Figure 2 - uploaded by Richard F Louie
Content may be subject to copyright.

Source publication
Article
Full-text available
To identify strategies with tactics that enable point-of-care (POC) testing (medical testing at or near the site of care) to effectively improve outcomes in emergencies, disasters, and public health crises, especially where community infrastructure is compromised. Logic model-critical path-feedback identified needs for improving practices. Reverse...

Citations

... Концепция "Point-of-care testing" определяется как тестирование у койки пациента непосредственно в момент оказания медицинской помощи и/ или диагностического поиска. Цель "Point-of-care testing" -предоставить немедленную информацию о состоянии пациента, интегрироваться в принятие решения о тактике лечении и осуществлять лабораторный мониторинг эффективности проводимой терапии [3]. ...
Full-text available
Article
The analysis in the centralized laboratory is the main model of laboratory diagnosis and monitoring in the conditions of intensive care. However, alternative models of “point-of-care testing” technology are being actively introduced nowadays. This review article presents the analysis of “Point-of-care testing” technologies from the perspective of the intensive care doctor. The main advantages of this monitoring idea include the speed of analysis and the cost of components. Among the disadvantages we can identify ambiguous assessment of the accuracy and objectivity of analyses, additional burden on the staff of resuscitation and intensive care units. Possible ways of resolving disputable issues aimed at improving quality and reproducibility of the analyses are outlined in this work. Despite the fact that currently “Point-of-care testing” technologies cannot replace centralized laboratories, they are steadily occupying a certain niche and are going to play a more important role in diagnosing and monitoring patients in critical condition.
... In this chapter, extreme POC testing will be referred to as POC diagnostic strategies that are or should be performed in low-resource settings, developing countries, or tropical areas where diagnostic infrastructures are often minimal or inexistent, and in situations following emergency crises or natural disasters where a minimal but efficient and clinically-relevant healthcare infrastructure must be rapidly put in place to avoid the onset (or minimize the expansion) of epidemics and limit the death toll [8][9][10][11][12]. From this point onwards, these areas will be designated "extreme environments". ...
... This is not a trivial issue, but providing the laboratory with a good capacity for cold storage would be highly recommended to protect test components from harsh and/or highly variable conditions falling outside the operational limits determined by manufacturers, conditions which have been shown to affect the performance of rapid diagnostic tests (RDTs) [27], glucose meters, and blood analyzers [25,28]. To further protect test components from the effects of high humidity, disposable cartridges, cassettes, or devices should be provided individually in sealed packages [9]. Alternatively, POC tests could be performed in enclosures designed to control temperature and humidity [29]. ...
Full-text available
Article
Extreme point-of-care (POC) testing for infections, as performed (endured) in low-resource settings, developing countries, tropical areas, or in conditions following emergency crises or natural disasters, must be undertaken under environmental, logistic, and societal conditions which impose a significant deal of stress on local human populations and healthcare providers. For disease diagnostics or management, simple and robust biomedical equipment and reagents are required and needed. This chapter aims to overview some of these stresses (requirements) and intends to describe some of the solutions already engineered at the heart of centripetal (centrifugal) microfluidic platforms such as that of GenePOC Inc. to enable rapid, robust, and reproducible nucleic acid-based diagnostics of infectious diseases, to better control the morbidity and mortality of infections and the expanding threat posed by antimicrobial resistance.
... Common sense dictates that distributing resources will enhance future resilience. Thus, POCT [10,11] has blossomed to become an innovative, ubiquitous and rapidly evolving point-of-need resource for resilience [12][13][14][15][16][17][18]. It is transforming not only disaster medicine [2], but also public health practice at points of contact worldwide. ...
