Point-of-care testing, near-patient testing and patient self-testing: warning points

Point-of-care testing (POCT), near-patient testing (NPT) and patient self-tests (PST) are diagnostic examinations performed at the time and place of patient care. While POCT and NPT are performed and analyzed by medical professionals, PST are based on samples and parameters directly collected and analyzed by lay users. These tests are spreading both in high income countries and in low to middle income countries as they are expected to improve healthcare efficiency and equity, by saving resources, releasing pressure from hospitals and reducing logistical barriers. However, accurate multidisciplinary assessment is mandatory to ensure that what they promise is real. We reviewed some important ethical aspects, international standards and regulations. The current risks associated with alternative ways of testing are explained by the principles of respect for patient autonomy and non-maleficence. Further evidence from multidisciplinary assessment is needed to evaluate pros and cons in light of the principles of beneficence and justice. Although POCT or NPT need common regulation and accurate provider training to ensure safe and appropriate interpretation of results, PST needs even more attention as they are subject to direct patient use. Randomized controlled trails including patient education should be conducted in order to provide reliable evidence on clinical outcomes, patient acceptance and cost-effectiveness. Mandatory regulation is needed to avoid harm and EU regulation should help different countries maintain a safe use of devices in a global population of producers and users.

Satisfaction with home blood sampling methods and expectations for future point-of-care testing in phenylketonuria: Perspectives from patients and professionals

INTRODUCTION

Phenylketonuria (PKU) requires regular phenylalanine monitoring to ensure optimal outcome. However, home sampling methods used for monitoring suffer high pre-analytical variability, inter-laboratory variability and turn-around-times, highlighting the need for alternative methods of home sampling or monitoring.

METHODS

A survey was distributed through email and social media to (parents of) PKU patients and professionals working in inherited metabolic diseases in Denmark, The Netherlands, and United Kingdom regarding satisfaction with current home sampling methods and expectations for future point-of-care testing (POCT).

RESULTS

210 parents, 156 patients and 95 professionals completed the survey. Countries, and parents and patients were analysed together, in absence of significant group differences for most questions. Important results are: 1) Many patients take less home samples than advised. 2) The majority of (parents of) PKU patients are (somewhat) dissatisfied with their home sampling method, especially with turn-around-times (3-5 days). 3) 37% of professionals are dissatisfied with their home sampling method and 45% with the turn-around-times. 4) All responders are positive towards developments for POCT: 97% (n = 332) of (parents of) patients is willing to use a POC-device and 76% (n = 61) of professionals would recommend their patients to use a POC-device. 5) Concerns from all participants for future POC-devices are costs/reimbursements and accuracy, and to professionals specifically, accessibility to results, over-testing, patient anxiety, and patients adjusting their diet without consultation.

CONCLUSION

The PKU community is (somewhat) dissatisfied with current home sampling methods, highlighting the need for alternatives of Phe monitoring. POCT might be such an alternative and the community is eager for its arrival.

Point-of-care self-testing for measuring total white blood cells and C-reactive protein - a pilot study for future home-monitoring of patients during antibiotic treatment at home

BACKGROUND

During home treatment with antibiotics, patients' laboratory results of total white blood cell count (WBC) with neutrophil counts and C-reactive protein (CRP) are drawn and monitored at the hospital. The aim of the study was to examine the feasibility and analytical accuracy of hospitalized patients 18 years or older self-testing using two point-of-care tests (POCT).

METHODS

The pilot study included 41 hospitalized patients. A subjective judgment of the patients' ability to conduct the self-testing was made along with a comparison of the POCT measurements of WBC, neutrophil counts and CRP with standard laboratory measurements. Correlation between the POCTs and laboratorial values was assessed by coefficient of determination and the level of agreement between the means was assessed by Bland Altman test.

RESULTS

Of the 38 patients conducting self-testing, 78% were men and the mean age was 61.8 years. 28 patients (73.7%) successfully performed self-testing on the first try while, 10 (26.3%) 'HemoCue WBC DIFF' measurements showed an error code. All the patients successfully performed the 'QuickRead go CRP' self-test. Comparison of the 'HemoCue WBC DIFF' results with the laboratory results of WBC and neutrophil counts showed good agreement. On the other hand, 'QuickRead go CRP' results showed a small but significant systematic disagreement compared to the laboratory results.

CONCLUSION

Our results showed that the POCTs can be used by some patients and factors influencing the patient participation included psychological and physical limitations. Both POCTs appeared to have an acceptable clinical level of accuracy.

Evaluating the feasibility and acceptability of a safety protocol to mitigate SARS-CoV-2 transmission risks when participating in full-capacity live mass events: a cross-sectional survey and interview-based study

OBJECTIVE

Investigate the feasibility and acceptability of a novel COVID-19 safety protocol combining professionally witnessed home-based videoed pre-event testing and a data-driven risk assessment model that was piloted at the Standon Calling Festival in July 2021.

DESIGN

Observational study using a sequential explanatory mixed-methods design involving a survey, personal interviews and group discussions with a cross section of participants.

SETTING

Standon Calling Festival, Hertfordshire, England.

PARTICIPANTS

4726 adults who attended Standon Calling and consented to participate in the study.

RESULTS

Nearly a quarter (23.1%; 1093) attendees (women 65%, men 35%) responded to the postevent survey. Eleven participants were interviewed before thematic saturation was reached. The majority (81.0%) of respondents found the at-home testing protocol convenient and of reasonable cost (73.6%). Confidence in the test result was enhanced due to professional-supported videoing (76.2%), whereas 72.6% had confidence in the security of the data. Videoed self-testing helped 45.0% of respondents to feel more confident in their lateral flow testing technique. The majority (85.5%) felt safer at the event and 93.7% agreed that the protocol did not interfere with their enjoyment of the event. Themes generated from interviews showed that the protocol could be applied to other disease areas and events, but there were concerns that over-reliance on test results alone could lead some people to have a false sense of security around the safety of the live event.

CONCLUSIONS

Our study showed that a protocol that combines professionally witnessed home-based videoed pre-event testing is highly acceptable and feasible, and it can inform decision making and support the safe reopening of live mass events at full capacity. Although COVID-19 is now considered endemic in the UK, this protocol can be of value for other countries where the live events industry remains heavily impacted. Risk modelling should be tested and evaluated at future events to further increase the robustness of this protocol.

A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program

BACKGROUND

A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences.

OBJECTIVE

This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants' engagement and satisfaction with the program.

METHODS

A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters.

RESULTS

Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F_1,162=9.65, P=.002, Cohen d=0.48) and resilience (F_1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes.

CONCLUSIONS

The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk.

Monitoring gestational diabetes at the point-of-care via dual glycated albumin lateral flow assays in conjunction with a handheld reader

A dual assay cartridge was developed and used in conjunction with a handheld reader for sensing % glycated albumin to monitor gestational diabetes at home.