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Miller R, Nixon G, Pickering JW, Stokes T, Turner RM, Young J, Gutenstein M, Smith M, Norman T, Watson A, George P, Devlin G, Du Toit S, Than M. A prospective multi-centre study assessing the safety and effectiveness following the implementation of an accelerated chest pain pathway using point-of-care troponin for use in New Zealand rural hospital and primary care settings. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2022; 11:418-427. [PMID: 35373255 PMCID: PMC9197428 DOI: 10.1093/ehjacc/zuac037] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Aims Most rural hospitals and general practices in New Zealand (NZ) are reliant on point-of-care troponin. A rural accelerated chest pain pathway (RACPP), combining an electrocardiogram (ECG), a structured risk score (Emergency Department Assessment of Chest Pain Score), and serial point-of-care troponin, was designed for use in rural hospital and primary care settings across NZ. The aim of this study was to evaluate the safety and effectiveness of the RACPP. Methods and results A prospective multi-centre evaluation following implementation of the RACPP was undertaken from 1 July 2018 to 31 December 2020 in rural hospitals, rural and urban general practices, and urgent care clinics. The primary outcome measure was the presence of 30-day major adverse cardiac events (MACEs) in low-risk patients. The secondary outcome was the percentage of patients classified as low-risk that avoided transfer or were eligible for early discharge. There were 1205 patients enrolled in the study. 132 patients were excluded. Of the 1073 patients included in the primary analysis, 474 (44.0%) patients were identified as low-risk. There were no [95% confidence interval (CI): 0–0.3%] MACE within 30 days of the presentation among low-risk patients. Most of these patients (91.8%) were discharged without admission to hospital. Almost all patients who presented to general practice (99%) and urgent care clinics (97.6%) were discharged to home directly. Conclusion The RACPP is safe and effective at excluding MACEs in NZ rural hospital and primary care settings, where it can identify a group of low-risk patients who can be safely discharged home without transfer to hospital.
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Affiliation(s)
- Rory Miller
- Department of General Practice and Rural Health, University of Otago, Dunedin School of Medicine , Dunedin , New Zealand
| | - Garry Nixon
- Department of General Practice and Rural Health, University of Otago, Dunedin School of Medicine , Dunedin , New Zealand
| | - John W Pickering
- Emergency Department, University of Otago – Christchurch , Christchurch , New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, University of Otago, Dunedin School of Medicine , Dunedin , New Zealand
| | - Robin M Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago , Dunedin , New Zealand
| | - Joanna Young
- Canterbury DHB, Christchurch Hospital , Christchurch , New Zealand
| | - Marc Gutenstein
- Rural Health Academic Centre Ashburton, University of Otago – Christchurch , Christchurch , New Zealand
| | - Michelle Smith
- Department of General Practice and Rural Health, University of Otago, Dunedin School of Medicine , Dunedin , New Zealand
| | - Tim Norman
- Project Office, Midlands Regional Health Network Charitable Trust , Hamilton , New Zealand
| | - Antony Watson
- Canterbury DHB, Christchurch Hospital , Christchurch , New Zealand
| | - Peter George
- Chemical Pathology, PathoGene, Merivale , Christchurch , New Zealand
| | | | | | - Martin Than
- Emergency Department, Canterbury DHB, Christchurch Hospital , Christchurch , New Zealand
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Norman T, Young J, Scott Jones J, Egan G, Pickering J, Du Toit S, Hamilton F, Miller R, Frampton C, Devlin G, George P, Than M. Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study. BMJ Open 2022; 12:e044801. [PMID: 35428610 PMCID: PMC9013998 DOI: 10.1136/bmjopen-2020-044801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home. DESIGN A prospective observational pilot evaluation. SETTING Twelve rural general (family) practices in the Midlands region of New Zealand. PARTICIPANTS Patients aged ≥18 years who presented acutely to rural general practice with suspected ischaemic chest pain for whom the doctor intended transfer to hospital for serial troponin measurement. OUTCOME MEASURES The proportion of patients managed using the low-risk pathway without transfer to hospital and without 30-day major adverse cardiac event (MACE); pathway adherence; rate of 30-day MACE; patient satisfaction with care; and agreement between point-of-care and laboratory measured troponin concentrations. RESULTS A total of 180 patients were assessed by the pathway. The pathway classified 111 patients (61.7%) as low-risk and all were managed in rural general practice with no 30-day MACE (0%, 95% CI 0.0% to 3.3%). Adherence to the low-risk pathway was 95.5% (106 out of 111). Of the 56 patients classified as non-low-risk and referred to hospital, 9 (16.1%) had a 30-day MACE. A further 13 non-low-risk patients were not transferred to hospital, with no events. The sensitivity of the pathway for 30-day MACE was 100.0% (95% CI 70.1% to 100%). Of low-risk patients, 94% reported good to excellent satisfaction with care. Good concordance was observed between point-of-care and duplicate laboratory measured troponin concentrations. CONCLUSIONS The use of an accelerated diagnostic chest pain pathway incorporating point-of-care troponin in a rural general practice setting was feasible and acceptable, with preliminary results suggesting that it may safely and effectively reduce the urgent transfer of low-risk patients to hospital.