Full-text available
Article
Ultrahigh sensitivity and specificity assays that detect Ebola virus disease or other highly contagious and deadly diseases quickly and successfully upstream in Spatial Care Paths™ can stop outbreaks from escalating into devastating epidemics ravaging communities locally and countries globally. Even had the WHO and CDC responded more quickly and not misjudged the dissemination of Ebola in West Africa and other world regions, mobile rapid diagnostics were, and still are, not readily available for immediate and definitive diagnosis, a stunning strategic flaw that needs correcting worldwide. This article strategizes point-of-care testing for diagnosis, triage, monitoring, recovery and stopping outbreaks in the USA and other countries; reviews Ebola molecular diagnostics, summarizes USA. FDA emergency use authorizations and documents why they should not be stop-gaps; and reduces community risk from internal and external infectious disease threats by enabling public health at points of need.
... The POCT tests may be grouped by important specifics: related to emergency medical indications for sending the patient to a hospital -troponin T, troponin I, BNP, glucose, myoglobin, D-dimer; related to specific, periodically tested laboratory parameters in chronic and prolonged illnesses, for therapy control -glucose, urea, creatinine, prothrombin time (PT / INR, Alere, Microvisk Ltd), hemoglobin; related to the patient's comfort during screening and diagnostic tests -urine analysis, cholesterol, glucose, triglycerides, HDL cholesterol, PSA, CRP, Streptococcus A, hepatitis B, hepatitis C, AIDS and other; in the hospital units and sectors, outside of the laboratory -ROTEG, acid-alkaline profile, glucose; POCT systems, grouped on the basis of different chemical principles: spectrophotometry, immune chromatography, biosensors. They are also grouped, based on their analytical reliability: range of detectability, accuracy, range of measurement of the method, cut off values [8,9,10]. The tests of that kind, allow to be conducted outside of the specialized medical laboratory. ...
... With entering of these technologies in England the stress of GPs was reduced. In Germany using of this type tests is 54 % of european market of POCT [10]. ...
Full-text available
Article
The paper present the perspectives and the possible benefits of the POCT tests, conducted outside of the clinical laboratories. Laboratory tests are objective in their character, which is one of the main reasons for the constant increase in the number of laboratory tests. The fast development of the technology in clinical laboratories, leads to the constant introduction of new markers, as well as the methods and equipment for the establishment of their values. Moving the laboratory diagnostics closer to the patient’s location (point of care testing) is a new tendency in the policy of health care. The tendency may be applied and is expanding, because of the fast development of biotechnologies. In a worldwide scale, POCT is essential for the public health care.
... POC testing has been demonstrated to not only reduce the amount of time it takes for physicians to make decisions regarding patient management, but also contributes to beneficial patient outcomes [141]. Proper implementation of testing at the point-of-need is also important for patient triage, such as in limited or low-resource settings, e.g., following an emergency, disaster, or other public health crisis [142]. To demonstrate the relevance of POC sensors to the field of medicine, we describe below three circumstances under which a hand-held device platform could be used to address real public health needs. ...
Full-text available
Article
This review investigates optical sensor platforms for protein multiplexing, the ability to analyze multiple analytes simultaneously. Multiplexing is becoming increasingly important for clinical needs because disease and therapeutic response often involve the interplay between a variety of complex biological networks encompassing multiple, rather than single, proteins. Multiplexing is generally achieved through one of two routes, either through spatial separation on a surface (different wells or spots) or with the use of unique identifiers/labels (such as spectral separation-different colored dyes, or unique beads-size or color). The strengths and weaknesses of conventional platforms such as immunoassays and new platforms involving protein arrays and lab-on-a-chip technology, including commercially-available devices, are discussed. Three major public health concerns are identified whereby detecting medically-relevant markers using Point-of-Care (POC) multiplex assays could potentially allow for a more efficient diagnosis and treatment of diseases.
