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Lilly CM, Wang Z, Dunlap D, Kaye J, Gohtard S, Teebagy S, Hafer N, Rogers EJ, Buchholz B, McManus D. 2021 Patient Preferences for Point of Care Testing Survey: More Acceptance and Less Concern. J Appl Lab Med 2022; 7:1302-1310. [PMID: 36093730 PMCID: PMC10641840 DOI: 10.1093/jalm/jfac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/12/2022] [Indexed: 10/27/2023]
Abstract
BACKGROUND The evolving opinions of our community members provide insights into how end-users perceive the value and identify key point-of-care test (POCT) characteristics. METHODS We deployed our validated 45-item English-language survey to uncompensated volunteers and compared the results from 1264 respondents in 2021 with those obtained in 2020. RESULTS Average responses for items regarding the benefits of POCTs demonstrated that the 2021 respondents indicated agreement with all 14 potential benefits. Average responses for items regarding concerns were distinctly different from those for benefits. The only concern item that scored in the agree range was "not having insurance coverage for POCTs." Average responses to the other 13 concern items were in the disagree range. For 8 of these items, the magnitude of disagreement was greater in the 2021 survey than was observed for the 2020 survey. Differences in POCT exposure over time and by US regions suggest that higher levels of exposure to POCTs in the East are associated with stronger public support. CONCLUSIONS Community members strongly support the development of accurate, convenient, easy-to-use, affordable, equitably available, in-home POCTs that produce immediate results. This empowers patients and home caregivers to diagnose, manage, enhance their adherence to medical treatments, and more efficiently engage their physicians.
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Affiliation(s)
- Craig M. Lilly
- Departments of Medicine, Worcester, MA, USA
- Anesthesiology, and Surgery, Worcester, MA, USA
- Graduate School of Biomedical Sciences, Worcester, MA, USA
- UMass Chan School of Medicine, Worcester, MA, USA
- UMass Memorial Health Care, Memorial Medical Center, Worcester, MA, USA
| | - Ziyue Wang
- UMass Chan School of Medicine, Worcester, MA, USA
| | - Denise Dunlap
- University of Massachusetts Lowell, Lowell, MA, USA
- Manning School of Business UMass Lowell, Lowell, MA, USA
| | - Jeffrey Kaye
- Department of Neurology and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Gohtard
- Department of Neurology and Biomedical Engineering, Oregon Health & Science University, Portland, OR, USA
| | - Sean Teebagy
- UMass Chan School of Medicine, Worcester, MA, USA
| | - Nathaniel Hafer
- Graduate School of Biomedical Sciences, Worcester, MA, USA
- UMass Center for Clinical and Translational Science, Worcester, MA, USA
- UMass Chan Program in Molecular Medicine, UMass Chan School of Medicine, Worcester, MA, USA
| | - Eugene J. Rogers
- University of Massachusetts Lowell, Lowell, MA, USA
- Department of Biomedical and Nutritional Sciences, Lowell, MA, USA
| | - Bryan Buchholz
- University of Massachusetts Lowell, Lowell, MA, USA
- Department of Bioengineering, UMass Lowell, Lowell, MA, USA
| | - David McManus
- Departments of Medicine, Worcester, MA, USA
- UMass Chan School of Medicine, Worcester, MA, USA
- UMass Memorial Health Care, Memorial Medical Center, Worcester, MA, USA
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Resmi PE, Sachin Kumar S, Alageswari D, Suneesh PV, Ramachandran T, Nair BG, Satheesh Babu TG. Development of a paper-based analytical device for the colourimetric detection of alanine transaminase and the application of deep learning for image analysis. Anal Chim Acta 2021; 1188:339158. [PMID: 34794561 DOI: 10.1016/j.aca.2021.339158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
A paper-based colourimetric assay for the detection of alanine transaminase has been developed. In the presence of alanine transaminase, 2,4-dinitrophenyl hydrazine changes to pyruvate hydrazone leading to a colour change from pale yellow to dark yellow. Reaction conditions were optimized using absorption spectroscopic studies. Hydrophobic patterns on the Whatman chromatographic paper were created by wax printing, and the reagents were drop cast at the reagent zone. On the paper device, the intensity of the yellow colour increases with ALT concentration in the range of 20-140 U/L in human serum. For the quantification of ALT, coloured images were captured using a digital camera and were processed with Image J software. The machine learning approach was also explored for the ALT analysis by training with colour images of the paper device and testing using a cross-validation procedure. The results obtained with real clinical samples on the paper device showed good accuracy of less than 5% relative error with the clinical lab results. Furthermore, the paper device shows high selectivity to ALT in the presence of various interfering species in blood serum with a sensitivity of 0.261 a.u/(U/L), a detection limit of 4.12 U/L, and precise results with an RSD of less than 7%. For the testing of whole blood, a plasma separation membrane was integrated with the patterned paper.
