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Walsh P, Hankins A, Bang H. Point-of-care lung ultrasound predicts hyperferritinemia and hospitalization, but not elevated troponin in SARS-CoV-2 viral pneumonitis in children. Sci Rep 2024; 14:5899. [PMID: 38467670 PMCID: PMC10928070 DOI: 10.1038/s41598-024-55590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
SARS-CoV-2 often causes viral pneumonitis, hyperferritinemia, elevations in D-dimer, lactate dehydrogenase (LDH), transaminases, troponin, CRP, and other inflammatory markers. Lung ultrasound is increasingly used to diagnose and stratify viral pneumonitis severity. We retrospectively reviewed 427 visits in patients aged 14 days to 21 years who had had a point-of-care lung ultrasound in our pediatric emergency department from 30/November/2019 to 14/August/2021. Lung ultrasounds were categorized using a 6-point ordinal scale. Lung ultrasound abnormalities predicted increased hospitalization with a threshold effect. Increasingly abnormal laboratory values were associated with decreased discharge from the ED and increased admission to the ward and ICU. Among patients SARS-CoV-2 positive patients ferritin, LDH, and transaminases, but not CRP or troponin were significantly associated with abnormalities on lung ultrasound and also with threshold effects. This effect was not demonstrated in SARS-CoV-2 negative patients. D-Dimer, CRP, and troponin were sometimes elevated even when the lung ultrasound was normal.
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Affiliation(s)
- Paul Walsh
- Pediatric Emergency Medicine, Sutter Medical Center Sacramento, 2825 Capitol Avenue, Sacramento, CA, USA.
| | - Andrea Hankins
- Sutter Institute for Medical Research, 2801 L Street, Sacramento, CA, USA
- Sutter Health Center for Health Systems Research, Sutter Health, Walnut Creek, CA, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, 1 Shields Ave, Davis, CA, USA
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Orwig T, Sutaria S, Wang Z, Howard-Wilson S, Dunlap D, Lilly CM, Buchholz B, McManus DD, Hafer N. Sampling of healthcare professionals' perspective on point-of-care technologies from 2019-2021: A survey of benefits, concerns, and development. PLoS One 2024; 19:e0299516. [PMID: 38457401 PMCID: PMC10923439 DOI: 10.1371/journal.pone.0299516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/09/2024] [Indexed: 03/10/2024] Open
Abstract
Point-of-care technology (POCT) plays a vital role in modern healthcare by providing a fast diagnosis, improving patient management, and extending healthcare access to remote and resource-limited areas. The objective of this study was to understand how healthcare professionals in the United States perceived POCTs during 2019-2021 to assess the decision-making process of implementing these newer technologies into everyday practice. A 5-point Likert scale survey was sent to respondents to evaluate their perceptions of benefits, concerns, characteristics, and development of point-of-care technologies. The 2021 survey was distributed November 1st, 2021- February 15th, 2022, with a total of 168 independent survey responses received. Of the respondents, 59% identified as male, 73% were white, and 48% have been in practice for over 20 years. The results showed that most agreed that POCTs improve patient management (94%) and improve clinician confidence in decision making (92%). Healthcare professionals were most concerned with potentially not being reimbursed for the cost of the POCT (37%). When asked to rank the top 3 important characteristics of POCT, respondents chose accuracy, ease of use, and availability. It is important to note this survey was conducted during the COVID-19 pandemic. To achieve an even greater representation of healthcare professionals' point of view on POCTs, further work to obtain responses from a larger, more diverse population of providers is needed.
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Affiliation(s)
- Taylor Orwig
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
| | - Shiv Sutaria
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
| | - Ziyue Wang
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
| | - Sakeina Howard-Wilson
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
| | - Denise Dunlap
- Manning School of Business, UMass Lowell, Lowell, MA, United States of America
| | - Craig M. Lilly
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
- Department of Anesthesiology and Perioperative Medicine, UMass Chan Medical School, Worcester, Massachusetts, United States of America
- Department of Surgery, UMass Chan Medical School, Worcester, Massachusetts, United States of America
| | - Bryan Buchholz
- Department of Biomedical Engineering, UMass Lowell, Lowell, MA, United States of America
| | - David D. McManus
- Department of Medicine, UMass Chan Medical School, Worcester, MA, United States of America
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, Worcester, MA, United States of America
| | - Nathaniel Hafer
- UMass Center for Clinical and Translational Science, UMass Chan Medical School, Worcester, MA, United States of America
- Program in Molecular Medicine, UMass Chan Medical School, Worcester, MA, United States of America
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103
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Deng J, Zhu H, An S, Huang H, Wang R, Chen Y, Chen P, Yu X. Accurate detection of influenza A virus by use of a novel cross-priming isothermal amplification-based point-of-care assay. Microbiol Spectr 2024; 12:e0307423. [PMID: 38349165 PMCID: PMC10913471 DOI: 10.1128/spectrum.03074-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024] Open
Abstract
Influenza virus is known to cause respiratory tract infections of varying severity in individuals of all ages. The EasyNAT Rapid Flu assay is a newly developed in vitro diagnostic test that employs cross-priming isothermal amplification (CPA) to detect and differentiate influenza A and B viruses in human nasopharyngeal (NP) swabs. The aim of this study is to determine the performance characteristics of the EasyNAT Rapid Flu assay for rapid detection of influenza virus. The limit of detection (LOD) and cross-reactivity of the EasyNAT Rapid Flu assay were assessed. The clinical performance of the assay was evaluated using NP swab samples that were tested with real-time reverse-transcription polymerase chain reaction (RT-PCR) and Xpert Xpress Flu/RSV assay. The LOD for the detection of influenza A and B using the EasyNAT Rapid Flu assay was found to be 500 copies/mL. Furthermore, the assay exhibited no cross-reactivity with other common respiratory viruses tested. For the 114 NP swab samples tested for influenza A using both the EasyNAT Rapid Flu assay and real-time RT-PCR, the two assays demonstrated a high level of agreement (κ = 0.963, P < 0.001), with a positive percentage agreement (PPA) of 97.7% and a negative percentage agreement (NPA) of 98.6%. Similarly, for the 43 NP swab samples tested for influenza A and B using both the EasyNAT Rapid Flu assay and Xpert Xpress Flu/RSV assay, the two assays showed a high level of agreement (κ = 0.933, P < 0.001), with the overall rate of agreement (ORA) of 97.7% for influenza A and 100% for influenza B. The EasyNAT Rapid Flu assay demonstrates excellent performance in the detection of influenza A, highlighted by its strong agreement with RT-PCR-based assays.IMPORTANCEThe newly developed EasyNAT Rapid Flu assay is an innovative cross-priming isothermal amplification-based method designed for detecting influenza A and B viruses at point-of-care settings. This study aims to thoroughly assess the analytical and clinical performance of the assay, offering valuable insights into its potential advantages and limitations. The findings of this research hold significant implications for clinical practice.
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Affiliation(s)
- Jiankai Deng
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongji Zhu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shu An
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Huang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruizhi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peisong Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuegao Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wu W, Li Y, Song P, Xu Q, Lei D, Wang J, Fu B, Kong W. UiOL@AIEgens-assisted lateral flow immunosensor for the ultrasensitive dual-modal point-of-care detection of aflatoxin B 1. J Hazard Mater 2024; 465:133103. [PMID: 38043421 DOI: 10.1016/j.jhazmat.2023.133103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/13/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
Aflatoxin B1 (AFB1) contamination in food has attracted worldwide attention. The sensitive detection of AFB1 is vital for ensuring food quality and safety. This study developed an ultrasensitive signal-enhanced lateral flow immunosensor (LFIS) based on the functionalized zirconium metal-organic framework (MOF) of a UiO linker enriched with abundant aggregation-induced emission luminogen (UiOL@AIEgens) probes for the rapid dual-modal point-of-care (POC) determination of AFB1. Using UiO MOFs with numerous active sites as the carrier facilitated abundant AIEgens enrichment on the surface. After coupling with enough anti-AFB1 monoclonal antibodies (mAbs), the green-emissive UiOL@AIEgens-mAbs probes with high specificity and remarkably-enhanced fluorescence responses were obtained to competitively capture target AFB1 in the standard or sample solution and AFB1 antigen immobilized on the test (T) line of the POC LFIS. Under optimum conditions, the LFIS was capable of visual qualitative and smartphone-assisted dual-modal determination of target AFB1 within 7 min. Detection occurred in a range of 0.01-5 ng/mL at an ultra-low detection limit of 0.003 ng/mL, which was 300- and 600-fold lower than traditional immunoassays and the maximum limit set by the European Union, respectively. Moreover, the feasibility and robustness of the LFIS platform were assessed by detecting AFB1 in maize and lotus seed samples with average recoveries of 94.3-109.0%. The developed UiOL@AIEgens-based POC LFIS can be used for ultrasensitive, reliable, on-site detection in food. This study provides a new method for the real-time monitoring of AFB1 and other harmful contaminants in food and more complex matrices.
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Affiliation(s)
- Wenjuan Wu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China; College of Science, China Agricultural University, Beijing 100193, China
| | - Ying Li
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Pengyue Song
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Qingbin Xu
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Doudou Lei
- State Key Laboratory of Southwestern Chinese Medicine Resources, Pharmacy College, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Jiabo Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
| | - Bin Fu
- College of Science, China Agricultural University, Beijing 100193, China
| | - Weijun Kong
- School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China.
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105
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Singh S, Raucci A, Cimmino W, Cinti S. Paper-Based Analytical Devices for Cancer Liquid Biopsy. Anal Chem 2024; 96:3698-3706. [PMID: 38377543 DOI: 10.1021/acs.analchem.3c04478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Liquid biopsies have caused a significant revolution in cancer diagnosis, and the use of point of care (PoC) platforms has the potential to bring liquid biopsy-based cancer detection closer to patients. These platforms provide rapid and on-site analysis by reducing the time between sample collection and results output. The aim of this tutorial content is to provide readers an in-depth understanding regarding the choice of the ideal sensing platform suitable for specific cancer-related biomarkers.
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Affiliation(s)
- Sima Singh
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | - Ada Raucci
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | - Wanda Cimmino
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131 Naples, Italy
| | - Stefano Cinti
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131 Naples, Italy
- BAT Center- Interuniversity Center for Studies on Bioinspired Agro-Environmental Technology, University of Napoli Federico II, 80055 Naples, Italy
- Bioelectronics Task Force at University of Naples Federico II, Via Cinthia 21, 80126 Naples, Italy
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106
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Jin B, Ma C, Zhang C, Yin H, Zhao G, Hu J, Li Z. Point-of-care detection of Monkeypox virus clades using high-performance upconversion nanoparticle-based lateral flow assay. Mikrochim Acta 2024; 191:177. [PMID: 38441684 DOI: 10.1007/s00604-024-06241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/26/2024] [Indexed: 03/07/2024]
Abstract
There is an urgent need for a point-of-care testing (POCT) method in developing and underserved regions to distinguish between two Monkeypox virus (MPXV) clades, given their varying transmissibility and clinical manifestations. In this paper, we target the specific complement protein gene fragment of two MPXV clades and construct a high-performance upconversion nanoparticles-based lateral flow assay (UCNPs-based LFA) with double T-lines and a shared C-line. This enables qualitative and quantitative dual-mode detection when combined with a smartphone and a benchtop fluorescence analyzer. The developed LFA exhibits stable performance, convenient operation, rapid readout (within 8 min), and a much lower limit of detection (LOD) (~ pM level) compared to existing POCT methods. The proposed detection platform demonstrates significant potential for pathogen diagnosis using a POCT approach.
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Affiliation(s)
- Birui Jin
- School of Materials and Chemical Engineering, Xi'an Technological University, Xi'an, 710021, People's Republic of China
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Chuan Ma
- School of Materials and Chemical Engineering, Xi'an Technological University, Xi'an, 710021, People's Republic of China
| | - Chuyao Zhang
- School of Materials and Chemical Engineering, Xi'an Technological University, Xi'an, 710021, People's Republic of China
| | - Huiling Yin
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Guoxu Zhao
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
- State Key Laboratory of Digital Medical Engineering, School of Biomedical Engineering, Hainan University, Haikou, 570228, People's Republic of China
| | - Jie Hu
- Suzhou DiYinAn Biotech Co., Ltd., Suzhou Innovation Center for Life Science and Technology, Suzhou, 215129, People's Republic of China.
| | - Zedong Li
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, People's Republic of China.
