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Kent B. Lewandrowski - One of the best experts on this subject based on the ideXlab platform.
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implementation of point of care Testing in a general internal medicine practice a confirmation study
Clinica Chimica Acta, 2017Co-Authors: Elizabethlee Lewandrowski, Sunu Yeh, Jason M Baron, Benjamin J Crocker, Kent B. LewandrowskiAbstract:Abstract Background In a previous study we reported on the impact of Point-of-Care Testing (POCT) on practice efficiency in an academic primary care practice that was established to develop new models of care delivery. Here we report a follow-on confirmation study in a more typical primary care practice in the community. Methods In this observational study with a retrospective comparison analysis we measured metrics of practice efficiency on two patient cohorts: those that did not receive POCT and those that did. Results In the patient cohort that received POCT there was a 99% reduction in letters to patients (p Conclusions Our data confirm the earlier published findings that POCT can improve metrics of practice efficiency in a primary care practice.
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assuring quality in point of care Testing evolution of technologies informatics and program management
Archives of Pathology & Laboratory Medicine, 2011Co-Authors: Kent B. Lewandrowski, Kimberly Gregory, Donna MacmillanAbstract:Context.—Managing the quality of Point-of-Care Testing (POCT) is a continuing challenge. Advances in Testing technologies and the development of specialized informatics for POCT have greatly improved the ability of hospitals to manage their POCT program. Objectives.—To present the evolving role of technology improvement, informatics, and program management as the key developments to ensure the quality of POCT. Data Sources.—This presentation is based on a review of the literature and on our experiences with POCT at the Massachusetts General Hospital (Boston). Conclusions.—Federal and state regulations, along with accreditation standards developed by the College of American Pathologists and The Joint Commission, have established guidelines for the performance of POCT and have provided a strong incentive to improve the quality of Testing. Many instruments for POCT have incorporated advanced design features to prevent analytic and operator errors. This, along with the development of connectivity standards an...
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Management of a Point-of-Care Testing program.
Clinics in laboratory medicine, 2009Co-Authors: Kim Gregory, Kent B. LewandrowskiAbstract:The approach to managing a Point-of-Care Testing (POCT) program has evolved over recent years. Although many of the essential features of early POCT management programs remain intact, contemporary challenges including expansion of the test menu, changing regulatory requirements, and the development of more sophisticated data management connectivity require ongoing adaptation of POCT management programs. Despite improvements in test quality and regulatory compliance, significant challenges for the management of POCT will continue for the foreseeable future.
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Point-of-Care Testing: An Overview and a Look to the Future (Circa 2009, United States)
Clinics in laboratory medicine, 2009Co-Authors: Kent B. LewandrowskiAbstract:Point-of-Care Testing is a rapidly growing area in laboratory medicine. Technologies related to Point-of-Care Testing have unique analytical features and are used in a number of clinical applications. These attributes combined with complex regulatory requirements have made Point-of-Care Testing a true specialty within pathology. Manufacturers continue to develop new Point-of-Care tests and have consolidated multiple assays to single small handheld or bench-top devices. Enterprise hospital-wide data management systems are available to facilitate improved regulatory compliance and transmit test results into the electronic medical record. Some studies have shown that Point-of-Care Testing can improve clinical outcomes or increase the efficiency of hospital operations. In spite of these developments, many challenges remain. In some cases, the quality of Point-of-Care tests performed by nonlaboratory personnel does not match that of Testing performed in the central laboratory. Data management connectivity remains a significant problem, especially for manually performed tests. Managing a Point-of-Care program to maintain regulatory compliance is also problematic. For these reasons, the future of Point-of-Care Testing is not entirely clear. The most likely scenario will be a slow but progressive growth of Point-of-Care Testing in the hospital, in the outpatient clinic, and in the home.
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Point-of-Care Testing. An overview and a look to the future.
Clinics in laboratory medicine, 2001Co-Authors: Elizabeth Lee-lewandrowski, Kent B. LewandrowskiAbstract:Point-of-Care Testing is an emerging specialty in laboratory medicine and has attracted considerable interest in the medical literature. This article presents a general overview of Point-of-Care Testing including its history, menu, clinical utility, aspects of analytical performance, regulatory issues, and management in the hospital setting. Some perspectives concerning the possible future of Point-of-Care Testing are also presented in view of current issues in the hospital and clinical laboratory.
Christopher P. Price - One of the best experts on this subject based on the ideXlab platform.
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Point-of-Care Testing in diabetes mellitus.