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Affiliation(s)
- P E Resmi
- Amrita Biosensor Research Lab, Amrita School of Engineering Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India; Department of Sciences, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India
| | - S Sachin Kumar
- Centre for Computational Engineering and Networking, Amrita School of Engineering Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India
| | - D Alageswari
- Amrita Biosensor Research Lab, Amrita School of Engineering Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India; Department of Sciences, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India
| | - P V Suneesh
- Amrita Biosensor Research Lab, Amrita School of Engineering Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India; Department of Sciences, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India
| | - T Ramachandran
- Department of Sciences, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India
| | - Bipin G Nair
- Amrita School of Biotechnology, Amritapuri, Kollam, 690525, India
| | - T G Satheesh Babu
- Amrita Biosensor Research Lab, Amrita School of Engineering Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India; Department of Sciences, Amrita School of Engineering, Coimbatore, Amrita Vishwa Vidyapeetham, 641112, India.
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Moed S, Suprenant M, Odjidja EN, Meguid T, Zaman MH. Economic Evaluation of Screening Interventions for Drug-induced Liver Injury. Clin Infect Dis 2021; 73:e3959-e3965. [PMID: 32898262 DOI: 10.1093/cid/ciaa1347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/03/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/AIDS and tuberculosis (TB) continue to be a significant global burden, disproportionately affecting low- and middle-income countries (LMICs). While much progress has been made in treating these epidemics, this has led to a rise in liver complications, as patients on ARTs and anti-TBs are at an increased risk of drug-induced liver injury (DILI). Therefore, patients on these medicines require consistent screening of liver function. Due to logistical barriers, gold standard DILI screening fails to be executed at the point-of-care in LMICs. For this reason, we used cost-effectiveness analysis to gauge the efficacy of a paper-test that could be implemented in these settings. METHODS We used a Markov Model to simulate HIV and TB coinfected patient care in LMICs using both publicly available data and data from Village Health Works in Burundi. We compared the cost-effectiveness of two screening interventions for liver function monitoring: 1. paper-based point-of-care testing, and 2. gold-standard laboratory testing. These interventions were compared against baseline clinical monitoring. RESULTS The paper test showed a 56% increase in efficacy over clinical monitoring alone. The paper-test is more cost-effective than the gold-standard method, at a ceiling cost of $1.60 per test. CONCLUSIONS With this information, policy makers can be informed as to the large potential value of paper-based tests when gold standard monitoring is not achievable. Scientists and engineers should also keep these analyses in mind and while in development limit the cost of an ALT screening test to $1.60.
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Affiliation(s)
- Saundria Moed
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Mark Suprenant
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | | | | | - Muhammad H Zaman
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA.,Department of Biomedical Engineering, Howard Hughes Medical Institute, Boston, Massachusetts, USA
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Abstract
Background Studies of current opinion of our community members for the characteristics, mode, and location of use, use cases, and overall enthusiasm for point-of-care testing (POCT) diagnosis and management tools are needed. Study Design and Methods Qualitative research methods were used to develop, refine, and evaluate hardcopy and electronic versions of a 45-item English language survey. The accuracy of the instrument was measured by recorded structured interview, and its precision was measured by comparison to its administration to a group of uncompensated volunteers. Main Findings and Results Comparison of survey and structured interview data demonstrated high levels of accuracy. Highly concordant with significant levels of correlation and of direct association indicated favorable precision. Ninety-three percent of respondents believed that POCT could improve their care, and 56% identified having a POCT in their home as a top priority. Accuracy, insurance coverage, immediacy of results, and ease of use were identified as the most important characteristics of a POCT. Conclusions Community members strongly support the development of accurate, in-home devices that produce immediate results that can be used to diagnose, manage, and encourage their adherence to treatments for their medical conditions.
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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