Gerald J. Kost's research while affiliated with University of California and other places

Publications (216)

Preprint
Our goal is to create point-of-care (POC) strategies that accelerate decision making, increase efficiency, improve outcomes, and enhance standards of care in island communities faced with global warming, rising oceans, population migration, and intensifying weather disasters. We assessed needs in the Bantayan Archipelago and mainland Cebu Province,...
Article
The Abbott i-STAT and Siemens Healthineers epoc are commonly used in the provision of care during emergency medical services calls and other settings. Maintaining these systems within manufacturer’s temperature claims in these settings poses challenges across the world. This review summarizes solutions that have been reported in the peer-reviewed l...
Article
Full-text available
Our primary objectives were (a) to determine the need for and the availability of point-of-care testing (POCT) for infectious diseases and (b) to recommend point-of-care testing strategies and Spatial Care PathsTM (SCPs) that enhance public health preparedness in the regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we co...
Preprint
Our primary objectives were a) to determine the need for, and the availability of point-of-care testing (POCT) for infectious diseases and b) to recommend point-of-care testing strategies and spatial care paths (SCPs) that enhance public health preparedness in regional districts of Thua Thien Hue Province (TTHP), Central Vietnam, where we conducted...
Article
Full-text available
This research uses mathematically derived visual logistics to interpret COVID-19 molecular and rapid antigen test (RAgT) performance, determine prevalence boundaries where risk exceeds expectations, and evaluate benefits of recursive testing along home, community, and emergency spatial care paths. Mathematica and open access software helped graph r...
Article
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Goal: The goal is to present key principles of point-of-care testing (POCT) in educational curricula that meet critical needs for rapid decision-making in disasters, outbreaks of highly infectious diseases, emergency management, and complex crises. Observations: The coronavirus disease 19 (COVID-19) pandemic unequivocally proved the value of POC...
Article
Context. – Coronavirus disease 2019 (COVID-19) rapid antigen tests generate intrinsically fast, inherently spatial, and immediately actionable results. They quickly confirm COVID-19, but weakly rule out infection. Test performance depends on prevalence and testing protocol. Both affect predictive values. Objectives. – To use original mathematics an...
Article
Context.— Timely reperfusion improves the recovery of patients with acute ischemic stroke. Laboratory results are crucial to guide treatment decisions in patients where abnormal laboratory tests are suspected. Objective.— To implement a new laboratory workflow for acute stroke patients and compare laboratory turnaround time (TAT) preimplementation...
Article
Context. Coronavirus disease 2019 (COVID-19) test performance depends on predictive values in settings of increasing disease prevalence. Geospatially distributed diagnostics with minimal uncertainty facilitate efficient point-of-need strategies. Objectives. To use original mathematics to interpret COVID-19 test metrics; assess Food and Drug Adminis...
Article
Context.—: Emergency medical services (EMS) programs have been using point-of-care testing (POCT) for more than 20 years. However, only a handful of reports have been published in all of that time on POCT practices in field settings. Objective.—: To provide an overview of POCT practices and failure modes in 3 of Alberta's EMS programs, and to pr...
Article
Context: Coronavirus infectious disease-19 (COVID-19) diagnostics require understanding of how predictive values depend on sensitivity, specificity, and especially, low prevalence. Clear expectations, high sensitivity and specificity, and manufacturer disclosure will facilitate excellence of tests. Objectives: To derive mathematical equations fo...
Article
Context. Point-of-care testing (POCT) is inherently spatial, that is, performed where needed, and intrinsically temporal, because it accelerates decision making. POCT efficiency and effectiveness have the potential to facilitate antimicrobial resistance (AMR) detection, decrease risks of co-infections for critically ill COVID-19 patients, and impro...
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 o...
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Full-text available
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 ot...
Article
Background: Anion gap (AG) aids the differential diagnosis of acid-base disorders. Its value has decreased, because of new analytical methods. Our goal was to compare AG reference intervals for different instruments and Southeast Asian populations. Methods: We studied AG at three hospitals. One used the cobas 8000; two others, the Architect c160...
Article
Goals Our primary objective was to describe needs for and availability of point-of-care testing for diabetes mellitus diagnosis/monitoring in Central Vietnam. Methods The field survey was designed to determine the status of point-of-care testing at 15 hospitals, comprising 1 provincial hospital (level 2), 7 district hospitals (level 3), and 7 commu...
Article
Full-text available
Hb mutations can alter the structure, behavior, stability, or quantity of the globin chain produced. Some Hb variants shorten the erythrocyte life span, resulting in physiologically lower hemoglobin A1c (HbA1c) levels. The hemoglobin E (HbE) phenotype involves a single-nucleotide polymorphism that reduces β-globin chain synthesis. We compared the H...
