff wellbeing. Point of care (POC) tests in EMS have been proposed to facilitate effective on-scene decision-making, reduced conveyance, improved clinical outcomes, enhanced system efficiency and patient experience. Despite an acceleration in POC testing during the Covid-19 pandemic, limited evidence exists for integrating POC tests into routine EMS practice. The aim of this research was to explore the impact, benefits, barriers, and facilitators of POC testing in United Kingdom (UK) EMS, alongside factors influencing future research on POC testing implementation. Convenience and snowballing sample techniques were used to recruit a diverse stakeholder group, including patient and public participants, for online semi-structured interviews between June and July 2023. Interviews were recorded, transcribed verbatim and thematically analysed using the framework method. The codes were pre-selected using the outcomes of a prior stakeholder event and double coded by the research team. A total of 25 participants took part in semi-structured interviews. Whilst most participants identified clear potential benefits associated with the implementation of further POC tests within UK EMS, barriers that need to be considered in future research were also highlighted. Three themes were identified: enhancing patient care and system efficiency through POC testing; navigating implementation challenges: balancing barriers and facilitators for successful implementation; building the foundations: key considerations for future research. Our study indicates that although the adoption of further POC testing was viewed positively, with substantial potential for impact, it will be essential to carefully address the barriers identified, along with insights from prior research, to overcome the associated challenges effectively.