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
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107
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Muttaqien SE, Khoris IM, Suryanggono J, Sadhukhan PC, Pambudi S, Chowdhury AD, Park EY. Point-of-care dengue detection: polydopamine-modified electrode for rapid NS1 protein testing for clinical samples. Mikrochim Acta 2024; 191:174. [PMID: 38436801 DOI: 10.1007/s00604-024-06259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Early diagnosis of dengue infection by detecting the dengue virus non-structural protein 1 (DENV-NS1) is important to the patients to initiate speedy treatment. Enzyme-linked immunosorbent assay (ELISA)-based NS1 detection and RT-PCR are time-consuming and too complex to be employed in remote areas of dengue-endemic countries. Meanwhile, those of NS1 rapid test by lateral flow assay suffer from low detection limit. Electrochemical-based biosensors using screen-printed gold electrodes (SPGEs) have become a reliable detection method to convey both ELISA's high sensitivity and rapid test portability. In this research, we developed an electrochemical biosensor for DENV-NS1 detection by employing polydopamine (PDA)-modified SPGE. The electrodeposition of PDA on the surface of SPGE serves as a bioconjugation avenue for anti-NS1 antibody through a simple and low-cost immobilization procedure. The biosensor performance was evaluated to detect DENV-NS1 protein in PBS and human serum through a differential pulse voltammetric (DPV) technique. The developed sensing platform displayed a low limit of detection (LOD) of 1.63 pg mL-1 and a wide linear range of 10 pg mL-1 to 1 ng mL-1 (R2 ∼ 0.969). The sensing platform also detected DEV-NS1 from four different serotypes in the clinical samples collected from dengue patients in India and Indonesia, with acceptable sensitivity, specificity, and accuracy values of 90.00%, 80.95%, and 87.65%, respectively. This result showcased the facile and versatile method of PDA coating onto the surface of screen-printed gold electrodes for a miniaturized point-of-care (PoC) detection device.
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Affiliation(s)
- Sjaikhurrizal El Muttaqien
- Research Institute of Green Science and Technology, Shizuoka University, 836 Ohya Suruga-Ku, Shizuoka, 422-8529, Japan
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), LAPTIAB 1, PUSPIPTEK, Tangerang Selatan, 15314, Indonesia
| | - Indra Memdi Khoris
- Research Institute of Green Science and Technology, Shizuoka University, 836 Ohya Suruga-Ku, Shizuoka, 422-8529, Japan
- Nanomaterials Research Division, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Ibaraki, 305-8565, Japan
| | - Jodi Suryanggono
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), LAPTIAB 1, PUSPIPTEK, Tangerang Selatan, 15314, Indonesia
| | - Provash C Sadhukhan
- ICMR-NICED Virus Laboratory, Kolkata, I.D. & B.G. Hospital, Banerjee Road, Kolkata, 700010, West Bengal, India
| | - Sabar Pambudi
- Research Center for Vaccine and Drugs, National Research and Innovation Agency (BRIN), LAPTIAB 1, PUSPIPTEK, Tangerang Selatan, 15314, Indonesia
| | - Ankan Dutta Chowdhury
- Amity Institute of Nanotechnology, Amity University Kolkata, Kolkata, 700084, West Bengal, India
| | - Enoch Y Park
- Research Institute of Green Science and Technology, Shizuoka University, 836 Ohya Suruga-Ku, Shizuoka, 422-8529, Japan.
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108
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Francisco Neto MJ, Lira Filho EBD, Queiroz MRGD. Point-of-Care in Clinical Practice: Consolidated Reality. Arq Bras Cardiol 2024; 121:e20230688. [PMID: 38451562 DOI: 10.36660/abc.20230688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/08/2023] [Indexed: 03/08/2024] Open
Affiliation(s)
- Miguel José Francisco Neto
- Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP - Brasil
| | - Edgar Bezerra de Lira Filho
- Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE) - Hospital Albert Einstein, São Paulo, SP - Brasil
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109
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Huang S, Cao S, Sun X, Zhang J. Gastric point-of-care ultrasonography in patients undergoing radical gastrointestinal surgery before anesthetic induction: an observational cohort study. BMC Anesthesiol 2024; 24:90. [PMID: 38433227 PMCID: PMC10910806 DOI: 10.1186/s12871-024-02473-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Pulmonary aspiration of gastric contents is a serious perioperative complication. Patients with gastric cancer may experience delayed gastric emptying. However, the role of qualitative and quantitative gastric ultrasound assessments in this patient population before anesthesia induction has not yet been determined. METHODS Adult patients with gastrointestinal cancer were recruited and examined using gastric point-of-care ultrasound (POCUS) before anesthetic induction from March 2023 to August 2023 in a tertiary cancer center. Three hundred patients with gastric cancer were conducted with POCUS prior to induction, and three hundred patients with colorectal cancer were included as controls. The cross-sectional area (CSA) of the gastric antrum and gastric volumes (GV) were measured and calculated. We determined the nature of the gastric contents and classified the antrum using a 3-point grading system. A ratio of GV to body weight > 1.5mL/Kg was defined as a high risk of aspiration. RESULTS In patients with gastric cancer, 70 patients were classified as grade 2 (23%, including 6 patients with solid gastric contents) and 63 patients (21%) were identified as having a high risk of aspiration. Whereas in patients with colorectal cancer, only 11 patients were classified as grade 2 (3.7%), and 27 patients (9.7%) were identified as having a high risk of aspiration. A larger tumor size (OR:1.169, 95% CI 1.045-1.307, P = 0.006), tumor located in antrum (OR:2.304, 95% CI 1.169-4.539,P = 0.016), gastrointestinal obstruction (OR:21.633, 95% CI 4.199-111.443, P < 0.0001) and more lymph node metastasis (OR:2.261, 95% CI 1.062-4.812, P = 0.034) were found to be positively while tumor site at cardia (OR:0.096, 95% CI 0.019-0.464, P = 0.004) was negatively associated with high aspiration risk in patients with gastric cancer. CONCLUSION The Gastric POCUS prior to induction provides an assessment of the status of gastric emptying and can identify the patients at high risk of aspiration, especially those with gastric cancer. TRIAL REGISTRATION Chinese Clinical Trial Registry ( www.chictr.org.cn ) identifier: ChiCTR2300069242; registered 10 March 2023.
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Affiliation(s)
- Siming Huang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Shumei Cao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Xia Sun
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.
- Department of Oncology, Shanghai Medical College, Fudan University, No.270, DongAn Road, Xuhui District, Shanghai, 200032, China.
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110
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Soliman SB. Challenges to address prior to considering performing musculoskeletal point-of-care ultrasound. J Osteopath Med 2024; 124:139-140. [PMID: 38073485 DOI: 10.1515/jom-2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Steven B Soliman
- Clinical Associate Professor, Division of Musculoskeletal Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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111
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Belard S, Taccari F, Kumwenda T, Huson MA, Wallrauch C, Heller T. Point-of-care ultrasound for tuberculosis and HIV-revisiting the focused assessment with sonography for HIV-associated tuberculosis (FASH) protocol and its differential diagnoses. Clin Microbiol Infect 2024; 30:320-327. [PMID: 37923216 DOI: 10.1016/j.cmi.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The 'Focused assessment with sonography for HIV-associated tuberculosis' (FASH) protocol has been applied and researched for over a decade in HIV-infected patients with suspected extra-pulmonary tuberculosis. Interpretation of target FASH features may be challenging as they can also indicate alternative opportunistic diseases. OBJECTIVES The primary aim of the review was summarizing the accumulated evidence on the diagnostic accuracy of the FASH protocol including description of diagnoses of target FASH features. SOURCES Literature was searched using PubMed, Google Scholar, and publications referencing the original FASH publications; data from identified studies were compiled with data from studies identified by a preceding Cochrane review. A meta-analysis was performed based on a generalized linearized mixed model. Data on differential diagnoses were compiled by literature review and retrospective evaluation of clinical data. CONTENT We identified ten studies; abdominal target FASH features were most studied. Sensitivity and specificity estimates were 39% (95% CI 25-54) and 89% (95% CI 83-96) for enlarged lymph nodes (ten studies), and 30% (95% CI 16-45%) and 93% (95% CI 89-98%) for hypoechoic spleen lesions (eight studies). In people living with HIV differential diagnoses of target FASH features are multiple and primarily include other opportunistic infections and malignancies such as non-tuberculous mycobacterial infection, bacillary angiomatosis, hepato-splenic brucellosis, meliodiosis, visceral leishmaniasis, invasive fungal infections, and lymphoma as well as Kaposi sarcoma. Ultrasound-guided diagnostic sampling may assist obtention of a definitive diagnosis. IMPLICATIONS On the basis of current evidence, although limited by methodology, and personal experience, we recommend basic ultrasound training, including the FASH protocol and ultrasound-guided diagnostic interventions, for all healthcare providers working with people living with HIV in resource-limited settings.
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Affiliation(s)
- Sabine Belard
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Partner Site Tübingen, German Center for Infection Research (DZIF), Tübingen, Germany.
| | - Francesco Taccari
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Michaëla Am Huson
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Tom Heller
- Lighthouse Clinic Trust, Lilongwe, Malawi; International Training and Education Center for Health, University of Washington, Seattle, WA, USA
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Pawlowski TW, Polidoro R, Fraga MV, Biasucci DG. Point-of-care ultrasound for non-vascular invasive procedures in critically ill neonates and children: current status and future perspectives. Eur J Pediatr 2024; 183:1037-1045. [PMID: 38085280 DOI: 10.1007/s00431-023-05372-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/02/2023] [Accepted: 12/05/2023] [Indexed: 03/20/2024]
Abstract
Point-of-care ultrasound (POCUS) has been established as an essential bedside tool for real-time image guidance of invasive procedures in critically ill neonates and children. While procedural guidance using POCUS has become the standard of care across many adult medicine subspecialties, its use has more recently gained popularity in neonatal and pediatric medicine due in part to improvement in technology and integration of POCUS into physician training programs. With increasing use, emerging data have supported its adoption and shown improvement in pediatric outcomes. Procedures that have traditionally relied on physical landmarks, such as thoracentesis and lumbar puncture, can now be performed under direct visualization using POCUS, increasing success, and reducing complications in our most vulnerable patients. In this review, we describe a global and comprehensive use of POCUS to assist all steps of different non-vascular invasive procedures and the evidence base to support such approach. CONCLUSION There has been a recent growth of supportive evidence for using point-of-care ultrasound to guide neonatal and pediatric percutaneous procedural interventions. A global and comprehensive approach for the use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures. WHAT IS KNOWN • Point-of-care ultrasound has been established as a powerful tool providing for real-time image guidance of invasive procedures in critically ill neonates and children and allowing to increase both safety and success. WHAT IS NEW • A global and comprehensive use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures: from diagnosis to semi-quantitative assessment, and from real-time puncture to follow-up.
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Affiliation(s)
| | | | - María V Fraga
- Children's Hospital of Philadelphia, Philadelphia, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy.