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Objectives: To develop awareness of benefits of point-of-care testing (POCT) education in schools of public health, to identify learning objectives for teaching POCT, to enable public health professionals and emergency responders to perform evidence-based diagnosis and triage effectively and efficiently at points of need, and to better improve futu...
Article
Full-text available
Objectives Objectives were to (a) advance point-of-care (POC) education, international exchange, and culture; (b) report needs assessment survey results from Thua Thien Hue Province, Central Vietnam; (c) determine diagnostic capabilities in regional health care districts of the small-world network of Hue University Medical Center; and (d) recommend...
Article
Introduction: U.S. hospitals that admitted Ebola virus disease (EVD) patients mitigated risk by using point-or-care testing (POCT) for critical support in isolation units. Success proved unequivocally the need for POCT. Additionally, molecular diagnostics have been used to help stop new outbreaks, and even handheld diagnostic solutions are emerging...
Article
Goals: The aims of this article were to report the first Taiwan pointof-care testing (POCT) needs assessment survey, to analyze distance/ time/economic metrics for POC diagnosis in Hualien, an eastern seaboard county vulnerable to typhoons, and to recommend national policy and guidelines (P&G) for enhancing POCT and resilience. Methods: We organize...
Article
In limited-resource settings, prediabetes and diabetes care demand efficient Spatial Care Paths and effective geospatial optimization of medical services upstream to avoid the economic penalties of untold patient complications downstream. Clever HbA1c technologies placed at the leading edge of primary care in health care small-world networks will i...
Article
Objective: Point of care (POC) is bogged down because of ineffective biohazard containment, insufficient environmental robustness, test clusters-cartridges unable to target rapidly emerging diseases, unpredictable errors in bedside results, dependence on misleading global parametric rather than local nonparametric statistical analysis, high margina...
Article
Full-text available
Background Rapid and accurate diagnosis drives evidence-based care in health. Point-of-care testing (POCT) aids diagnosis by bringing advanced technologies closer to patients. Health small-world networks are constrained by natural connectivity in the interactions between geography of resources and social forces. Using a geographic information syste...
Article
Background: Hospitals in tropical countries experience conditions that exceed manufacturer temperature and humidity limits for point-of-care (POC) glucose reagents. Our goal was to assess the effects of out-of-limits storage temperature, operating temperature, and operating humidity on POC glucose measurement reliability. Methods: Quality contro...
Article
Full-text available
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 no...
Article
Full-text available
To present a vision where point-ofcare testing (POCT) accelerates an Ebola Spatial Care Path™ (SCP) and future molecular diagnostics enable facilitated-access self-testing (FAST POC); to design an alternate care facility (ACF) for the SCP; to innovate an Ebola diagnostic center (DC); and to propel rapid POCT to the frontline to create resilience th...
Article
The surveillance error grid (SEG) analysis is a tool for analysis and visualization of blood glucose monitoring (BGM) errors, based on the opinions of 206 diabetes clinicians who rated 4 distinct treatment scenarios. Resulting from this large-scale inquiry is a matrix of 337 561 risk ratings, 1 for each pair of (reference, BGM) readings ranging fro...
Article
Objective The objective was to assess the effects of short-term (≤1 hour) static high temperature and humidity stresses on the performance of point-of-care (POC) glucose test strips and meters. Background Glucose meters are used by medical responders and patients in a variety of settings including hospitals, clinics, homes, and the field. Reagent...
Article
Efficient emergency and disaster response is challenged by environmental conditions exceeding test reagent storage and operating specifications. We assessed the effectiveness of vial and foil packaging in preserving point-of-care (POC) glucose and lactate test strip performance in humid conditions. Glucose and lactate test strips in both packaging...
Article
By shortening the time to pathogen identification and allowing for detection of organisms missed by blood culture, new molecular methods may provide clinical benefits for the management of patients with sepsis. While a number of reviews on the diagnosis of sepsis have recently been published we here present up-to-date new developments including mul...
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Full-text available
Introduction During disasters and complex emergencies, environmental conditions can adversely affect the performance of point-of-care (POC) testing. Knowledge of these conditions can help device developers and operators understand the significance of temperature and humidity limits necessary for use of POC devices. First responders will benefit fro...
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...
Article
To describe, innovate, recommend, and foster the implementation of point-of-care (POC) testing in disaster caches to enhance crisis standards of care and to improve triage, diagnosis, monitoring, treatment, and management of victims and volunteers in complex emergencies and disasters. The authors compared POC testing in United States disaster cache...
Article
Abstract Strategic integration of point-of-care (POC) diagnostic tools during crisis response can accelerate triage and improve management of victims. Timely differential diagnosis is essential wherever care is provided to rule out or rule in disease, expedite life-saving treatment, and improve utilization of limited resources. POC testing needs to...