Clinical chemistry and laboratory medicine, 2003Co-Authors: Christopher P. PriceAbstract:Diabetes mellitus is an excellent case study of the evolution, and successful application, of Point-of-Care Testing. It offers a valuable history of the way in which technology has evolved, and continues to evolve, to meet the needs of patients whilst also providing for a more optimal delivery of care. Diabetes mellitus is also a good exemplar of where test and treatment regimes must operate in complete harmony in order to achieve the greatest benefit. Thus whilst the measurement of blood glucose is central to the screening, diagnosis and management of diabetes, it is in the latter use, largely related to supporting compliance with therapy, that Point-of-Care Testing is of greatest relevance. In addition, there are other tests, more associated with the management of diabetes and early detection of the complications associated with diabetes, that are appropriate to the Point-of-Care Testing modality. This Review will focus on the developments in technology and the harnessing of this innovation to support the delivery of clinical, organisational and economic benefits in the care of patients with diabetes mellitus.
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Point of Care Testing
Disease Management & Health Outcomes, 2002Co-Authors: Christopher P. PriceAbstract:Point of care Testing describes Testing using handheld or benchtop technology, where the result will be used in the screening for, or the diagnosis and/or the management of, disease. It is an alternative to using the services of a centralized facility such as a laboratory. The successful use of point of care Testing technology demands that the quality of the result can be assured and that a clinical and/or economic benefit can be demonstrated. As with benchtop technology, handheld technologies have features to deal with all the steps in the analytical process. The quality of the result depends on the manufacturing process of the device and the competence of the operator. The potential for clinical and/or economic benefit will exist wherever the rapid provision of the result enables a decision to be made immediately and appropriate action implemented. This may include making or ruling out a diagnosis; the latter leading to an alternative diagnostic pathway or discharge of the patient. The clinical benefits, however, will also depend on the implementation of an intervention and will be measured in terms of improved morbidity and mortality. However, in both the design of outcome studies as well as the routine management of patients, surrogate markers of outcome may be used to assess the value of the test and intervention. In patients with chronic diseases a test may be used to assess the status of the patient and the effectiveness of the intervention, thus playing an important role in maintaining patient compliance. Diabetes mellitus provides an excellent exemplar of point of care Testing producing both positive clinical and economic outcomes in the management of a chronic disease. The speedy availability of results has also been shown to facilitate rapid decision making in acute medical situations such as in the emergency room and operating room. As a more patient-focussed approach to healthcare is being adopted leading to the requirement for faster access to results, as well as more Testing being undertaken in the home and the primary care setting, the demand for point of care Testing technology is set to increase dramatically. Changes in clinical practice will need to be made to maximize the benefits of Testing to the patient and healthcare provider. Furthermore, a wider perspective will have to be adopted with regard to resource allocation because point of care Testing, as a Testing modality, will be expensive but the wider economic benefit will be greater.
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Medical and Economic Outcomes of Point-of-Care Testing
Clinical chemistry and laboratory medicine, 2002Co-Authors: Christopher P. PriceAbstract:Point-of-Care Testing is concerned with the immediacy of response, primarily because of the need to act in a life-threatening crisis or to provide counsel in the ongoing management of a chronic disease. There are both clinical, operational and economic benefits that can accrue from this Testing modality which may be observed from several perspectives--the patient, the clinician, the healthcare provider, the healthcare purchaser and society. Thus Point-of-Care Testing can improve the management of chronic diseases such as diabetes, compromised coagulation status and epilepsy--both in terms of optimisation of, and compliance with, therapy. There are also life-threatening crises that can be averted by rapid provision of test results. Each of these scenarios can lead to more efficient use of healthcare resources.
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Point of care Testing.
BMJ (Clinical research ed.), 2001Co-Authors: Christopher P. PriceAbstract:Point of care Testing, otherwise referred to as near patient, bedside, or extra laboratory Testing, is not new. Many of the early “diagnostic tests” were first done at the bedside—for example, urine Testing. Over the past few years, however, analytical systems have been developed that enable a wide range of tests to be done quickly and simply without the need for sophisticated laboratory equipment.1 The key objective of point of care Testing is to generate a result quickly so that appropriate treatment can be implemented, leading to an improved clinical or economic outcome (figure). This article sets out the requirements for delivering an effective point of care Testing service and reviews the evidence of the clinical and economic effectiveness of point of care Testing. #### Summary points Point of care Testing requires trained operators to ensure a good quality service Testing is effective only if action taken on the result Testing has been shown to reduce hospital stay, improve adherence to treatment, and reduce complications Although point of care Testing is more expensive than laboratory Testing, it produces wider economic benefits I searched the literature with Medline and Embase using the key phrases “point of care Testing,” “bedside Testing,” “near patient Testing,” and “extra laboratory Testing.” I also hand searched relevant laboratory medicine and disease related journals (such as those on diabetes) and health technology assessment reports. Two broad types of technology support point of care Testing: small bench top analysers (for example, blood gas and electrolyte systems) and hand held, single use devices (such as urine albumin, blood glucose, and coagulation tests). The bench top systems are smaller versions of laboratory analysers in which vulnerable operator dependent steps have been automated—for example, automatic flushing of sample after analysis, calibration, and quality control. Hand held devices have been developed using microfabrication techniques. …
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Point of Care Testing in Haematology.