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Lafferty L, Beadman M, Ward J, Flynn E, Hosseini-Hooshyar S, Martinello M, Treloar C. Patient and healthcare provider perceptions of acceptability of fingerstick point-of-care hepatitis C testing at Aboriginal Community Controlled Health Services in Australia. Int J Drug Policy 2024; 125:104335. [PMID: 38342050 DOI: 10.1016/j.drugpo.2024.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/13/2023] [Accepted: 01/21/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Hepatitis C (HCV) is highly prevalent in First Nations communities globally. Barriers in the uptake of testing and treatment create challenges to realise elimination of HCV in these communities. In efforts to reduce barriers to testing and treatment, the SCALE-C study implemented an HCV test-and-treat intervention integrating point-of-care HCV testing and FibroScan®. SCALE-C was carried out at four Aboriginal Community Controlled Health Services (ACCHS; renowned for providing culturally safe care) in four regional towns in Australia. This qualitative analysis sought to understand healthcare provider and patient perceptions of acceptability of a community-based HCV test-and-treat intervention within ACCHS. METHODS Semi-structured interviews were undertaken with 23 patient participants and 14 healthcare personnel (including Aboriginal Health Workers/Practitioners, nurses, general practitioners, and practice managers) from across the four ACCHS involved in SCALE-C. A coding framework was developed among study authors and informed by Sekhon's Theoretical Framework of Acceptability. RESULTS The SCALE-C intervention enabled opportunities for healthcare providers to listen to patients, and for patients to feel heard (affective attitude). HCV testing was opportunistic and often occurred outside of the allocated SCALE-C clinical hours (burden). For patients, HCV testing within SCALE-C was viewed as a moral responsibility and ensured protection of self and others (ethicality). For personnel, SCALE-C (including following up visits) was regarded as an opportunity to engage with patients especially those with complex health needs which may be unrelated to HCV risk factors (ethicality). Patients and personnel widely regarded the SCALE-C intervention to be effective, and the test-and-treat model was preferable for both patients and personnel. CONCLUSION The SCALE-C intervention was broadly perceived to be acceptable among both healthcare providers and patients within ACCHS. Whilst the prioritisation of HCV was viewed as increasing patient engagement, it was also regarded as an opportunity for addressing other healthcare needs within Aboriginal communities. HCV test-and-treat models of care delivered by ACCHS simplify the HCV care pathway and ensure all HCV care is provided in a culturally safe setting (e.g., patients did not need to attend external services such as pathology).
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Affiliation(s)
- Lise Lafferty
- Centre for Social Research in Health, UNSW Sydney, Australia; The Kirby Institute, UNSW Sydney, Australia.
| | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia
| | - Erin Flynn
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, Australia; Wardliparingga Aboriginal Health Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Australia
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114
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Dai CY, Batsaikhan B, Huang CF. 'One-stop-shop' point-of-care hepatitis C RNA testing intervention in the prison - some issues. J Hepatol 2024; 80:e106-e107. [PMID: 37562747 DOI: 10.1016/j.jhep.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/20/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Affiliation(s)
- Chia-Yen Dai
- Department of Internal Medicine and Health Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Medicine and Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Batbold Batsaikhan
- Department of Internal Medicine, Institute of Medical Sciences, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia; Department of Health Research, Graduate School, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chung-Feng Huang
- Department of Internal Medicine and Health Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; College of Medicine and Drug Development and Value Creation Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Chen F, Lyu C, Li Z, Xiu L, Li H, Xie Y, Cao R, Hu Q, Yin K. Fully Integrated Microfluidic Platform for Multiplexed Detection of Hunov by a Dynamic Confined-Space-Implemented One-Pot Rpa-Lamp System. Adv Sci (Weinh) 2024; 11:e2306612. [PMID: 38126673 PMCID: PMC10916549 DOI: 10.1002/advs.202306612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Indexed: 12/23/2023]
Abstract
Human norovirus (HuNoV) is the leading cause of nonbacterial acute gastroenteritis, which is highly infectious, rapidly evolving, and easily transmitted through feces. The accurate and early detection of HuNoV subtypes is essential for effective treatment, early surveillance, risk assessment, and disease prevention. In this study, a portable multiplex HuNoV detection platform that combines integrated microfluidics and cascade isothermal amplification, using a streamlined protocol for clinical fecal-based diagnosis is presented. To overcome the problems of carryover contamination and the incompatibility between recombinase polymerase amplification (RPA) and loop-mediated isothermal amplification (LAMP), a Dynamic confined-space-implemented One-pot RPA-LAMP colorimetric detection system (DORLA) is developed by creating a hydrogen bond network. The DORLA system exhibits excellent sensitivity, with detection limits of 10 copies µL-1 and 1 copy µL-1 for HuNoV GI and GII, respectively. In addition, a portable diagnostic platform consisting of a thermostatic control module and an integrated 3D-printed microfluidic chip for specific HuNoV capture, nucleic acid pretreatment, and DORLA detection, which enables simultaneous diagnosis of HuNoV GI and GII is developed. A DORLA-based microfluidic platform exhibits satisfactory performance with high sensitivity and portability, and has high potential for the rapid point-of-care detection of HuNoV in clinical fecal samples, particularly in resource-limited settings.
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Affiliation(s)
- Fumin Chen
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Chenang Lyu
- Department of Food Science and TechnologySchool of Agriculture and BiologyShanghai Jiao Tong UniversityShanghai200240P. R. China
| | - Zhao Li
- Stake Key Laboratory on Integrated OptoelectronicsInstitute of SemiconductorsChinese Academy of SciencesBeijing100083P. R. China
- College of Materials Science and Opto‐Electronic TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Leshan Xiu
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Huimin Li
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Yi Xie
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Runzhen Cao
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Qinqin Hu
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
| | - Kun Yin
- School of Global HealthChinese Center for Tropical Diseases ResearchShanghai Jiao Tong University School of MedicineShanghai200025P. R. China
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Batool A, Koratala A. Cardiac tamponade diagnosed on nephrologist-performed point-of-care ultrasonography. Kidney Int 2024; 105:641. [PMID: 38388152 DOI: 10.1016/j.kint.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Aisha Batool
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Abhilash Koratala
- Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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117
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Ockenden ES, Frischer SR, Cheng H, Noble JA, Chami GF. The role of point-of-care ultrasound in the assessment of schistosomiasis-induced liver fibrosis: A systematic scoping review. PLoS Negl Trop Dis 2024; 18:e0012033. [PMID: 38507368 PMCID: PMC10954168 DOI: 10.1371/journal.pntd.0012033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Abdominal ultrasound imaging is an important method for hepatic schistosomiasis diagnosis and staging. Several ultrasound staging systems have been proposed, each attempting to standardise schistosomal periportal fibrosis (PPF) diagnosis. This review aims to establish the role of ultrasound in the diagnosis and staging of schistosomal PPF, and to map the evolution of ultrasound staging systems over time, focusing on internal validation and external reproducibility. METHODS A systematic search was undertaken on 21st December 2022 considering the following databases: PubMed/MEDLINE (1946-present), Embase (1974-present), Global Health (1973-present), Global Index Medicus (1901-present), and Web of Science Core Collection-Science Citation Index Expanded (1900-present) and the Cochrane Central Register of Controlled Trials (1996-present). Case reports, systematic reviews and meta-analyses, and studies exclusively using transient or shear-wave elastography were excluded. Variables extracted included study design, study population, schistosomal PPF characteristics, and diagnostic methods. The PRISMA-ScR (2018) guidelines were followed to inform the structure of the scoping analysis. RESULTS The initial search yielded 573 unique articles, of which 168 were removed after screening titles and abstracts, 43 were not retrieved due to full texts not being available online or through inter-library loans, and 170 were excluded during full text review. There were 192 remaining studies eligible for extraction. Of the extracted studies, 61.8% (76/123) of studies that reported study year were conducted after the year 2000. Over half of all extracted studies (59.4%; 114/192) were conducted in Brazil (26.0%; 50/192), China (18.8%; 36/192) or Egypt (14.6%; 28/192). For the species of schistosome considered, 77.6% (149/192) of studies considered S. mansoni and 21.4% (41/192) of studies considered S. japonicum. The ultrasound staging systems used took on three forms: measurement-based, feature-based and image pattern-based. The Niamey protocol, a measurement and image pattern-based system, was the most used among the staging systems (32.8%; 63/192), despite being the most recently proposed in 1996. The second most used was the Cairo protocol (20.8%; 40/192). Of the studies using the Niamey protocol, 77.8% (49/63) only used the image patterns element. Where ultrasound technology was specified, studies after 2000 were more likely to use convex transducers (43.4%; 33/76) than studies conducted before 2000 (32.7%; 16/49). Reporting on ultrasound-based hepatic diagnoses and their association with clinical severity was poor. Just over half of studies (56.2%; 108/192) reported the personnel acquiring the ultrasound images. A small number (9.4%; 18/192) of studies detailed their methods of image quality assurance, and 13.0% (25/192) referenced, discussed or quantified the inter- or intra-observer variation of the staging system that was used. CONCLUSIONS The exclusive use of the image patterns in many studies despite lack of specific acquisition guidance, the increasing number of studies over time that conduct ultrasound staging of schistosomal PPF, and the advances in ultrasound technology used since 2000 all indicate a need to consider an update to the Niamey protocol. The protocol update should simplify and prioritise what is to be assessed, advise on who is to conduct the ultrasound examination, and procedures for improved standardisation and external reproducibility.
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Affiliation(s)
- Eloise S. Ockenden
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Sandrena Ruth Frischer
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Huike Cheng
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - J. Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Goylette F. Chami
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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118
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Ke CH, Du MY, Hsieh WJ, Lin CC, Ting JM, Chiou MT, Lin CN. Implementation of point-of-care platforms for rapid detection of porcine circovirus type 2. J Vet Sci 2024; 25:e28. [PMID: 38568829 PMCID: PMC10990909 DOI: 10.4142/jvs.23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Porcine circovirus type 2 (PCV2) infection is ubiquitous around the world. Diagnosis of the porcine circovirus-associated disease requires clinic-pathological elements together with the quantification of viral loads. Furthermore, given pig farms in regions lacking access to sufficient laboratory equipment, developing diagnostic devices with high accuracy, accessibility, and affordability is a necessity. OBJECTIVES This study aims to investigate two newly developed diagnostic tools that may satisfy these criteria. METHODS We collected 250 specimens, including 170 PCV2-positive and 80 PCV2-negative samples. The standard diagnosis and cycle threshold (Ct) values were determined by quantitative polymerase chain reaction (qPCR). Then, two point-of-care (POC) diagnostic platforms, convective polymerase chain reaction (cPCR, qualitative assay: positive or negative results are shown) and EZtargex (quantitative assay: Ct values are shown), were examined and analyzed. RESULTS The sensitivity and specificity of cPCR were 88.23% and 100%, respectively; the sensitivity and specificity of EZtargex were 87.65% and 100%, respectively. These assays also showed excellent concordance compared with the qPCR assay (κ = 0.828 for cPCR and κ = 0.820 for EZtargex). The statistical analysis showed a great diagnostic power of the EZtargex assay to discriminate between samples with different levels of positivity. CONCLUSIONS The two point-of-care diagnostic platforms are accurate, rapid, convenient and require little training for PCV2 diagnosis. These POC platforms can discriminate viral loads to predict the clinical status of the animals. The current study provided evidence that these diagnostics were applicable with high sensitivity and specificity in the diagnosis of PCV2 infection in the field.
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Affiliation(s)
- Chiao-Hsu Ke
- Sustainable Swine Research Center, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Mao-Yuan Du
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
| | - Wang-Ju Hsieh
- Schweitzer Biotech Company Ltd., Taipei 11493, Taiwan
| | | | | | - Ming-Tang Chiou
- Sustainable Swine Research Center, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
| | - Chao-Nan Lin
- Sustainable Swine Research Center, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Animal Disease Diagnostic Center, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Veterinary Medicine, College of Veterinary Medicine, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.
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Aitcheson N, Sacks E, Nyamundaya TH, Muchuchuti C, Cohn J. The Cascade of Care for Early Infant Diagnosis in Zimbabwe: Point of Care HIV Testing at Birth and 6-8 Weeks. Pediatr Infect Dis J 2024; 43:e87-e91. [PMID: 38241648 DOI: 10.1097/inf.0000000000004198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Routine birth testing of HIV-exposed infants (HEI) using point of care (POC) nucleic acid testing may allow for earlier diagnosis and treatment of infants living with HIV, but more data are needed on retention in care for those diagnosed at birth and re-testing for those with a negative HIV birth test. METHODS POC birth testing (within 48 hours of birth) was offered to all HEI born at 10 public maternities in Zimbabwe from November 2018 to July 2019. Data were abstracted from routine registers, including information on re-testing at 6-8 weeks for infants testing HIV-negative at birth and 6-month retention in care among infants diagnosed with HIV at birth. RESULTS Of 2854 eligible HEIs, 2806 (98.3%) received POC HIV birth testing. Thirty-nine infants with HIV were identified (1.4%), and 23 (59%) were started on antiretroviral therapy (ART). Twenty infants (51%) remained on ART at 6 months. Of the 2694 infants who tested negative at birth, 1229 (46.5%) had a documented retest at 6-8 weeks. 7 (0.6%) of those infants tested HIV-positive. CONCLUSIONS The uptake of POC birth testing was high in study facilities, but low rates of ART initiation after a positive birth test, despite high retention on ART through 6 months, diminish the impact of POC birth testing and must be addressed. Among infants who tested negative at birth, rates of testing at 6-8 weeks of life (46%) were slightly lower than national rates of testing at the same age without a birth test (56%) during the study period. Improving infant HIV testing rates at 6-8 weeks, regardless of birth testing, should be a priority.