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Affiliation(s)
- Tim Norman
- Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand
- Department of Population Health, University of Waikato, Hamilton, New Zealand
| | - Joanna Young
- Department of Cardiology, Canterbury District Health Board, Christchurch, New Zealand
| | - Jo Scott Jones
- Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand
| | - Gishani Egan
- Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand
| | - John Pickering
- Emergency Department, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Stephen Du Toit
- Department of Clinical Chemistry, Waikato District Health Board, Hamilton, New Zealand
| | - Fraser Hamilton
- Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand
- Heart Foundation of New Zealand, Auckland, New Zealand
| | - Rory Miller
- Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand
- Department of Medicine, University of Otago - Dunedin Campus, Dunedin, New Zealand
| | - Chris Frampton
- Christchurch School of Medicine and Health Sciences, University of Otago Christchurch, Christchurch, New Zealand
| | - Gerard Devlin
- Heart Foundation of New Zealand, Auckland, New Zealand
- Department of Cardiology, Waikato District Health Board, Hamilton, New Zealand
| | - Peter George
- MedLab Pathology, Sydney, New South Wales, Australia
| | - Martin Than
- Emergency Department, Canterbury District Health Board, Christchurch, New Zealand
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Miller R, Young J, Nixon G, Pickering JW, Stokes T, Turner R, Devlin G, Watson A, Gutenstein M, Norman T, George PM, Du Toit S, Than M. Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations. J Prim Health Care 2021; 12:129-138. [PMID: 32594980 DOI: 10.1071/hc19059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/15/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Accelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand's rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMS To assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODS This is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURES The primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital.
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Affiliation(s)
- Rory Miller
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and Corresponding author.
| | - Joanna Young
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Garry Nixon
- Cardiology, Canterbury DHB, Christchurch Hospital, Christchurch and Department of Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - John W Pickering
- Medicine, University of Otago - Christchurch and Emergency Department, Christchurch Hospital and Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Turner
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | | | - Antony Watson
- Emergency Care Foundation, St Albans, Christchurch, New Zealand
| | - Marc Gutenstein
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; and Rural Health Academic Centre Ashburton, University of Otago and Christchurch and Emergency Department, Nelson Hospital, Nelson, New Zealand
| | - Tim Norman
- Project Office, Midlands Regional Health Network Charitable Trust, Hamilton, New Zealand
| | | | - Stephen Du Toit
- Biochemistry, Waikato DHB. Biochemistry Department, Waikato Hospital, Hamilton, New Zealand
| | - Martin Than
- Emergency Department, Canterbury DHB, Christchurch Hospital, Christchurch, New Zealand
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Singh G, Savage NM, Gunsolus B, Foss KA. Requiem for the STAT Test: Automation and Point of Care Testing. Lab Med 2020; 51:e27-e31. [PMID: 31747455 DOI: 10.1093/labmed/lmz080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Quick turnaround of laboratory test results is needed for medical and administrative reasons. Historically, laboratory tests have been requested as routine or STAT. With a few exceptions, a total turnaround time of 90 minutes has been the usually acceptable turnaround time for STAT tests. METHODS We implemented front-end automation and autoverification and eliminated batch testing for routine tests. We instituted on-site intraoperative testing for selected analytes and employed point of care (POC) testing judiciously. The pneumatic tube system for specimen transport was expanded. RESULTS The in-laboratory turnaround time was reduced to 45 minutes for more than 90% of tests that could reasonably be ordered STAT. With rare exceptions, the laboratory no longer differentiates between routine and STAT testing. Having a single queue for all tests has improved the efficiency of the laboratory. CONCLUSION It has been recognized in manufacturing that batch processing and having multiple queues for products are inefficient. The same principles were applied to laboratory testing, which resulted in improvement in operational efficiency and elimination of STAT tests. We propose that the target for in-laboratory turnaround time for STAT tests, if not all tests, be 45 minutes or less for more than 90% of specimens.