Hematology (Amsterdam Netherlands), 1998Co-Authors: Christopher P. PriceAbstract:Changes in the way that patient care is delivered are beginning to have a major impact on the way that diagnostic services are provided. Analytical scientists and industry are responding to this need with an innovative array of devices that can be employed at the point of care. There are several situations in which a rapid response to a diagnostic question is required and evidence is now becoming available to indicate that both clinical and operational benefits can be achieved. However, the success of point of care Testing will depend on proper organisation and management as an adjunct to a central laboratory service, the latter providing a reference point and appropriate support.
Fei Li - One of the best experts on this subject based on the ideXlab platform.
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A review on advances in methods for modification of paper supports for use in Point-of-Care Testing
Microchimica Acta, 2019Co-Authors: Rui Hua Tang, Xiao Cong He, Yong Hao Ni, Li Na Liu, Xiu Jun Li, Su Feng Zhang, Feng Xu, Fei LiAbstract:Paper is a widely used support for use in devices for Point-of-Care Testing (POCT) in clinical diagnosis, food safety monitoring and environmental pollution. Paper is inexpensive, biocompatible, biodegradable and allows a sample fluid to flow by capillary force. Numerous method have been developed recently for chemical modification of papers in order to introduce different functionalities. This review (with 148 refs.) summarizes the recent progress in paper-based POCT devices. The introduction summarizes the state of the art of paper-based POCT devices and the physicochemical properties of existing unmodified materials (including cellulose, cellulose-based composites, cotton fibers, glass fibers, nitrocellulose, thread). Methods for paper modification for sample pretreatment are summarized next, with subsections on sample storage and collection, sample separation, nucleic acid extraction and sample preconcentration. Another main section covers approaches for paper modification for improving POCTs, with subsections on assays for proteins, nucleic acids, drugs, ion and organic molecules. The advantages and disadvantages of these approaches are compared. Several tables are presented that summarize the various modification techniques. A concluding section summarizes the current status, addresses challenges and gives an outlook on future perspectives of POCTs. Graphical abstractThis review summarizes the progress that has been made in paper based Point-of-Care Testing (POCT) and lateral flow assays (LFAs), quite often by using advanced nanomaterials for paper modification.
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Paper-Based Electrochemical Biosensors for Point-of-Care Testing of Neurotransmitters
Journal of Analysis and Testing, 2019Co-Authors: Yingchun Li, Rongyan He, Yan Niu, Fei LiAbstract:Neurotransmitters are important biological molecules related to several nervous system diseases (NSDs). Point-of-Care Testing (POCT) of neurotransmitters is of great importance in preclinical research and early diagnosis of NSDs. Among various POCT platforms, paper-based electrochemical biosensors have achieved great advances in detection of neurotransmitters, thus taking a significant role in POCT of neurotransmitters nowadays. This review gives an overview of the recent advances of paper-based electrochemical biosensors for POCT of neurotransmitters. We first introduce the types of neurotransmitters and biological sample sources mainly used for neurotransmitter detection. Second, we review the components and the traditional fabrication technologies for paper-based electrochemical POCT biosensors, and then the functional modification methods of biosensor surfaces and three-dimensional fabrication methods for further enhancement of their detection performance. Then, we list examples of paper-based electrochemical biosensors used for detecting different neurotransmitters in biological samples. Last, we give a conclusion and promising development direction of paper-based electrochemical biosensors for neurotransmitters detection. The purpose of this review is to introduce the paper-based electrochemical biosensors as an emerging technology for POCT of neurotransmitters, offering a reference for readers and researchers for early diagnosis of NSDs using POCT technologies.