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Affiliation(s)
- Nancy Aitcheson
- From the Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emma Sacks
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | | | - Jennifer Cohn
- From the Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Gleeson B, Piton J, Mazzola L, McHugh S, Bender J, Lear M, Gavrikova T, Van Der Pol B, Daniels B, Osborn J, Dailey P, Ferreyra C. Development of a Novel Fluorescent-Based Lateral Flow Assay for the Detection of Neisseria gonorrhoeae at the Point of Care. Sex Transm Dis 2024; 51:186-191. [PMID: 38412465 DOI: 10.1097/olq.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Neisseria gonorrhoeae (NG) has acquired significant resistance, primarily due to extensive and unwarranted antibiotic utilization over several decades. This resistance has largely been associated with the syndromic management of sexually transmitted infections, particularly in low- and middle-income countries where affordable point of care tests are unavailable. To address this diagnostic gap, FIND has developed a low-cost lateral flow assay for the detection of NG at the point of care. METHODS The early performance of the lateral flow assay was evaluated using frozen clinical samples. Limit of detection, inclusivity, and exclusivity studies were performed using well-characterized NG strains, common commensal genital microorganisms, and other Neisseria bacteria. Subsequently, clinical performance was evaluated at 2 sexual health clinics in Birmingham, Alabama. RESULTS The observed limit of detection with reference NG strains was 5 × 103 CFU/mL. Inclusivity was demonstrated for 31 NG strains. Exclusivity testing showed no cross-reactivity with 28 non-Neisseria and nongonococcal Neisseria species; cross-reactivity was observed with Neisseria meningitidis, Neisseria lactamica, and Neisseria polysaccharea. The lateral flow assay demonstrated clinical sensitivity and specificity of 78.6% and 100% in female vaginal swabs and 100% and 89.7% in male urine, respectively. CONCLUSIONS FIND has developed a lateral flow assay that aligns with the majority of the World Health Organization Target Product Profile criteria for confirming or excluding NG infection at the point of care. The NG lateral flow assay has now achieved design freeze (final device optimization) and is ready for technology transfer to a manufacturing partner. This test has the potential to support the shift in patient management from a syndromic to an etiological approach.
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Affiliation(s)
| | | | | | | | | | | | - Tatyana Gavrikova
- UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Barbara Van Der Pol
- UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Brice Daniels
- UAB Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Wakai A, Atkinson P. Non-specialist emergency physician-performed point-of-care ultrasound (POCUS) for renal colic-No hocus POCUS! CAN J EMERG MED 2024; 26:139-140. [PMID: 38367158 DOI: 10.1007/s43678-024-00662-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024]
Affiliation(s)
- Abel Wakai
- Department of Emergency Medicine, Beaumont Hospital, Dublin, and Emergency Care Research Unit (ECRU), Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Horizon Health Network, Saint John, NB, Canada
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Clarkin-Breslin RC, Brainard BM. Point-of-care and traditional erythrocyte sedimentation rate, point-of-care rheometry, and cell-free DNA concentration in dogs with or without systemic inflammation. J Vet Diagn Invest 2024; 36:177-186. [PMID: 38372154 DOI: 10.1177/10406387241226971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024] Open
Abstract
RBC aggregation and deformability characteristics are altered by inflammatory, microcirculatory, and hemorheologic disease. These changes can be indirectly evaluated using the erythrocyte sedimentation rate (ESR). Newer point-of-care devices employ syllectometry to evaluate RBC rheology, which can give information beyond the ESR. We evaluated 2 point-of-care rheometers (iSED and MIZAR; Alcor Scientific) in 52 dogs presented to a university teaching hospital. Whole blood samples were analyzed for correlation between the ESR using the Westergren (ESRw) method (measured at 1 h and 24 h) and the predicted ESR using iSED. Plasma fibrinogen and cell-free DNA concentrations were also measured as probable markers of inflammation. The iSED-predicted ESR was positively correlated to the ESRw method at 1 h (r = 0.74; p < 0.001) and 24 h (r = 0.62; p < 0.001). Comparing dogs with or without inflammation (defined as plasma fibrinogen concentration >3.5 g/L [350 mg/dL]), significant differences were seen in the MIZAR parameters of base point, amplitude, integral, and half-time. Median cell-free DNA concentrations were higher in the group of dogs with inflammation (117 [range: 51-266] ng/mL vs. 82.7 [range: 19-206] ng/mL; p = 0.024). The iSED-predicted ESR is a good predictor of the ESRw and was obtained more rapidly. Rheometric parameters measured by MIZAR may be useful in detecting inflammation and monitoring secondary morphologic and functional changes in canine RBCs.
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Affiliation(s)
- Rachel C Clarkin-Breslin
- Department of Small Animal Medicine and Surgery, University of Georgia Veterinary Teaching Hospital, Athens, GA, USA
| | - Benjamin M Brainard
- Department of Small Animal Medicine and Surgery, University of Georgia Veterinary Teaching Hospital, Athens, GA, USA
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Rigot M, Boysen SR, Masseau I, Letendre JA. Evaluation of B-lines with 2 point-of-care lung ultrasound protocols in cats with radiographically normal lungs. J Vet Emerg Crit Care (San Antonio) 2024; 34:143-152. [PMID: 38407524 DOI: 10.1111/vec.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To compare 2 point-of-care lung ultrasound (LUS) protocols for quantification of B-lines in cats without evidence of respiratory disease based on history, physical examination, and thoracic radiography. DESIGN Prospective observational study. SETTING Single center, veterinary teaching hospital. ANIMALS Fifty-seven cats without respiratory disease based on history, physical examination, and thoracic radiographs. INTERVENTIONS All cats had 2 point-of-care LUS protocols performed bilaterally: a regional protocol (veterinary bedside lung ultrasound evaluation [VetBLUE]) and a more comprehensive vertical sweeping (VS) protocol. The total number of B-lines per cat, number of sites with B-lines, and maximal number of B-lines at each site were recorded and compared. MEASUREMENTS AND MAIN RESULTS Ten cats (18%) had at least 1 B-line identified with VetBLUE, versus 29 (51%) with VS. Comparing protocols, VS had a statistically higher total number of B-lines per cat, higher number of sites with B-lines, and higher maximal number of B-lines per site. B-lines that were too numerous to count were identified at a single location in 1 cat with VetBLUE and 2 cats with VS. A maximum of 3 B-lines were identified at all other positive sites regardless of the protocol used. On average, it took 1.79 times longer to complete VS bilaterally compared to VetBLUE (median [interquartile range]: 140 [33] and 78 [14] s, respectively) (P = 0.001). CONCLUSIONS This study demonstrates it is not uncommon to identify a single or even multiple B-lines in 1 or several sites on LUS in cats deemed to be clinically free of respiratory pathology-essential knowledge when using LUS as a screening test and to monitor intrathoracic lesions. In cats asymptomatic for respiratory disease, VS generally identifies more B-lines than VetBLUE, likely because it assesses a larger lung surface area. The sonographic identification of B-lines should be interpreted considering the LUS protocol used, history, and other diagnostics to determine their clinical significance.
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Affiliation(s)
- Manon Rigot
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Søren R Boysen
- Department of Veterinary Clinical and Diagnostic Sciences, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Jo-Annie Letendre
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
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124
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Hercz D, Mechanic OJ, Varella M, Fajardo F, Levine RL. Ultrasound Performed by Emergency Physicians for Deep Vein Thrombosis: A Systematic Review. West J Emerg Med 2024; 25:282-290. [PMID: 38596931 PMCID: PMC11000565 DOI: 10.5811/westjem.18125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) performed by emergency physicians (EP) has emerged as an effective alternative to radiology department ultrasounds for the diagnosis of lower extremity deep vein thrombosis (DVT). Systematic reviews suggested good sensitivity and specificity overall for EP-performed POCUS for DVT diagnosis, yet high levels of heterogeneity were reported. Methods In this systematic review and meta-analysis, we aimed to provide the most up-to-date estimates of the accuracy of EP-performed POCUS for diagnosis of DVT and to explore potential correlations with test performance. We performed systematic searches in MEDLINE and Embase for original, primary data articles from January 2012-June 2021 comparing the efficacy of POCUS performed by EPs to the local standard. Quality Assessment of Diagnostic Accuracy Studies-2 for individual articles are reported. We obtained summary measures of sensitivity, specificity, and their corresponding 95% confidence intervals (CI) using bivariate mixed-effects regression models. We performed meta-regression, subgroup, and sensitivity analyses as planned in the protocol CRD42021268799 submitted to PROSPERO. Results Fifteen publications fit the inclusion criteria, totaling 2,511 examinations. Pooled sensitivity and specificity were 90% (95% CI 82%-95%) and 95% (CI 91%-97%), respectively. Subgroup analyses by EP experience found significantly better accuracy for exams performed by EP specialists (93%, CI 88%-97%) vs trainees (77%, CI 60%-94%). Specificity for EP specialists (97%, CI 94%-99%) was higher than for trainees (87%, CI 76%-99%, P = 0.01). Three-point compression ultrasound (CUS) was more sensitive than two-point CUS but was only statistically significant when limited to EP specialists (92% vs 88%, P = 0.07, and 95% vs 88%, P = 0.02, respectively). Conclusion Point-of-care ultrasound performed by emergency physicians is sensitive and specific for the diagnosis of suspected DVT when performed by trained attending EPs. Three-point compression ultrasound examination may be more sensitive than two-point CUS.
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Affiliation(s)
- Daniel Hercz
- Jackson Memorial Hospital, Department of Emergency Medicine, Miami, Florida
- University of Miami, Department of Surgery, Miami, Florida
| | - Oren J Mechanic
- Mount Sinai Medical Center, Department of Emergency Medicine, Miami Beach, Florida
- Florida International University, Herbert Wertheim College of Medicine, Department of Medical Education, Miami, Florida
| | - Marcia Varella
- Florida International University, Herbert Wertheim College of Medicine, Department of Medical Education, Miami, Florida
| | - Francisco Fajardo
- Florida International University, Herbert Wertheim College of Medicine, Department of Medical Education, Miami, Florida
| | - Robert L Levine
- Florida International University, Herbert Wertheim College of Medicine, Department of Emergency Medicine and Critical Care, Miami, Florida
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125
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Raiko K, Nääjärvi O, Ekman M, Koskela S, Soukka T, Martiskainen I, Salminen T. Improved sensitivity and automation of a multi-step upconversion lateral flow immunoassay using a 3D-printed actuation mechanism. Anal Bioanal Chem 2024; 416:1517-1525. [PMID: 38280018 PMCID: PMC10861389 DOI: 10.1007/s00216-024-05156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/04/2023] [Accepted: 01/09/2024] [Indexed: 01/29/2024]
Abstract
The development of sensitive point-of-care (POC) assay platforms is of interest for reducing the cost and time of diagnostics. Lateral flow assays (LFAs) are the gold standard for POC systems, but their sensitivity as such is inadequate, for example, in the case of cardiac diagnostics. The performance can be improved by incorporating different steps, such as pre-incubation to prolong the interaction time between sample and reporter for immunocomplex formation, and washing steps for background reduction. However, for POC assays, manual steps by the assay conductor are not desired. In this research, upconverting nanoparticles (UCNPs) were coated with poly(acrylic acid) (PAA) and conjugated to anti-cTnI antibodies, yielding non-clustering particles with low non-specific binding. The performance of cTnI-LFA in the PAA-anti-cTnI-UCNPs was compared to the same UCNPs with a commercial carboxyl surface. A kitchen-timer mechanism was embedded in a 3D-printed housing to produce a low-cost actuator facilitating a timed pre-incubation step for reporter and sample, and a washing step, to enable a multi-step cTnI-LFA with minimized manual labour. PAA-UCNPs showed improved mobility on nitrocellulose compared to those with a commercial surface. The mechanical actuator system was shown to improve sensitivity compared to a labour-intensive multi-step dipstick method, despite pre-incubation occurring during shaking and heating in the dipstick method. The limit of detection decreased from 7.6 to 1.5 ng/L cTnI in human plasma. The presented actuator can be easily modified for sensitivity improvement in the LFA for different analytes via pre-incubation and washing steps.