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Affiliation(s)
- Gurmukh Singh
- Professor of Pathology, Shepeard Chair in Clinical Pathology, Vice Chair of Pathology, Augusta, Georgia
| | - Natasha M Savage
- Associate Professor of Pathology, Director of Hematology and Hematopathology, Augusta, Georgia
| | - Brandy Gunsolus
- Pathology Utilization Manager, Clinical Pathology, Augusta, Georgia
| | - Kellie A Foss
- Administrative Director for Pathology Services, Medical College of Georgia at Augusta University, Department of Pathology, Augusta, Georgia
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5
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Vafaie M, Stoyanov KM, Katus HA, Giannitsis E. Kardiales Troponin und mehr beim akuten Koronarsyndrom. Internist (Berl) 2019; 60:555-563. [DOI: 10.1007/s00108-019-0611-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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Tsui AKY, Lyon ME, van Diepen S, Goudreau BL, Thomas D, Higgins T, Raizman JE, Füzéry AK, Rodriguez-Capote K, Estey M, Cembrowski G. Analytical Concordance of Diverse Point-of-Care and Central Laboratory Troponin I Assays. J Appl Lab Med 2018; 3:764-774. [PMID: 31639752 DOI: 10.1373/jalm.2018.026690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiac troponin I (cTnI) 99th percentile cutoffs, used in the diagnosis of acute myocardial infarction, are not standardized across cTnI assays. We compared 3 point-of-care (POC) and 1 central laboratory contemporary cTnI assays against the Abbott high-sensitivity (hs) cTnI to evaluate the analytical concordance and the feasibility of using a single cutoff value for all assays. METHODS Fresh blood samples collected from 102 inpatients in the coronary care unit were measured on central laboratory instruments (Beckman Coulter DxI AccuTnI+3 TnI, Abbott Architect hs-TnI) and cTnI POC analyzers (Alere Triage Troponin I, Radiometer AQT90, Abbott i-STAT). Agreement and correlation between the contemporary cTnI assays and hs-cTnI assay were assessed using regression analysis. Proportional bias was assessed using Bland-Altman plots. Concordance between the contemporary cTnI and hs-cTnI assays was determined by diagnostic contingency tables at specific cutoffs. RESULTS Most POC cTnI assays had excellent correlation with the Abbott hs-cTnI method (r 2 = 0.955-0.970) except for Alere Triage (r 2 = 0.617), while proportional bias is evident between all cTnI assays. Overall concordance between POC contemporary cTnI assays and hs-cTnI assay was 80% to 90% at their respective 99th percentile cutoffs. The concordance increased to 90% to 95% when a fixed cutoff of 0.03 to 0.05 ng/mL was used across the assays. CONCLUSIONS This study demonstrates poor analytical concordance between cTnI assays at the 99th percentile and supports the notion of a single clinical decision limit for cTnI and consequently standardization of diagnostic protocols despite the analytical differences among these assays.
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Affiliation(s)
- Albert K Y Tsui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada; .,Department of Laboratory Medicine and Pathology, Alberta Health Services, Edmonton, AB, Canada
| | - Martha E Lyon
- Department of Pathology and Laboratory Medicine, Saskatoon Health Region, Saskatoon, SK, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, Division of Cardiology, University of Alberta, Edmonton, AB, Canada
| | - Bobbi Lynn Goudreau
- Department of Laboratory Medicine and Pathology, Alberta Health Services, Edmonton, AB, Canada
| | - Dylan Thomas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,DynaLIFE Medical Labs, Edmonton, AB, Canada
| | - Trefor Higgins
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,DynaLIFE Medical Labs, Edmonton, AB, Canada
| | - Joshua E Raizman
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, Alberta Health Services, Edmonton, AB, Canada
| | - Anna K Füzéry
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, Alberta Health Services, Edmonton, AB, Canada
| | - Karina Rodriguez-Capote
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,DynaLIFE Medical Labs, Edmonton, AB, Canada
| | - Mathew Estey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,DynaLIFE Medical Labs, Edmonton, AB, Canada
| | - George Cembrowski
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.,Department of Laboratory Medicine and Pathology, Alberta Health Services, Edmonton, AB, Canada
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Suzuki K, Komukai K, Nakata K, Kang R, Oi Y, Muto E, Kashiwagi Y, Tominaga M, Miyanaga S, Ishikawa T, Okuno K, Uzura M, Yoshimura M. The Usefulness and Limitations of Point-of-care Cardiac Troponin Measurement in the Emergency Department. Intern Med 2018; 57:1673-1680. [PMID: 29434124 PMCID: PMC6047987 DOI: 10.2169/internalmedicine.0098-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective This study was carried out to examine the usefulness of point-of-care (POC) cardiac troponin in diagnosing acute coronary syndrome (ACS) and to understand the limitations of a POC cardiac troponin I/T-based diagnoses. Methods Patients whose cardiac troponin levels were measured in the emergency department using a POC system (AQT System; Radiometer, Tokyo, Japan) between January and December 2016 were retrospectively examined (N=1,449). Patients who were < 20 years of age or who were admitted with cardiopulmonary arrest were excluded. The sensitivity and specificity of the POC cardiac troponin levels for the diagnosis of ACS were determined. Result One hundred and twenty of 1,449 total patients had ACS (acute myocardial infarction, n=88; unstable angina n=32). On comparing the receiver operating characteristic (ROC) curves, the area under the curve (AUC) values for POC cardiac troponin I and cardiac troponin T were 0.833 and 0.786, respectively. The sensitivity and specificity of POC cardiac troponin I when using the 99th percentile (0.023 ng/mL) as the diagnostic cut-off value were 69.0% and 88.1%, respectively. The sensitivity of POC cardiac troponin I (99th percentile) was higher in the patients sampled > 3 hours after symptom onset (83.3%) than in those sampled ≤ 3 hours after symptom onset (58.8%, p < 0.01). Conclusion When sampled > 3 hours after the onset of symptoms, the POC cardiac troponin I level is considered to be suitable for use in diagnosing ACS. However, when sampled ≤ 3 hours after the onset of symptoms, careful interpretation of POC cardiac troponins is therefore required to rule out ACS.
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Affiliation(s)
- Kenichiro Suzuki
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Kimiaki Komukai
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Kotaro Nakata
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Ryeonshi Kang
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Yuhei Oi
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Eri Muto
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Yusuke Kashiwagi
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | | | - Satoru Miyanaga
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Tetsuya Ishikawa
- Division of Cardiology, The Jikei University Kashiwa Hospital, Japan
| | - Kenji Okuno
- Emergency and Critical Care Center, The Jikei University Kashiwa Hospital, Japan
| | - Masahiko Uzura
- Emergency and Critical Care Center, The Jikei University Kashiwa Hospital, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
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8
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Miller R, Nixon G. The assessment of acute chest pain in New Zealand rural hospitals utilising point-of-care troponin. J Prim Health Care 2018; 10:90-92. [DOI: 10.1071/hc18007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Greiser A, Winter T, Mahfoud H, Kallner A, Ittermann T, Masuch A, Lubenow N, Kohlmann T, Greinacher A, Nauck M, Petersmann A. The 99th percentile and imprecision of point-of-care cardiac troponin I in comparison to central laboratory tests in a large reference population. Clin Biochem 2017; 50:1198-1202. [DOI: 10.1016/j.clinbiochem.2017.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/19/2017] [Accepted: 08/10/2017] [Indexed: 01/28/2023]
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10
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Jung J, Lee J, Shin S, Kim YT. Development of a Telemetric, Miniaturized Electrochemical Amperometric Analyzer. SENSORS (BASEL, SWITZERLAND) 2017; 17:E2416. [PMID: 29065534 PMCID: PMC5677258 DOI: 10.3390/s17102416] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 01/14/2023]
Abstract
In this research, we developed a portable, three-electrode electrochemical amperometric analyzer that can transmit data to a PC or a tablet via Bluetooth communication. We performed experiments using an indium tin oxide (ITO) glass electrode to confirm the performance and reliability of the analyzer. The proposed analyzer uses a current-to-voltage (I/V) converter to convert the current generated by the reduction-oxidation (redox) reaction of the buffer solution to a voltage signal. This signal is then digitized by the processor. The configuration of the power and ground of the printed circuit board (PCB) layer is divided into digital and analog parts to minimize the noise interference of each part. The proposed analyzer occupies an area of 5.9 × 3.25 cm² with a current resolution of 0.4 nA. A potential of 0~2.1 V can be applied between the working and the counter electrodes. The results of this study showed the accuracy of the proposed analyzer by measuring the Ruthenium(III) chloride ( Ru III ) concentration in 10 mM phosphate-buffered saline (PBS) solution with a pH of 7.4. The measured data can be transmitted to a PC or a mobile such as a smartphone or a tablet PC using the included Bluetooth module. The proposed analyzer uses a 3.7 V, 120 mAh lithium polymer battery and can be operated for 60 min when fully charged, including data processing and wireless communication.
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Affiliation(s)
- Jaehyo Jung
- IT Fusion Technology Research Center, Department of IT Fusion Technology, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.
| | - Jihoon Lee
- IT Fusion Technology Research Center, Department of IT Fusion Technology, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.
| | - Siho Shin
- IT Fusion Technology Research Center, Department of IT Fusion Technology, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.
| | - Youn Tae Kim
- IT Fusion Technology Research Center, Department of IT Fusion Technology, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea.