... In crisis response, strategic integration of POC diagnostic tools, such as portable multiplex cardiac biomarker testing, at alternate care facilities can accelerate triaging and improve management of victims. 9 The incidence of acute myocardial infarction is elevated during complex emergencies and disasters [10][11][12] and thought to be emotionally triggered. 13,14 Therefore, timely differential diagnosis of acute coronary syndrome is essential wherever care is provided to enable ruling-out or rulingin of the disease, expedite appropriate life-saving treatments, and improve utilization of limited resources. ...
Article
To characterize the effects of environmental stress on point-of-care (POC) cardiac biomarker testing during a simulated rescue. Multiplex test cassettes for cardiac troponin I (cTnI), brain natriuretic peptide (BNP), CK-MB, myoglobin, and D-dimer were exposed to environmental stresses simulating a 24-hour rescue from Hawaii to the Marshall Islands and back. We used Tenney environmental chambers (T2RC and BTRC) to simulate flight conditions (20°C, 10 percent relative humidity) and ground conditions (22.3-33.9°C, 73-77 percent). We obtained paired measurements using stressed versus control (room temperature) cassettes at seven time points (T1-7 with T1,2,6,7 during flight and T3-5 on ground). We analyzed paired differences (stressed minus control) with Wilcoxon signed rank test. We assessed the impact on decision-making at clinical thresholds. cTnI results from stressed test cassettes (n = 10) at T4 (p < 0.05), T5 (p < 0.01), and T7 (p < 0.05) differed significantly from control, when testing samples with median cTnI concentration of 90 ng/L. During the ground rescue, 36.7 percent (11/30) of cTnI measurements from stressed cassettes generated significantly lowered results. At T5, 20 percent (2/10) of cTnI results were highly discrepant-stressed cassettes reported normal results, when control results were >100 ng/L. With sample median concentration of 108 pg/mL, BNP results from stressed test cassettes differed significantly from controls (p < 0.05). Despite modest, short-term temperature elevation, environmental stresses led to erroneous results. False negative cTnI and BNP results potentially could miss acute myocardial infarction and congestive heart failure, confounded treatment, and increased mortality and morbidity. Therefore, rescuers should protect POC reagents from temperature extremes.
Article
Context. Point-of-care testing (POCT), diagnostic testing at or near the site of patient care, is inherently spatial, that is, performed at points of need, and also intrinsically temporal, because it produces fast actionable results. Outbreaks generate geospatial “hotspots.” POC strategies help control hotspots, detect spread, and speed treatment of highly infectious diseases. Objectives. To stop outbreaks, accelerate detection, facilitate emergency response for epidemics, mobilize public health practitioners, enhance community resilience, and improve crisis standards of care. Data Sources. PubMed, WWW, newsprint, others were searched until COVID-19 was declared a pandemic, the US, a national emergency, and Europe, the epicenter. Coverage comprised interviews in Asia, email to/from Wuhan, papers, articles, chapters, documents, maps, flowcharts, schematics, and geospatial-associated concepts. EndNote X9.1 (Clarivate Analytics) consolidated literature as abstracts, ULRs, and PDFs, recovering 136 hotspot articles. More than 500 geospatial science articles were assessed for relevance to point-of-care testing. Conclusions POCT can interrupt spirals of dysfunction and delay by enhancing disease detection, decision making, contagion containment, and safe spacing, thereby softening outbreak surges and diminishing risk before human, economic, and cultural losses mount. Point-of-care tests results identify where infected individuals spread COVID-19, when delays cause death, and how to deploy resources. Results in national cloud databases help optimize outbreak control, mitigation, emergency response, and community resilience. The COVID-19 pandemic demonstrates unequivocally that governments must support POCT and multidisciplinary healthcare personnel must learn its principles, then adopt POC geospatial strategies, so that onsite diagnostic testing can ramp up to meet needs in times of crisis.