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Affiliation(s)
- Kirsti Raiko
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland.
| | - Oskari Nääjärvi
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Miikka Ekman
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Sonja Koskela
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Tero Soukka
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Iida Martiskainen
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Teppo Salminen
- Biotechnology Unit, Department of Life Technologies, Faculty of Technology, University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
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Spampinato MD, Luppi F, Cristofaro E, Benedetto M, Cianci A, Bachechi T, Ghirardi C, Perna B, Guarino M, Passaro A, De Giorgio R, Sofia S. Diagnostic accuracy of Point Of Care UltraSound (POCUS) in clinical practice: A retrospective, emergency department based study. J Clin Ultrasound 2024; 52:255-264. [PMID: 38059395 DOI: 10.1002/jcu.23619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
AIMS Point-of-care ultrasound (POCUS) is the acquisition and interpretation of ultrasound imaging at the bedside to solve specific clinical questions based on signs and symptoms of presentation. While several studies evaluated POCUS diagnostic accuracy for a variety of clinical pictures in the emergency department (ED), only a few data are available on POCUS diagnostic accuracy performed by physicians with different POCUS skills. The objective of this research was to evaluate the diagnostic accuracy of POCUS compared to standard diagnostic imaging in the ED. MATERIALS AND METHODS This was a retrospective study conducted in the ED of a third-level university hospital. Patients who underwent cardiac, thoracic, abdominal, or venous lower limb POCUS and a standard imaging examination between June 2021 and January 2022 were included. RESULTS 1047 patients were screened, and 844 patients included. A total of 933 POCUS was included (102, 12.09%, cardiac; 466, 55.21%, thoracic; 336, 39.8%, abdominal; 29, 3.44%, lower limb venous POCUS), accounting for 2029 examinations. POCUS demonstrated 96.6% (95% CI 95.72-97.34) accuracy, 47.73 (95% CI 33.64-67.72) +LR, 0.09 (95% CI 0.06-0.12) -LR. +LR was greater than 10 for all investigations but for hydronephrosis (5.8), and -LR never exceeded 0.4. CONCLUSIONS POCUS exhibited high diagnostic accuracy for virtually all conditions when performed by emergency department physicians.
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Affiliation(s)
- Michele Domenico Spampinato
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Francesco Luppi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Enrico Cristofaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Marcello Benedetto
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Antonella Cianci
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Tommaso Bachechi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Caterina Ghirardi
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Matteo Guarino
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- School of Emergency Medicine, University of Ferrara, Ferrara, Italy
| | - Soccorsa Sofia
- Emergency Department, Maggiore Hospital, AUSL di Bologna, Bologna, Italy
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De Carvalho H, Godiveaux N, Javaudin F, Le Bastard Q, Kuczer V, Pes P, Montassier E, Le Conte P. Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound: Survey on 515 Physicians. Ultrasound Q 2024; 40:46-50. [PMID: 37756253 DOI: 10.1097/ruq.0000000000000660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT Point-of-care ultrasound (POCUS) curriculum varies among countries. However, the length of training required for physicians is still under debate. We investigated the impact of different training methods: short hands-on courses (STS), long academic training sessions (LTS), or both (mixed training [MTS]), for POCUS daily use and self-reported confidence overall and specific to specific clinical situations. This was a descriptive study conducted over a 3-month period through a Web-based survey designed to assess the influence of different methods of POCUS training among physicians and residents on their daily practice. The survey was sent to 1212 emergency physicians with prior POCUS training; 515 answers (42%) could be analyzed. Participants in the STS group performed POCUS less frequently than physicians in the LTS or MTS group. Daily use in the STS group was 51% versus 82% in the LTS group and 83% in the MTS group ( P < 0.01). The overall self-reported confidence in POCUS was lower in the STS group ( P < 0.01) in all studied clinical situations. There was no significant difference between LTS and MTS groups ( P > 0.05). Method of POCUS training significantly influenced POCUS daily use. Physicians who underwent long training sessions used POCUS more frequently in their routine practice and were significantly more confident in their ability to perform and interpret a POCUS examination.
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Affiliation(s)
| | | | | | | | | | - Philippe Pes
- Emergency Department, Centre Hospitalier Universitaire
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Vinci F, Tiseo M, Colosimo D, Calandrino A, Ramenghi LA, Biasucci DG. Point-of-care brain ultrasound and transcranial doppler or color-coded doppler in critically ill neonates and children. Eur J Pediatr 2024; 183:1059-1072. [PMID: 38112802 DOI: 10.1007/s00431-023-05388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/21/2023]
Abstract
Point-of-care brain ultrasound and transcranial doppler or color-coded doppler is being increasingly used as an essential diagnostic and monitoring tool at the bedside of critically ill neonates and children. Brain ultrasound has already established as a cornerstone of daily practice in the management of the critically ill newborn for diagnosis and follow-up of the most common brain diseases, considering the easiness to insonate the brain through transfontanellar window. In critically ill children, doppler based techniques are used to assess cerebral hemodynamics in acute brain injury and recommended for screening patients suffering from sickle cell disease at risk for stroke. However, more evidence is needed regarding the accuracy of doppler based techniques for non-invasive estimation of cerebral perfusion pressure and intracranial pressure, as well as regarding the accuracy of brain ultrasound for diagnosis and monitoring of acute brain parenchyma alterations in children. This review is aimed at providing a comprehensive overview for clinicians of the technical, anatomical, and physiological basics for brain ultrasonography and transcranial doppler or color-coded doppler, and of the current status and future perspectives of their clinical applications in critically ill neonates and children. CONCLUSION In critically ill neonates, brain ultrasound for diagnosis and follow-up of the most common cerebral pathologies of the neonatal period may be considered the standard of care. Data are needed about the possible role of doppler techniques for the assessment of cerebral perfusion and vasoreactivity of the critically ill neonate with open fontanelles. In pediatric critical care, doppler based techniques should be routinely adopted to assess and monitor cerebral hemodynamics. New technologies and more evidence are needed to improve the accuracy of brain ultrasound for the assessment of brain parenchyma of critically ill children with fibrous fontanelles. WHAT IS KNOWN • In critically ill neonates, brain ultrasound for early diagnosis and follow-up of the most common cerebral and neurovascular pathologies of the neonatal period is a cornerstone of daily practice. In critically ill children, doppler-based techniques are more routinely used to assess cerebral hemodynamics and autoregulation after acute brain injury and to screen patients at risk for vasospasm or stroke (e.g., sickle cell diseases, right-to-left shunts). WHAT IS NEW • In critically ill neonates, research is currently focusing on the use of novel high frequency probes, even higher than 10 MHz, especially for extremely preterm babies. Furthermore, data are needed about the role of doppler based techniques for the assessment of cerebral perfusion and vasoreactivity of the critically ill neonate with open fontanelles, also integrated with a non-invasive assessment of brain oxygenation. In pediatric critical care, new technologies should be developed to improve the accuracy of brain ultrasound for the assessment of brain parenchyma of critically ill children with fibrous fontanelles. Furthermore, large multicenter studies are needed to clarify role and accuracy of doppler-based techniques to assess cerebral perfusion pressure and its changes after treatment interventions.
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Affiliation(s)
- Francesco Vinci
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Marco Tiseo
- Intensive Care Unit, 'Tor Vergata' University Hospital, Rome, Italy
| | - Denise Colosimo
- Pediatric Intensive Care Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Andrea Calandrino
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Luca Antonio Ramenghi
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Neonatal Intensive Care Unit, IRCCS Giannina Gaslini Institute, Genoa, Italy
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, 'Tor Vergata' University of Rome, Rome, Italy.
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Bianchini A, Susi F, Laici C, Zangheri E, Gollinucci B, Siniscalchi A. Preoperative point-of-care neck ultrasound: beyond the airway. J Ultrasound 2024; 27:185-190. [PMID: 38040941 PMCID: PMC10908738 DOI: 10.1007/s40477-023-00840-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/02/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE A preoperative point-of-care neck ultrasound, carried out during preoperative airway evaluation by extending the scans to the regions close to the larynx and trachea, can allow for the rapid identification of unknown pathologies or abnormalities in a cost-effective and non-invasive manner. This prospective, observational study examines a series of ultrasound findings in structures close to the airway, made through preoperative point-of-care neck ultrasound in a cohort of 230 patients. METHODS We conducted a prospective observational study, enrolling 230 adult patients selected for elective abdominal surgery. The primary goal was to verify the predictive role of airway ultrasound in identifying difficult airways, while the secondary goal was to evaluate structures close to the airway such as jugular veins, carotid arteries, thyroid gland and soft tissues. RESULTS Overall, preoperative point-of-care neck ultrasound proved to be an effective and reliable method of obtaining details about local or systemic pathologies, which could affect perioperative care. For example, the exam consistently revealed the presence of carotid plaques or venous congestion, which could be used to best determine the patient's cardiovascular risk or to instigate further investigations. It also allowed for more accurate central venous catheter placement planning and better airway management and it warned about possible thyroid or neoplastic pathologies that would have otherwise remained unknown. In some cases, information from preoperative point-of-care neck ultrasound has even led to modifications in perioperative therapy. CONCLUSION Preoperative point-of-care neck ultrasound is fast, inexpensive, and non-invasive, and it can be easily performed by a properly trained professional during the preoperative airway ultrasound evaluation. It can be considered as a new preoperative assessment tool.
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Affiliation(s)
- Amedeo Bianchini
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Filippo Susi
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy.
| | - Cristiana Laici
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Zangheri
- Anesthesia and Pain Therapy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Benedetta Gollinucci
- Department of Medical and Surgical Sciences (DIMEC), Università di Bologna, Bologna, Italy
| | - Antonio Siniscalchi
- Post-Surgical and Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Bell C, Sheppard G, Andani R, Katz N, Kim DJ. Canadian association of emergency physicians emergency ultrasound committee best practice recommendations on point-of-care ultrasound disinfection. CAN J EMERG MED 2024; 26:145-147. [PMID: 38289565 DOI: 10.1007/s43678-024-00652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Colin Bell
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University, St. John's, NF, Canada
| | - Rafiq Andani
- Department of Emergency Medicine, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Noam Katz
- Department of Emergency Medicine, Max Rady College of Medicine, Winnipeg, MB, Canada
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada
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131
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Mauramo M, Uutela P, Sorsa T, Tervahartiala T, Bornstein MM, Waltimo T. Oral active matrix metalloproteinase-8 immunotest may be less accurate in haemato-oncologic patients. Oral Dis 2024; 30:624-630. [PMID: 35925017 DOI: 10.1111/odi.14335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study examines the associations of active matrix metalloproteinase-8 (aMMP-8) point-of-care immunotest (Periosafe) outcomes with oral health of patients with haemato-oncologic diseases. METHODS Adult patients diagnosed with haematological diseases aimed to be treated with haematopoietic stem cell transplantation (HSCT) between 2018 and 2019 were included in the study. Clinical and radiological dental examination were taken immediately prior to transplantation. The presence of oral foci of infections, caries or periodontitis was examined and compared with the outcomes of aMMP-8 immunotest. RESULTS Acute oral infection foci were present in 11.9%, chronic in 44.1% and periodontitis in 42.0% of the 143 subjects. aMMP-8 immunotest was positive in 13.3% of all the 143 subjects. Among subjects with periodontitis (n = 60), the aMMP-8 immunotest was also positive in 13.3% of these subjects. However, the subjects with positive aMMP-8 immunotest (n = 19) had more often acute or chronic infection foci and more than one of the examined dental treatment needs compared with subjects with negative immunotest (all p < 0.05). There were no differences in age, sex, hyposalivation, DMFT-index values nor with plasma levels of leukocytes, neutrophils or C-reactive protein between subjects with positive or negative aMMP-8 immunotest. CONCLUSIONS aMMP-8 immunotest accuracy might be reduced, in relation to periodontitis, in haemato-oncologic patients.