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direct writing electrodes using a ball pen for paper based point of care Testing
Analyst, 2015Co-Authors: Zedong Li, Fei Li, Jie Hu, Belinda Pingguanmurphy, T J Lu, Feng XuAbstract:The integration of paper with an electrochemical device has attracted growing attention for Point-of-Care Testing, where it is of great importance to fabricate electrodes on paper in a low-cost, easy and versatile way. In this work, we report a simple strategy for directly writing electrodes on paper using a pressure-assisted ball pen to form a paper-based electrochemical device (PED). This method is demonstrated to be capable of fabricating electrodes on paper with good electrical conductivity and electrochemical performance, holding great potential to be employed in Point-of-Care applications, such as in human health diagnostics and food safety detection. As examples, the PEDs fabricated using the developed method are applied for detection of glucose in artificial urine and melamine in sample solutions. Furthermore, our developed strategy is also extended to fabricate PEDs with multi-electrode arrays and write electrodes on non-planar surfaces (e.g., paper cup, human skin), indicating the potential application of our method in other fields, such as fabricating biosensors, paper electronics etc.
Neil A. Halpern - One of the best experts on this subject based on the ideXlab platform.
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Point-of-Care Testing in the intensive care unit : the intensive care physician's perspective
American Journal of Clinical Pathology, 1995Co-Authors: John Oropello, Neil A. HalpernAbstract:Technological advancements have, for the first time, made the entire laboratory Testing process feasible at the bedside. Physicians working in the intensive care unit have always had immediate access to patients' medical history, physical examination, and physiologic monitoring data, but had to wait for laboratory results. Using Point-of-Care Testing, laboratory parameters targeted to critical illnesses can now be integrated into initial diagnostic assessments, on patient rounds, and during therapeutic maneuvers. The concept of Point-of-Care Testing in the intensive care unit is relatively new, but as technology progresses, physicians will undoubtedly become aware and use it in the intensive care unit. This article focuses on the intensive care physician's perspective on laboratory Testing, the evolution of the intensive care unit laboratory, advantages of Point-of-Care Testing in that setting, new developments in arterial blood gas analyzers and monitors, and cost-effectiveness and incorporation of Point-of-Care Testing.
Feng Xu - One of the best experts on this subject based on the ideXlab platform.
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A review on advances in methods for modification of paper supports for use in Point-of-Care Testing
Microchimica Acta, 2019Co-Authors: Rui Hua Tang, Xiao Cong He, Yong Hao Ni, Li Na Liu, Xiu Jun Li, Su Feng Zhang, Feng Xu, Fei LiAbstract:Paper is a widely used support for use in devices for Point-of-Care Testing (POCT) in clinical diagnosis, food safety monitoring and environmental pollution. Paper is inexpensive, biocompatible, biodegradable and allows a sample fluid to flow by capillary force. Numerous method have been developed recently for chemical modification of papers in order to introduce different functionalities. This review (with 148 refs.) summarizes the recent progress in paper-based POCT devices. The introduction summarizes the state of the art of paper-based POCT devices and the physicochemical properties of existing unmodified materials (including cellulose, cellulose-based composites, cotton fibers, glass fibers, nitrocellulose, thread). Methods for paper modification for sample pretreatment are summarized next, with subsections on sample storage and collection, sample separation, nucleic acid extraction and sample preconcentration. Another main section covers approaches for paper modification for improving POCTs, with subsections on assays for proteins, nucleic acids, drugs, ion and organic molecules. The advantages and disadvantages of these approaches are compared. Several tables are presented that summarize the various modification techniques. A concluding section summarizes the current status, addresses challenges and gives an outlook on future perspectives of POCTs. Graphical abstractThis review summarizes the progress that has been made in paper based Point-of-Care Testing (POCT) and lateral flow assays (LFAs), quite often by using advanced nanomaterials for paper modification.
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direct writing electrodes using a ball pen for paper based point of care Testing
Analyst, 2015Co-Authors: Zedong Li, Fei Li, Jie Hu, Belinda Pingguanmurphy, T J Lu, Feng XuAbstract:The integration of paper with an electrochemical device has attracted growing attention for Point-of-Care Testing, where it is of great importance to fabricate electrodes on paper in a low-cost, easy and versatile way. In this work, we report a simple strategy for directly writing electrodes on paper using a pressure-assisted ball pen to form a paper-based electrochemical device (PED). This method is demonstrated to be capable of fabricating electrodes on paper with good electrical conductivity and electrochemical performance, holding great potential to be employed in Point-of-Care applications, such as in human health diagnostics and food safety detection. As examples, the PEDs fabricated using the developed method are applied for detection of glucose in artificial urine and melamine in sample solutions. Furthermore, our developed strategy is also extended to fabricate PEDs with multi-electrode arrays and write electrodes on non-planar surfaces (e.g., paper cup, human skin), indicating the potential application of our method in other fields, such as fabricating biosensors, paper electronics etc.