Full-text available
Article
Objectives: (a) To understand how to integrate geospatial concepts when implementing point-of-care testing (POCT); (b) to facilitate emergency, outbreak, and disaster preparedness and emergency management in healthcare small-world networks; (c) to enhance community resilience by using POCT in tandem with geographic information systems (GISs) and other geospatial tools; and (d) to advance crisis standards of care at points of need, adaptable and scalable for public health practice in limited-resource countries and other global settings. Content: Visual logistics help integrate and synthesize POCT and geospatial concepts. The resulting geospatial solutions presented here comprise: (1) small-world networks and regional topography; (2) space-time transformation, hubs, and asset mapping; (3) spatial and geospatial care paths™; (4) GIS-POCT; (5) isolation laboratories, diagnostics isolators, and mobile laboratories for highly infectious diseases; (6) alternate care facilities; (7) roaming POCT—airborne, ambulances, space, and wearables; (8) connected and wireless POCT outside hospitals; (9) unmanned aerial vehicles; (10) geospatial practice—demographic care unit resource scoring, geographic risk assessment, and national POCT policy and guidelines; (11) the hybrid laboratory; and (12) point-of-careology. Value: Small-world networks and their connectivity facilitate efficient and effective placement of POCT for optimal response, rescue, diagnosis, and treatment. Spatial care paths™ speed transport from primary encounters to referral centers bypassing topographic bottlenecks, process gaps, and time-consuming interruptions. Regional GISs position POCT close to where patients live to facilitate rapid triage, decrease therapeutic turnaround time, and conserve economic resources. Geospatial care paths™ encompass demographic and population access features. Timeliness creates value during acute illness, complex crises, and unexpected disasters. Isolation laboratories equipped with POCT help stop outbreaks and safely support critically ill patients with highly infectious diseases. POCT-enabled spatial grids can map sentinel cases and establish geographic limits of epidemics for ring vaccination. Impact: Geospatial solutions generate inherently optimal and logical placement of POCT conceptually, physically, and temporally as a means to improve crisis response and spatial resilience. If public health professionals, geospatial scientists, and POCT specialists join forces, new collaborative teamwork can create faster response and higher impact during disasters, complex crises, outbreaks, and epidemics, as well as more efficient primary, urgent, and emergency community care.
Article
È rilevante la mancanza di studi in letteratura sulla reale utilità dei sistemi PoCT in eventi complessi, quali i disastri e le grandi emergenze, nonostante l’analisi dei processi sanitari nelle grandi catastrofi degli ultimi anni abbia confermato la necessità di un uso proattivo del PoCT in queste circostanze. All’interno degli standard di cura in condizioni di crisi delineati dall’Institute of Medicine, non vi è ancora sufficiente attenzione sulle modalità di impiego dei sistemi PoCT e non vengono previste procedure specifiche di intervento diagnostico nell’ambito del percorso terapeutico. Non appaiono infatti adeguati i modelli di intervento elaborati in tempo di pace o in condizioni ordinarie, data la diversità del contesto; per questo sta emergendo il più largo concetto di punto di necessità, in luogo del punto di cura. Tuttavia la Medicina di Laboratorio non è stata ancora chiamata a chiarire il campo e il contesto d’azione dell’attività diagnostica in vitro in queste particolari condizioni. Il principale scopo dell’articolo è definire per la prima volta alcune raccomandazioni relative ai criteri, ai modelli flessibili e alle strategie da attuare in condizioni di crisi: in particolare si fa riferimento ad alcune caratteristiche dei dispositivi (robustezza e tipologia di prestazioni), alle necessità dell’innovazione tecnologica e all’emergente esigenza di test diversi e mirati. Viene inoltre rivisto il concetto di leadership del coordinatore PoCT (con riferimento al set di abilità, all’analisi dell’esposizione al rischio e al piano di emergenza), sostenuta la necessità di nuove procedure per la formazione e l’addestramento (telemedicina, risorse web e impiego di smartphone) e infine riservata particolare attenzione alle strategie per la garanzia di qualità dei risultati dei test di laboratorio, dato il prevedibile incremento di potenziali rischi di errore nelle situazioni di crisi.