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Affiliation(s)
- Matti Mauramo
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Pauliina Uutela
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Timo Sorsa
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Institute of Dentistry, Helsinki, Finland
- Department of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - Taina Tervahartiala
- Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Institute of Dentistry, Helsinki, Finland
| | - Michael M Bornstein
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
| | - Tuomas Waltimo
- Department for Oral Health & Medicine, UZB University Centre for Dental Medicine Basel UZB, University of Basel, Basel, Switzerland
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132
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Brito M, Rufatto R, Murta F, Sampaio V, Balieiro P, Baía-Silva D, Castro V, Alves B, Alencar A, Duparc S, Grewal Daumerie P, Borghini-Fuhrer I, Jambert E, Peterka C, Edilson Lima F, Carvalho Maia L, Lucena Cruz C, Maciele B, Vasconcelos M, Machado M, Augusto Figueira E, Alcirley Balieiro A, Menezes A, Ataídes R, Batista Pereira D, Lacerda M. Operational feasibility of Plasmodium vivax radical cure with tafenoquine or primaquine following point-of-care, quantitative glucose-6-phosphate dehydrogenase testing in the Brazilian Amazon: a real-life retrospective analysis. Lancet Glob Health 2024; 12:e467-e477. [PMID: 38365417 PMCID: PMC10882209 DOI: 10.1016/s2214-109x(23)00542-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 02/18/2024]
Abstract
BACKGROUND To achieve malaria elimination, Brazil must implement Plasmodium vivax radical cure. We aimed to investigate the operational feasibility of point-of-care, quantitative, glucose-6-phosphate dehydrogenase (G6PD) testing followed by chloroquine plus tafenoquine or primaquine. METHODS This non-interventional, observational study was done at 43 health facilities in Manaus (Amazonas State) and Porto Velho (Rondônia State), Brazil, implementing a new P vivax treatment algorithm incorporating point-of-care quantitative G6PD testing to identify G6PD status and single-dose tafenoquine (G6PD normal, aged ≥16 years, and not pregnant or breastfeeding) or primaquine (intermediate or normal G6PD, aged ≥6 months, not pregnant, or breastfeeding >1 month). Following training of health-care providers, we collated routine patient records from the malaria epidemiological surveillance system (SIVEP-Malaria) retrospectively for all consenting patients aged at least 6 months with parasitologically confirmed P vivax malaria mono-infection or P vivax plus P falciparum mixed infection, presenting between Sept 9, 2021, and Aug 31, 2022. The primary endpoint was the proportion of patients aged at least 16 years with P vivax mono-infection treated or not treated appropriately with tafenoquine in accordance with their G6PD status. The trial is registered with ClinicalTrials.gov, NCT05096702, and is completed. FINDINGS Of 6075 patients enrolled, 6026 (99·2%) had P vivax mono-infection, 2685 (44·6%) of whom were administered tafenoquine. G6PD status was identified in 2685 (100%) of 2685 patients treated with tafenoquine. The proportion of patients aged at least 16 years with P vivax mono-infection who were treated or not treated appropriately with tafenoquine in accordance with their G6PD status was 99·7% (95% CI 99·4-99·8; 4664/4680). INTERPRETATION Quantitative G6PD testing before tafenoquine administration was operationally feasible, with high adherence to the treatment algorithm, supporting deployment throughout the Brazilian health system. FUNDING Brazilian Ministry of Health, Municipal and State Health Secretariats; Fiocruz; Medicines for Malaria Venture; Bill & Melinda Gates Foundation; Newcrest Mining; and the UK Government. TRANSLATION For the Portuguese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Marcelo Brito
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Rosilene Rufatto
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | - Felipe Murta
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Vanderson Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Patrícia Balieiro
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Djane Baía-Silva
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Universidade do Estado do Amazonas, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; Universidade Nilton Lins, Manaus, Brazil
| | | | - Brenda Alves
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | - Aline Alencar
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
| | | | | | | | | | | | | | | | | | - Bruna Maciele
- Centro de Pesquisa em Medicina Tropical de Rondônia, Porto Velho, Brazil
| | | | | | | | | | | | | | | | - Marcus Lacerda
- Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Fiocruz, Manaus, Brazil; University of Texas Medical Branch, Galveston, TX, USA.
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Kolay A, Kumar A. A Novel Liver Cancer POC Diagnostic Detection Technique by a Gate-engineered Source-extended TFET Device. Med Eng Phys 2024; 125:104133. [PMID: 38508806 DOI: 10.1016/j.medengphy.2024.104133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
This work reports a novel POC diagnostic technique to identify the cancerous liver cell lines by designing a Source-Extended (SE) Tunnel Field Effect Transistor (TFET) having a Single-Gate (SG) with Single-Metal (SM) and Dual-Metal (DM) structure. The proposed structures have been equipped with nanocavities by trenching the gate oxide layer where the needle biopsy obtained liver sample has been immobilized. The detection is based on the difference in drain current and the ratio of the proposed device's ON and OFF state currents, which has been evaluated by obtaining the sensitivities. The cancerous and non-cancerous liver cell lines possess different dielectric properties in high frequencies ranging from 100 MHz to 5 GHz, affecting the cavity region's effective capacitances. The change in the dielectric constant of the specimen at 900 MHz has been considered which results in the change in device drain current and device performance. Various parameters of the device, like the adhesive layer in the cavity region, the material of the gate, the length of the cavities, and the orientation of the cavities, have been modified to observe the performance. The total work has been done in the simulation environment, which includes the study considering the different proportions of cancerous and non-cancerous cells in a particular specimen. A comparative analysis has been made between the performance of the proposed SM and DM gate structure. The proposed detection method has been compared with the existing methods reported in the literature. The proposed method can be considered a novel technique and can be implemented as a point of care (POC) diagnostic to detect whether the specimen liver cell line is cancerous.
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Affiliation(s)
- Anirban Kolay
- Nextgen Adaptive Systems Group, Department of Electrical Engineering, National Institute of Technology Patna, Bihar, India
| | - Amitesh Kumar
- Nextgen Adaptive Systems Group, Department of Electrical Engineering, National Institute of Technology Patna, Bihar, India.
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134
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Sheehan Y, Grebely J, Lloyd AR. Reply to: " 'One-stop-shop' point-of-care hepatitis C RNA testing intervention in the prison - some issues". J Hepatol 2024; 80:e107-e108. [PMID: 37890725 DOI: 10.1016/j.jhep.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
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135
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Hodgson JA, Rivera-Rodriguez H, Wu P, Udani J, Weiss J. Point-of-Care Ultrasound Aids in the Management of Patient Taking Semaglutide Before Surgery: A Case Report. A A Pract 2024; 18:e01762. [PMID: 38498670 DOI: 10.1213/xaa.0000000000001762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Semaglutide, a glucagon-like peptide-1 (GLP-1) analog, has various effects on the gastrointestinal tract. In patients undergoing anesthesia delayed gastric emptying time can have sequelae if not identified preoperatively. Modalities include thorough history regarding the last dose administration of a GLP-1 analog and ultrasound of gastric contents before induction of anesthesia. We present a case in which gastric ultrasound identified a patient at increased risk for aspiration on induction and allowed for appropriate alterations in the anesthetic plan.
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Affiliation(s)
- John A Hodgson
- From the Department of Anesthesiology, Tampa General Hospital, Tampa, Florida
| | | | - Peter Wu
- From the Department of Anesthesiology, Tampa General Hospital, Tampa, Florida
- Department of Medical Education, University of South Florida, Tampa Florida
| | - Jaison Udani
- From the Department of Anesthesiology, Tampa General Hospital, Tampa, Florida
| | - Jeffrey Weiss
- From the Department of Anesthesiology, Tampa General Hospital, Tampa, Florida
- Department of Medical Education, University of South Florida, Tampa Florida
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Spinelli M, Gandhi M. Point-of-care urine tenofovir monitoring of adherence to drive interventions for HIV treatment and prevention. Expert Rev Mol Diagn 2024; 24:169-175. [PMID: 38353417 DOI: 10.1080/14737159.2024.2312122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/26/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Although effective antiretroviral and pre-exposure prophylaxis/PrEP regimens are available globally, adherence challenges persist. Objective measures of adherence can both measure adherence accurately and can be used to drive interventions. The first point-of-care pharmacologic adherence measure, urine tenofovir testing using a lateral flow assay, is now available. AREAS COVERED This review examines the ability of pharmacologic metrics of adherence to predict HIV and PrEP clinical outcomes and the past use of pharmacologic metrics of adherence as tools to drive adherence interventions. The success of preliminary studies using point-of-care adherence metrics to guide interventions is then discussed. EXPERT OPINION Large randomized clinical trials are now needed to test the impact of point-of-care adherence interventions on HIV and PrEP clinical outcomes, given promising results of the pilot studies summarized here. Hybrid implementation-effectiveness studies will be needed to examine optimal approaches to incorporating point-of-care testing into routine clinical care delivery, including in guiding resistance testing, adherence counseling, and delivery of other evidence-based adherence interventions. Given the ability of point-of-care tenofovir testing to be implemented in settings where viral load testing is not available, and at more frequent intervals due to its low cost, urine-based tenofovir assays have the potential to be highly scalable in diverse clinical settings.
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Affiliation(s)
- Matthew Spinelli
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
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137
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Otto C, Chen D. Point of Care Molecular Testing: Current State and Opportunities for Diagnostic Stewardship. Clin Lab Med 2024; 44:23-32. [PMID: 38280795 DOI: 10.1016/j.cll.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Inappropriate ordering practices, either under or over ordering of diagnostic tests, are recognized problems with possible negative downstream consequences. As the menu of clinical tests, especially molecular tests grows, it is becoming increasingly important to provide guidance to providers on the appropriate utilization. Diagnostic stewardship programs have been established at many institutions to help direct the appropriate utilization of laboratory testing to ultimately guide patient management and treatment decisions. Many molecular tests have now received Clinical Laboratory Improvement Amendments (CLIA)-waived status for use in a point-of-care (POC) setting; however, parallel diagnostic stewardship programs have not been established to help guide providers on how best to use these tests. In this article, we will discuss the available molecular POC tests and opportunities and challenges for establishing diagnostic stewardship programs for molecular testing performed in the POC setting.
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Affiliation(s)
- Caitlin Otto
- Department of Pathology, New York University Langone Health, 560 1st Avenue, New York, NY 10016, USA.
| | - Dan Chen
- Department of Pathology, New York University Langone Health, 560 1st Avenue, New York, NY 10016, USA
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138
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Weingrow D. Implications and Limitations of Point-of-Care Ultrasound in Diagnosing Acute Cholecystitis. Ann Emerg Med 2024; 83:247-249. [PMID: 38388078 DOI: 10.1016/j.annemergmed.2024.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Daniel Weingrow
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA.
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139
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Brown E, Hay AD. Point-of-care tests: the key to reducing antibiotic prescribing for respiratory tract infections in primary care? Expert Rev Mol Diagn 2024; 24:139-141. [PMID: 37222481 DOI: 10.1080/14737159.2023.2217330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/19/2023] [Indexed: 05/25/2023]
Affiliation(s)
- Emily Brown
- Centre of Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, Canynge Hall, UK
| | - Alastair D Hay
- Centre of Academic Primary Care, NIHR School for Primary Care Research, Bristol Medical School: Population Health Sciences, Canynge Hall, UK
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Fanshawe TR, Tonner S, Turner PJ, Cogdale J, Glogowska M, de Lusignan S, Okusi C, Perera R, Sebastianpillai P, Williams A, Zambon M, Nicholson BD, Hobbs FDR, Hayward GN. Diagnostic accuracy of a point-of-care antigen test for SARS-CoV-2 and influenza in a primary care population (RAPTOR-C19). Clin Microbiol Infect 2024; 30:380-386. [PMID: 38103638 DOI: 10.1016/j.cmi.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/20/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES Limited evidence exists for the diagnostic performance of point-of-care tests for SARS-CoV-2 and influenza in community healthcare. We carried out a prospective diagnostic accuracy study of the LumiraDx™ SARS-CoV-2 and influenza A or B assay in primary care. METHODS Total of 913 adults and children with symptoms of current SARS-CoV-2 infection were recruited from 18 UK primary care practices during a period when Omicron was the predominant COVID variant of concern (June 2022 to December 2022). Trained health care staff performed the index test, with diagnostic accuracy parameters estimated for SARS-CoV-2 and influenza against real-time reverse-transcription PCR (rtRT-PCR). RESULTS 151/887 participants were SARS-CoV-2 rtRT-PCR positive, 109 positive for Influenza A, 6 for Influenza B. Index test sensitivity for SARS-CoV-2 was 80.8% (122 of the 151, 95% CI, 73.6-86.7%) and specificity 98.9% (728 of the 736, 95% CI, 97.9-99.5%). For influenza A, sensitivity was 61.5% (67 of the 109, 95% CI, 51.7-70.6%) and specificity 99.4% (771 of the 776, 95% CI, 98.5-99.8%). Sensitivity to detect SARS-CoV-2 and influenza dropped sharply at rtRT-PCR cycle thresholds (Ct) > 30. DISCUSSIONS The LumiraDx™ SARS-CoV-2 and influenza A/B assay had moderate sensitivity for SARS-CoV-2 in symptomatic patients in primary care, with lower performance with high rtRT-PCR Ct. Negative results in this patient group cannot definitively rule out SARS-CoV-2 or influenza.