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11
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Pecoraro V, Banfi G, Germagnoli L, Trenti T. A systematic evaluation of immunoassay point-of-care testing to define impact on patients' outcomes. Ann Clin Biochem 2017; 54:420-431. [PMID: 28135840 DOI: 10.1177/0004563217694377] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Point-of-care testing has been developed to provide rapid test results. Most published studies focus on analytical performance, neglecting its impact on patient outcomes. Objective To review the analytical performance and accuracy of point-of-care testing specifically planned for immunoassay and to evaluate the impact of faster results on patient management. Methods A search of electronic databases for studies reporting immunoassay results obtained in both point-of-care testing and central laboratory scenarios was performed. Data were extracted concerning the study details, and the methodological quality was assessed. The analytical characteristics and diagnostic accuracy of six points-of-care testing: troponin, procalcitonin, parathyroid hormone, brain natriuretic peptide, C-reactive protein and neutrophil gelatinase-associated lipocalin were evaluated. Results A total of 116 scientific papers were analysed. Studies measuring procalcitonin, parathyroid hormone and neutrophil gelatinase-associated lipocalin reported a limited impact on diagnostic decisions. Seven studies measuring C-reactive protein claimed a significant reduction of antibiotic prescription. Several authors evaluated brain natriuretic peptide or troponin reporting faster decision-making without any improvement in clinical outcome. Forty-four per cent of studies reported analytical data, showing satisfactory correlations between results obtained through point-of-care testing and central laboratory setting. Half of studies defined the diagnostic accuracy of point-of-care testing as acceptable for troponin (median sensitivity and specificity: 74% and 94%, respectively), brain natriuretic peptide (median sensitivity and specificity: 82% and 88%, respectively) and C-reactive protein (median sensitivity and specificity 85%). Conclusions Point-of-care testing immunoassay results seem to be reliable and accurate for troponin, brain natriuretic peptide and C-reactive protein. The satisfactory analytical performance, together with an excellent practicability, suggests that it could be a consistent tool in clinical practice, but data are lacking regarding the patient outcomes.
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Affiliation(s)
- Valentina Pecoraro
- 1 Department of Laboratory Medicine, Clinical Pathology-Toxicology, Ospedale Civile Sant'Agostino Estense, Modena, Italy.,2 Laboratory of Regulatory Policies, IRCCS - "Mario Negri", Institute of Pharmacological Research, Milan, Italy
| | - Giuseppe Banfi
- 3 Vita-Salute San Raffaele University, Milan, Italy.,4 I.R.C.C.S. Orthopedic Institute Galeazzi, Milan, Italy
| | | | - Tommaso Trenti
- 1 Department of Laboratory Medicine, Clinical Pathology-Toxicology, Ospedale Civile Sant'Agostino Estense, Modena, Italy
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Christenson RH, Jacobs E, Uettwiller-Geiger D, Estey MP, Lewandrowski K, Koshy TI, Kupfer K, Li Y, Wesenberg JC. Comparison of 13 Commercially Available Cardiac Troponin Assays in a Multicenter North American Study. ACTA ACUST UNITED AC 2017; 1:544-561. [DOI: 10.1373/jalm.2016.022640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/27/2016] [Indexed: 11/06/2022]
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13
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Vafaie M, Biener M, Mueller M, Abu Sharar H, Hartmann O, Hertel S, Katus HA, Giannitsis E. Addition of copeptin improves diagnostic performance of point-of-care testing (POCT) for cardiac troponin T in early rule-out of myocardial infarction — A pilot study. Int J Cardiol 2015; 198:26-30. [DOI: 10.1016/j.ijcard.2015.06.122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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14
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Glatz JFC, Renneberg R. Added value of H-FABP as plasma biomarker for the early evaluation of suspected acute coronary syndrome. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/clp.13.87] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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15
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Wilgen U, Pretorius CJ, Ungerer JPJ. Improved sensitivity of point of care troponin I values using reporting to below 99th percentile of normals. Schneider HG et al. Clin Biochem 2013; 46:1774-5. [PMID: 23872257 DOI: 10.1016/j.clinbiochem.2013.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 06/23/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Urs Wilgen
- Pathology Queensland, Department of Chemical Pathology, Royal Brisbane and Women's Hospital, Herston Road, Herston 4029, Queensland, Australia; University of Queensland, School of Medicine, Brisbane, St Lucia 4072, Queensland, Australia.
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