Chapter
This book, composed of 34 chapters, provides a comprehensive discussion on the current state of and emerging trends in the field of disaster management. It is composed of 10 sections: (1) disaster management and homeland security: a prologue; (2) training, mitigation and medical preparedness; (3) the crucial role of communication in disaster manage...
Conference Paper
When a crisis occurs, emergency medical responders must often operate outside of a hospital setting without basic resources such as electricity. As a result, they rely on point-of-care (POC) testing devices, which are designed to be portable for monitoring critical parameters such as blood gases and glucose levels. Unfortunately, POC devices often...
Article
Objective: The 2004 earthquake/tsunami devastated Southeast Asia. We studied point-of-care testing (POCT) and O2 saturation monitoring in Phang Nga, hardest hit southern coastal province, to develop preparedness strategies for low-resource small-world networks (SWNs). Design, Setting, and Participants: Early 2005, we surveyed 4 provinces then, in 2...
Article
Objectives: The objectives of this article are (a) to identify current deficiencies in performance evaluation for which there are proven solutions that will improve clinical decision-making; (b) to prioritize useful initiatives, such as noninvasive monitoring, for resiliency in low-resource countries and island nations; and (c) to introduce the con...
Article
Aims: To verify monoplex and multiplex gene-specific linear-after-the-exponential polymerase chain reaction (LATE-PCR) assays for identifying 17 microbial pathogens (i.e., Klebsiella sp., Acinetobacter baumannii, Staphylococcus aureus, Enterobacter sp., Pseudomonas aeruginosa, coagulase negative staphylococci, Enterococcus sp., Candida sp.) common...
Article
Resilience through use of point-of-care (POC) testing in small-world networks will change the future landscape by bringing evidence-based decision-making to sites of need globally. Point-of-care (POC) testing is performed at or near the site of care to accelerate decision-making. This chapter provides value propositions that show new POC technologi...
Article
We hypothesize that a medical geographical information system (GIS) can improve medical response during complex emergencies and disasters by facilitating the strategic placement and management of point-of-care (POC) technologies within a small-world network (SWN). Point-of-care testing is defined as testing at or near the site of patient care. An S...
Article
Objectives: Our objectives were (a) to define resiliency strategies for catastrophic floods; (b) to report how these strategies that evolved during the Great Bangkok Flood; (c) to anticipate crisis care during weather disasters and mitigate risk for victims, patients, residents, and professionals; (d) to offer leadership approaches for disaster lab...
Article
Aims: The goal of this study was to construct a single-tube multiplex molecular diagnostic assay using linear-after-the-exponential (LATE)-PCR for the detection of 17 microbial pathogens commonly associated with septicaemia. Methods and results: The assay described here detects 17 pathogens associated with sepsis via amplification and analysis o...
Article
Objective: To characterize the performance of glucose meter test strips using simulated dynamic temperature and humidity disaster conditions. Methods: Glucose oxidase- and glucose dehydrogenase-based test strips were dynamically stressed for up to 680 hours using an environmental chamber to simulate conditions during Hurricane Katrina. Paired me...
Article
Objective: The objective of this study was to characterize the effects of dynamic temperature and humidity stresses on quality control (QC) reagents used for 2 glucose meter systems. Methods: Quality control solutions tested on glucose meter systems GMS1 (StatStrip; Nova Biomedical, Waltham, Mass) and GMS2 (Accu-Chek; Roche Diagnostics, Indianapoli...
Article
Background: Blood contamination on glucose meters potentially can spread infectious agents that may lead to nosocomial infections. The goal of this study was to use reduced phenolphthalein as a point-of-care test at community hospitals and primary care units (PCUs) in Thailand for surveying on blood contamination on glucose meters. Methods: Reduced...
Article
Objective: Our purpose was to evaluate the effects of a dynamic cold profile on the performance of epoc (Alere, Waltham, Mass) test cards for blood gas and electrolyte measurements using quality control (QC) reagents. Methods: Test cards for the epoc system were stressed under a profile modeling the conditions experienced during the rescue and reco...
Article
BACKGROUND: We assessed point-of-care device specifications and needs for pathogen detection in urgent care, emergencies, and disasters. METHODS: We surveyed American Association for Clinical Chemistry members and compared responses to those of disaster experts. Online SurveyMonkey questions covered performance characteristics, device design, patho...
Article
A health care small-world network (SWN) evolves naturally from social interactions and population dynamics. However, during a crisis, the SWN becomes constrained by interrupted transportation within the limited geographic topology. Hence, practice principles for optimizing point-of-care (POC) testing in SWNs are designed to enhance emergency care,...