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Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Sharon Tonner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jade Cogdale
- Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cecilia Okusi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Praveen Sebastianpillai
- Immunization and Vaccine Preventable Diseases Division and Public Health Programmes, UK Health Security Agency, UK
| | - Alice Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Maria Zambon
- Influenza and Respiratory Virology and Polio Reference Service, UK Health Security Agency, UK; NIHR Health Protection Research Unit, Imperial College London, UK
| | - Brian D Nicholson
- Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; Virus Reference Department, Respiratory Virus Unit, UK Health Security Agency, UK
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Wilson SJ, Thavanathan R, Cheng W, Stuart J, Kim DJ, Glen P, Duigenan S, Shorr R, Woo MY, Perry JJ. Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis. Ann Emerg Med 2024; 83:235-246. [PMID: 37855790 DOI: 10.1016/j.annemergmed.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
Acute cholecystitis accounts for up to 9% of hospital admissions for acute abdominal pain, and best practice entails early surgical management. Ultrasound is the standard modality used to confirm diagnosis. Our objective was to perform a systematic review and meta-analysis to determine the diagnostic accuracy of emergency physician-performed point-of-care ultrasound for the diagnosis of acute cholecystitis when compared with a reference standard of final diagnosis (informed by available surgical pathology, discharge diagnosis, and radiology-performed ultrasound). We completed a systematic review and meta-analysis, registered in PROSPERO, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched 7 databases as well as gray literature in the form of select conference abstracts from inception to February 8, 2023. Two independent reviewers completed study selection, data extraction, and risk of bias (QUADAS-2) assessment. Disagreements were resolved by consensus with a third reviewer. Data were extracted from eligible studies to create 2 × 2 tables for diagnostic accuracy meta-analysis. Hierarchical Summary Receiver Operating Characteristic models were constructed. Of 1855 titles/abstracts, 40 were selected for full-text review. Ten studies (n=2356) were included. Emergency physician-performed point-of-care ultrasound with final diagnosis as the reference standard (7 studies, n=1,772) had a pooled sensitivity of 70.9% (95% confidence interval [CI] 62.3 to 78.2), specificity of 94.4% (95% CI 88.2 to 97.5), positive likelihood ratio of 12.7 (5.8 to 27.5), and negative likelihood ratio of 0.31 (0.23 to 0.41) for the diagnosis of acute cholecystitis. Emergency physician-performed point-of-care ultrasound has high specificity and moderate sensitivity for the diagnosis of acute cholecystitis in patients with clinical suspicion. This review supports the use of emergency physician-performed point-of-care ultrasound to rule in a diagnosis of acute cholecystitis in the emergency department, which may help expedite definitive management.
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Affiliation(s)
- Samuel J Wilson
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Rajiv Thavanathan
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Wei Cheng
- Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Joanna Stuart
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel J Kim
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada; Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Glen
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Shauna Duigenan
- Department of Radiology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Risa Shorr
- Health Sciences Library, The Ottawa Hospital, Ottawa, ON, Canada
| | - Michael Y Woo
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Snelling PJ, Jones P, Bade D, Bindra R, Davison M, Gillespie A, McEniery J, Moore M, Keijzers G, Ware RS. Diagnostic Accuracy of Point-of-Care Ultrasound Versus Radiographic Imaging for Pediatric Distal Forearm Fractures: A Randomized Controlled Trial. Ann Emerg Med 2024; 83:198-207. [PMID: 37999655 DOI: 10.1016/j.annemergmed.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023]
Abstract
STUDY OBJECTIVE In patients aged 5 to 15 years with a clinically nondeformed distal forearm injury presenting to the emergency department (ED), we examined whether point-of-care ultrasound or radiographic imaging had better diagnostic accuracy, with the reference diagnosis determined by an expert panel review. METHODS This multicenter, open-label, diagnostic randomized controlled trial was conducted in South East Queensland, Australia. Eligible patients were randomized to receive initial imaging through point-of-care ultrasound performed by an ED clinician or radiograph. Images were defined as "no," "buckle," or "other" fracture by the treating clinician. The primary outcome was the diagnostic accuracy of the treating clinician's interpretation compared against the reference standard diagnosis, which was determined retrospectively by an expert panel consisting of an emergency physician, pediatric radiologist, and pediatric orthopedic surgeon, who reviewed all imaging and follow-up. RESULTS Two-hundred and seventy participants were enrolled, with 135 randomized to each initial imaging modality. There were 132 (97.8%) and 112 (83.0%) correctly diagnosed participants by ED clinicians in the point-of-care ultrasound and radiograph groups, respectively (absolute difference [AD]=14.8%; 95% confidence interval [CI] 8.0% to 21.6%; P<.001). Point-of-care ultrasound had better accuracy for participants with "buckle" fractures (AD=18.5%; 95% CI 7.1% to 29.8%) and "other" fractures (AD=17.1%; 95% CI 2.7% to 31.6%). No clinically important fractures were missed in either group. CONCLUSION In children and adolescents presenting to the ED with a clinically nondeformed distal forearm injury, clinician-performed (acquired and interpreted) point-of-care ultrasound more accurately identified the correct diagnosis than clinician-interpreted radiographic imaging.
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Affiliation(s)
- Peter J Snelling
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia; Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.
| | - Philip Jones
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Sonography Innovation and Research (Sonar) Group, Queensland, Australia
| | - David Bade
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia; Department of Orthopaedics, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute, Griffith University, Southport, Queensland, Australia
| | - Randy Bindra
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michelle Davison
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Alan Gillespie
- Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Jane McEniery
- Department of Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Moore
- Department of Emergency Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Gerben Keijzers
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia; Department of Emergency Medicine, Gold Coast University Hospital, Southport, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Robert S Ware
- School of Medicine and Dentistry Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Heniff AC, Lynch AM, Ruterbories LK, Minter LJ, Georoff TA, Balko JA. INVESTIGATION OF A POINT-OF-CARE VISCOELASTIC COAGULATION MONITOR AND ITS COMPARISON TO THROMBOELASTOGRAPHY IN CLINICALLY HEALTHY AFRICAN ELEPHANTS ( LOXODONTA AFRICANA). J Zoo Wildl Med 2024; 55:164-172. [PMID: 38453499 DOI: 10.1638/2022-0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 03/09/2024] Open
Abstract
Elephant endotheliotropic herpesvirus (EEHV) can induce fatal hemorrhagic disease (HD) in African elephants (Loxodonta africana). Once clinical signs develop, progression is rapid, even with aggressive treatment. There is a critical need to develop point-of-care diagnostic tests to aid in identification of EEHV-HD prior to the onset of overt clinical signs. Study objectives were to investigate a novel, point-of-care viscoelastic coagulation monitor (VCM Vet), compare the results to thromboelastography (TEG), and report traditional hemostatic analytes in adult African elephants. Whole blood was collected from seven clinically healthy elephants (four females and three males, 18-47 yr) and analyzed in duplicate via VCM Vet and kaolin-activated TEG 1-3 and 30 min following collection, respectively. Separated plasma was frozen for ancillary coagulation testing. Both analyses generated quantifiable clotting reactions with variables (median [range]) describing clot formation rate (VCM Vet, clot time = 682 s [530-987 s], clot formation time = 244 s [186-744 s], Alpha = 40° [14-47°]; TEG, reaction time = 6.2 min [3.7-11.8 min], kinetic time = 1.3 min [0.9-2.6 min], Alpha = 70° [57-77°]), clot strength (VCM Vet, maximum clot formation = 34 units [20-45 units]; TEG, maximum amplitude = 75 mm [69-80 mm], shear elastic modulus strength = 14.7 Kdynes/s [11.3-19.5 Kdynes/s]), and clot lysis (VCM Vet, lysis index at 30 min = 100% [100-99%], lysis index at 45 min = 98% [95-100%]; TEG, lysis index at 30 min = 0% [0-0.4%], lysis index at 60 min = 1.4% [0-2.6%]) recorded. Additional testing (median [range]) included D-dimer concentration (33 ng/ml [28-94 ng/ml]), prothrombin time (12.4 s [12.2-13.2 s]), activated partial thromboplastin time (17.2 s [14.2-18.8 s]), and fibrinogen concentration (297 [282-383] mg/dL). Tracings generated by VCM Vet and TEG were clinically similar, and there was visual agreement and minimal difference between quantitative variables for duplicate tests. VCM Vet is a promising, user-friendly tool for use in identification and management of coagulopathies in African elephants.
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Affiliation(s)
- Ashlyn C Heniff
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Alex M Lynch
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Laura K Ruterbories
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
| | - Larry J Minter
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
- North Carolina Zoo, Asheboro, NC 27205, USA
| | - Timothy A Georoff
- College of Veterinary Medicine, Departments of Clinical Sciences, North Carolina State University, Raleigh, NC 27606, USA
- North Carolina Zoo, Asheboro, NC 27205, USA
| | - Julie A Balko
- Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC 27606, USA,
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144
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Moerman A, De Waele JJ, Boelens J. An overview of point-of-care testing for infections in critically ill patients. Expert Rev Mol Diagn 2024; 24:193-200. [PMID: 38414348 DOI: 10.1080/14737159.2024.2322146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Molecular diagnostic systems for point-of-care (POC) testing are nowadays routinely used and are part of many labs. Although often intended for bedside use outside of the microbiology lab, there is still room for expansion. AREAS COVERED This review discusses the two techniques that are currently the most widespread, real-time polymerase-chain reaction (RT-PCR) and loop-mediated isothermal amplification (LAMP). An overview is provided of the various manufacturers and products as well as the evidence and current use in clinical practice. The article further sheds light on some newer techniques, such as CRISPR-based diagnostics and lab-on-a-chip, which are still in development. EXPERT OPINION With many new platforms and techniques still in the pipeline and their potential currently not yet fully exploited, we expect the use of molecular POC testing to increase in the years to come. However, even when used in hospital - in lab, the main advantages of the tests being fast and easy to perform already provide significant benefits in terms of patient outcome.
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Affiliation(s)
- Alena Moerman
- Department of Medical microbiology, Ghent University Hospital, Gent, Belgium
| | - Jan J De Waele
- Department of Critical Care Medicine, Ghent University Hospital, Gent, Belgium
| | - Jerina Boelens
- Department of Medical microbiology, Ghent University Hospital, Gent, Belgium
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145
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Ganesh PS, Elugoke SE, Lee SH, Kim SY, Ebenso EE. Smart and emerging point of care electrochemical sensors based on nanomaterials for SARS-CoV-2 virus detection: Towards designing a future rapid diagnostic tool. Chemosphere 2024; 352:141269. [PMID: 38307334 DOI: 10.1016/j.chemosphere.2024.141269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
In the recent years, researchers from all over the world have become interested in the fabrication of advanced and innovative electrochemical and/or biosensors for respiratory virus detection with the use of nanotechnology. These fabricated sensors demonstrated a number of benefits, including precision, affordability, accessibility, and miniaturization which makes them a promising test method for point-of-care (PoC) screening for SARS-CoV-2 viral infection. In order to comprehend the principles of electrochemical sensing and the role of various types of sensing interfaces, we comprehensively explored the underlying principles of electroanalytical methods and terminologies related to it in this review. In addition, it is addressed how to fabricate electrochemical sensing devices incorporating nanomaterials as graphene, metal/metal oxides, metal organic frameworks (MOFs), MXenes, quantum dots, and polymers. We took an effort to carefully compile current developments, advantages, drawbacks, possible solutions in nanomaterials based electrochemical sensors.
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Affiliation(s)
- Pattan Siddappa Ganesh
- Interaction Laboratory, Advanced Technology Research Center, Future Convergence Engineering, Korea University of Technology and Education, Cheonan-si, Chungcheongnam-do, 330-708, Republic of Korea.
| | - Saheed Eluwale Elugoke
- Centre for Material Science, College of Science, Engineering and Technology, University of South Africa, Johannesburg 1709, South Africa; Institute for Nanotechnology and Water Sustainability (iNanoWS), College of Science, Engineering and Technology, University of South Africa, Johannesburg 1709, South Africa
| | - Seok-Han Lee
- Interaction Laboratory, Advanced Technology Research Center, Future Convergence Engineering, Korea University of Technology and Education, Cheonan-si, Chungcheongnam-do, 330-708, Republic of Korea
| | - Sang-Youn Kim
- Interaction Laboratory, Advanced Technology Research Center, Future Convergence Engineering, Korea University of Technology and Education, Cheonan-si, Chungcheongnam-do, 330-708, Republic of Korea.
| | - Eno E Ebenso
- Centre for Material Science, College of Science, Engineering and Technology, University of South Africa, Johannesburg 1709, South Africa; Institute for Nanotechnology and Water Sustainability (iNanoWS), College of Science, Engineering and Technology, University of South Africa, Johannesburg 1709, South Africa.
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146
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Maddaloni C, De Rose DU, Ronci S, Pugnaloni F, Martini L, Caoci S, Bersani I, Conforti A, Campi F, Lombardi R, Capolupo I, Tomà P, Dotta A, Calzolari F. The role of point-of-care ultrasound in the management of neonates with congenital diaphragmatic hernia. Pediatr Res 2024; 95:901-911. [PMID: 37978315 DOI: 10.1038/s41390-023-02889-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/13/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
In the last few years, current evidence has supported the use of point-of-care ultrasound (POCUS) for a number of diagnostic and procedural applications. Considering the valuable information that POCUS can give, we propose a standardized protocol for the management of neonates with a congenital diaphragmatic hernia (CDH-POCUS protocol) in the neonatal intensive care unit. Indeed, POCUS could be a valid tool for the neonatologist through the evaluation of 1) cardiac function and pulmonary hypertension; 2) lung volumes, postoperative pleural effusion or pneumothorax; 3) splanchnic and renal perfusion, malrotations, and/or signs of necrotizing enterocolitis; 4) cerebral perfusion and eventual brain lesions that could contribute to neurodevelopmental impairment. In this article, we discuss the state-of-the-art in neonatal POCUS for which concerns congenital diaphragmatic hernia (CDH), and we provide suggestions to improve its use. IMPACT: This review shows how point-of-care ultrasound (POCUS) could be a valid tool for managing neonates with congenital diaphragmatic hernia (CDH) after birth. Our manuscript underscores the importance of standardized protocols in neonates with CDH. Beyond the well-known role of echocardiography, ultrasound of lungs, splanchnic organs, and brain can be useful. The use of POCUS should be encouraged to improve ventilation strategies, systemic perfusion, and enteral feeding, and to intercept any early signs related to future neurodevelopmental impairment.
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Affiliation(s)
- Chiara Maddaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Domenico Umberto De Rose
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy.
- PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome "Tor Vergata", Rome, Italy.
| | - Sara Ronci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Pugnaloni
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Ludovica Martini
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Stefano Caoci
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Iliana Bersani
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Roberta Lombardi
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Flaminia Calzolari
- Neonatal Intensive Care Unit - "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
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147
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Mueller CT, Aman M, Grünfelder F, Haug V, Thomas B, Bollmann C, Kneser U, Harhaus L. Ultrasound-An Easy Available and Useful Point-of-Care Adjunct for Clinical Decision-Making in Hand Infections: Review of the Literature and a Case Series. Ultrasound Q 2024; 40:20-26. [PMID: 37801592 DOI: 10.1097/ruq.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
ABSTRACT Initial findings of hand infections warrant a thorough treatment strategy depending on the progress of the infection. The decision for surgical treatment can be unclear. Searching to improve the quality of diagnostics, we reviewed the literature regarding the use of point-of-care ultrasound (PCUS) in hand infections and analyzed patients undergoing decision-making with PCUS. We searched PubMed, Scopus, Cochrane Register, and Google Scholar for the use of PCUS in therapy planning in infections of the hand. In addition, we screened our patients from July 1, 2020, to November 30, 2020, to validate the potential benefit of ultrasound examination in suspected hand infections. We evaluated initial clinical examinations versus blinded sonographic assessments in the context of correct decision to proceed with surgery or conservative treatment. Two thousand forty-eight studies within the topic were identified, but only 9 studies were found eligible to be included with a total of 88 patients. The studies illustrate that ultrasound can be performed on all patients, including children and pregnant women, and can be performed in a timely manner. In our retrospective analysis of 20 patients with suspected hand infection, the clinical and ultrasound assessment led to surgery in 13 cases. Of those 13 patients, 7 revealed intraoperative pus. By retrospective assessment of solely the ultrasound images, surgery would have been indicated in 9 cases, including all 7 cases with intraoperative pus. Clinical examination and ultrasound can help in detecting infections of the hand. Ultrasound examination, however, seems to yield a lower false-positive rate than clinical examination. Ultrasound could be a valuable addition to clinical examination.
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Affiliation(s)
| | | | | | - Valentin Haug
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
| | - Benjamin Thomas
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
| | | | - Ulrich Kneser
- BG Klinik Ludwigshafen, Plastische und Rekonstruktive Chirurgie, Mikrochirurgie, Schwerbrandverletztenzentrum, Universität Heidelberg, Heidelberg
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148
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Lee WF, Goh SJ, Lee B, Juan SJ, Asinas-Tan M, Lim BL. Renal point-of-care ultrasound performed by ED staff with limited training and 30-day outcomes in patients with renal colic. CAN J EMERG MED 2024; 26:198-203. [PMID: 38219263 DOI: 10.1007/s43678-023-00645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 12/28/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIM Emergency Department (ED) renal point-of-care ultrasound (PoCUS) in renal colic by accredited specialists has good prognostic value. This may not be generalizable to under-resourced EDs. We investigated PoCUS in renal colic in our ED with lesser training. METHODS We performed a single-centre health records review of adult ED patients with renal colic and PoCUS. Patients were managed by a non-ED specialist/resident doctor with no POCUS accreditation in consultation with an attending. These doctors attended a 3.5-h training session conducted by accredited attendings to examine hydronephrosis. They needed to verify their PoCUS findings with an attending during the first two weeks of their six-month posting before performing it independently. The primary outcome was 30-day urological procedures in hydronephrotic vs. non-hydronephrotic groups. Secondary outcomes were the distribution of primary outcome with grades of hydronephrosis, 30-day ED nephrolithiasis-related reattendances in hydronephrotic vs. non-hydronephrotic groups and its distribution with grades of hydronephrosis. We compared outcomes using Fisher's exact test. We also reported crude odds ratio (COR) and 95% CI of primary outcome between hydronephrotic vs. non-hydronephrotic groups. p values ≤ 0.05 were significant. RESULTS We recruited 651 patients; 160 (24.6%) without and 491 (75.4%) with hydronephrosis. Rates of grades of hydronephrosis were: mild (76.6%), moderate (13.8%), severe (1.2%) and undifferentiated (8.4%). There was a difference in 30-day urological procedures (rates [95% CI]) in hydronephrotic vs. non-hydronephrotic groups, 11.2 [8.7-14.0]% vs. 2.5 [1.0-6.3]%; p < 0.001; COR (95% CI) 4.9 (1.8-13.8); p = 0.002. Increasing 30-day urological procedural rates were associated with increasing grade of hydronephrosis [no: 2.5%, mild: 7.7%, moderate: 23.5%, severe: 67.0% and undifferentiated: 14.6%; p < 0.001]. No differences occurred in other secondary outcomes. CONCLUSIONS Renal PoCUS could be performed by non-ED specialist/resident doctors to identify patients without hydronephrosis who rarely required urological intervention. Hydronephrotic patients could benefit from further risk stratification.
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Affiliation(s)
- W F Lee
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore.
| | - S J Goh
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - Berlin Lee
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - S J Juan
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - Marxengel Asinas-Tan
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
| | - B L Lim
- Emergency Department, Ng Teng Fong General Hospital, 1, Jurong East Street 21, Singapore, 609606, Singapore
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149
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Alacevich C, Abi Nehme AM, Lee JH, Li D, Mobley EM, Close JL, George TJ, LeLaurin JH, Hong YR, Shenkman EA, Gutter MS, Salloum RG. A point-of-care pilot randomized intervention to connect patients with cancer-induced financial toxicity to telehealth financial counseling. Cancer Causes Control 2024; 35:393-403. [PMID: 37794203 PMCID: PMC10872295 DOI: 10.1007/s10552-023-01794-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Elevated costs of cancer treatment can result in economic and psychological "financial toxicity" distress. This pilot study assessed the feasibility of a point-of-care intervention to connect adult patients with cancer-induced financial toxicity to telehealth-delivered financial counseling. METHODS We conducted a three-armed parallel randomized pilot study, allocating newly referred patients with cancer and financial toxicity to individual, group accredited telehealth financial counseling, or usual care with educational material (1:1:1). We assessed the feasibility of recruitment, randomization, retention, baseline and post-intervention COmprehensive Score for Financial Toxicity (COST), and Telehealth Usability Questionnaire (TUQ) scores. RESULTS Of 382 patients screened, 121 were eligible and enrolled. 58 (48%) completed the intervention (9 individual, 9 group counseling, 40 educational booklet). 29 completed follow-up surveys: 45% female, 17% African American, 79% white, 7% Hispanic, 55% 45-64 years old, 31% over 64, 34% lived in rural areas, 24% had cancer stage I, 21% II, 7% III, 31% IV. Baseline characteristics were balanced across arms, retention status, surveys completion. Mean (SD) COST was 12.4 (6.1) at baseline and 16.0 (8.4) post-intervention. Mean (SD) COST score differences were 6.3 (11.6) after individual counseling, 5.8 (8.5) after group counseling, and 2.5 (6.4) after usual care. Mean TUQ score among nine counseling participants was 5.5 (0.9) over 7.0. Non-parametric comparisons were not statistically meaningful. CONCLUSION Recruitment and randomization were feasible, while study retention presented challenges. Nine participants reported good usability and satisfaction with telehealth counseling. Larger-scale trials focused on improving participation, retention, and impact of financial counseling among patients with cancer are justified.
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Affiliation(s)
- Caterina Alacevich
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA.
| | - Anna Maria Abi Nehme
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Ji-Hyun Lee
- Department of Biostatistics, University of Florida, Gainesville, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, USA
| | - Derek Li
- Department of Biostatistics, University of Florida, Gainesville, USA
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida, Jacksonville, USA
| | - Julia L Close
- Division of Hematology and Oncology, University of Florida, Gainesville, USA
| | - Thomas J George
- Division of Hematology and Oncology, University of Florida, Gainesville, USA
| | - Jennifer H LeLaurin
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Young-Rock Hong
- Health Services Research, Management and Policy, University of Florida, Gainesville, USA
| | - Elizabeth A Shenkman
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
| | - Michael S Gutter
- Department of Family, Youth and Community Sciences, University of Florida, Gainesville, USA
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, USA
| | - Ramzi G Salloum
- Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, USA
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150
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Juntereal NA. Measuring Human Milk Biomarkers at Point-of-Care: An Emerging Opportunity for Nurses. MCN Am J Matern Child Nurs 2024; 49:116-117. [PMID: 38403912 DOI: 10.1097/nmc.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
- Nina A Juntereal
- Nina A. Juntereal is a Lecturer and former Hillman Scholar in Nursing Innovation at the University of Pennsylvania School of Nursing, Philadelphia, PA, and a 2023 MCN Editorial Fellow. Dr. Juntereal can be reached at
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