Article
The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA '88 documentation requi...
Article
The objectives of this article were to identify the skills, functions, and leadership characteristics of personnel who perform point-of-care (POC) testing, coordinate it for the health system, and also respond to crises; to describe how to assess beneficial and poor outcomes resulting from emergency events and how also to perform hazard vulnerabili...
Article
Most entrepreneurial ventures fail long before the core technology can be brought to the marketplace because of disconnects in performance and usability measures such as accuracy, cost, complexity, assay stability, and time requirements between technology developers' specifications and needs of the end-users. By going through a clinical needs asses...
Article
Resiliency through use of point-of-care (POC) testing in small-world networks will change the future landscape by bringing evidence-based decision-making to sites of need globally. This issue of Point of Care addresses fundamental principles and essential building blocks that mitigate crises and enhance standards of care. Several papers on needs as...
Article
OBJECTIVES: To study health resources and point-of-care (POC) testing requirements for urgent, emergency, and disaster care in Phang Nga Province, Thailand; to determine instrument design specifications through a direct needs assessment survey; to describe POC test menus useful in the small-world network; and to assess strategies for preparedness f...
Article
The goal of this study is to determine the clinical value of multiplex polymerase chain reaction (PCR) study for enhancing pathogen detection in patients with suspected septicemia after trauma, emergency, and burn surgery. PCR-based pathogen detection quickly reveals occult bloodstream infections in these high-risk patients and may accelerate the i...
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...
Article
The goal is to introduce visual performance mapping efficient for establishing acceptance criteria and facilitating decisions regarding the utility of hospital point-of-care devices. This approach uniquely reveals the quality of performance locally, as opposed to globally. After presenting theoretical foundations, this study illustrates the approac...
Article
The case studies reported in this article strive to illustrate the clinical value of multiplex polymerase chain reaction (PCR)-based pathogen detection in patients with burn sepsis. Adult (age ≥18 years) burn patients (≥20% TBSA) presenting with signs and symptoms of burn sepsis were enrolled into a prospective, observational trial. Patients receiv...
Article
Objectives: The objectives of the study were (a) to perform point-of-care (POC) hemoglobin A1c (HbA1c) testing at primary care units (PCUs) in rural villages, (b) to devise strategies for improved diabetes control, (c) to improve efficiency managing high-volume diabetic patients, and (d) to implement a small-world network (SWN) of PCUs, a community...
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Full-text available
The increasingly global focus on health care issues continues to underline the importance of point-of-care technologies and their ability to provide cost-effective solutions that address many unmet health care needs. Further, the current crisis in health care costs has critically underscored the need for research and development into highly effecti...
Article
OBJECTIVE: The goal of this paper is to identify strategies for connectivity that will optimize point-of-care testing (POCT) organized as small-world networks in disaster settings. METHODS: We evaluated connectivity failures during the 2010 Haiti Earthquake, applied small-world network concepts, and reviewed literature for point-of-care (POC) conne...
Article
The objectives of this article were 1) to identify current trends in critical values practices in North America, Europe, and other regions; 2) to describe progress toward harmonization of critical limits; and 3) to synthesize strategies that will encourage global consensus. Critical limits are described in national surveys. Critical value practices...
Data
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Substitution factors. Description: For institutions that presently have only culture based data available, the substitutions in this additional data file allow utilization of the model to estimate potential gains from PCR.
Data
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Cost per PCR test. This additional file explains the cost components for one PCR test. Furthermore, two graphs represent how the key results would change with different PCR costs.
Article
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Delays in adequate antimicrobial treatment contribute to high cost and mortality in sepsis. Polymerase chain reaction (PCR) assays are used alongside conventional cultures to accelerate the identification of microorganisms. We analyze the impact on medical outcomes and healthcare costs if improved adequacy of antimicrobial therapy is achieved by pr...
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Full-text available
To define pathogen tests and device specifications needed for emerging point-of-care (POC) technologies used in disasters. Surveys included multiple-choice and ranking questions. Multiple-choice questions were analyzed with the chi2 test for goodness-of-fit and the binomial distribution test. Rankings were scored and compared using analysis of vari...
Article
OBJECTIVES:: To improve the speed of efficient diagnosis of acute chest pain in patients in rural emergency departments of low-resource community hospitals (CHs), to optimize point-of-care cardiac biomarker testing, and to carefully align referral and treatment within strategic care paths. METHODS AND SETTING:: Near the Mekong River in northern Isa...
Article
The goals of needs assessment are to assess future point-of-care (POC) designs, to define instrument characteristics, and to specify test clusters, here focused on emergency and disaster care.We developed a survey tool based on disaster medicine expert feedback, the Warfare Analysis Laboratory Exercise, and multidisciplinary consultation. The surve...