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Tase A, Micocci M, Buckle P, Ni M, Hanna G. Pathway map development for medical device event reporting in operating theatres: a human factors approach to improving the existing system. BMJ Surg Interv Health Technol 2023; 5:e000155. [PMID: 36873658 PMCID: PMC9980347 DOI: 10.1136/bmjsit-2022-000155] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/05/2023] [Indexed: 03/07/2023] Open
Abstract
Objectives This study aimed to develop the actual pathway to reporting and information transfer in operating theatres in relation to medical technology malfunction/failure. This with the aim of understanding the differences with the pathway published by NHS Improvement and identification of points for improvement. Design This is a qualitative study involving stakeholder interviews with doctors, nurses, manufacturers, medical device safety officer and Medicines and Healthcare products Regulatory Agency. Setting Data were collected on reporting pathway used in operating theatres. Clinical staff who took part worked in different trusts throughout UK while manufacturers provided devices in UK and EU/USA. Participants Semistructured interviews were completed with 15 clinicians and 13 manufacturers. Surveys were completed by 38 clinicians and 5 manufacturers. Recognised methods of pathway development were used. The Lean Six Sigma principles adapted to healthcare were used to develop suggestions for improvement. Main outcome measures To identify the differences between the set pathway to reporting and information transfer to what is occurring on a day-to-day basis as reported by staff. Identify points in the pathway where improvements could be applied. Results The developed pathway demonstrated great complexity of the current reporting system for medical devices. It identified numerous areas that give rise to problems and multiple biases in decision making. This highlighted the core issues leading to under-reporting and lack of knowledge on device performance and patient risk. Suggestions for improvement were deduced based on end user requirements and identified problems. Conclusions This study has provided a detailed understanding of the key problem areas that exist within the current reporting system for medical devices and technology. The developed pathway sets to address the key problems to improve reporting outcomes. The identification of pathway differences between 'work as done' and 'work as imagined' can lead to development of quality improvements that could be systematically applied.
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Affiliation(s)
| | | | | | | | - George Hanna
- Surgery and Cancer, Imperial College London, London, UK
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Green K, Micocci M, Hicks T, Winter A, Martin JE, Shinkins B, Shaw L, Price C, Davies K, Allen JA. Perceived feasibility, facilitators and barriers to incorporating point-of-care testing for SARS-CoV-2 into emergency medical services by ambulance service staff: a survey-based approach. BMJ Open 2022; 12:e064038. [PMID: 36328389 PMCID: PMC9638752 DOI: 10.1136/bmjopen-2022-064038] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES This body of work aimed to elicit ambulance service staff's perceptions on the barriers and facilitators to adoption, and clinical utility of incorporating rapid SARS-CoV-2 testing during ambulance assessments. DESIGN A mixed-methods survey-based project using a framework analysis method to organise qualitative data. SETTING Emergency and non-emergency care ambulatory services in the UK were approached to take part. PARTICIPANTS Current, practising members of the UK ambulance service (paramedics, technicians, assistants and other staff) were included in this body of work. RESULTS Survey 1: 226 responses were collected between 3 December 2020 and 11 January 2021, 179 (79.2%) of which were completed in full. While the majority of respondents indicated that an ambulance-based testing strategy was feasible in concept (143/190, 75.3%), major barriers to adoption were noted. Many open-ended responses cited concerns regarding misuse of the service by the general public and other healthcare services, timing and conveyance issues, and increased workloads, alongside training and safety concerns. Survey 2: 26 responses were received between 8 February 2021 and 22 February 2021 to this follow-up survey. Survey 2 revealed conveyance decision-making, and risk stratification to be the most frequently prioritised use cases among ambulance service staff. Optimal test characteristics for clinical adoption according to respondents were; accuracy (above 90% sensitivity and specificity), rapidity (<30 min time to results) and ease of sample acquisition. CONCLUSIONS The majority of commercially available lateral flow devices are unlikely to be supported by paramedics as their duty of care requires both rapid and accurate results that can inform clinical decision making in an emergency situation. Further investigation is needed to define acceptable test characteristics and criteria required for ambulance service staff to be confident and supportive of deployment of a SARS-CoV-2 test in an emergency care setting.
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Affiliation(s)
- Kile Green
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Imperial College London, London, UK
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Joanne E Martin
- Centre for Genomics and Child Health, Barts and The London NHS Trust, Blizard Institute, London, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Price
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Kerrie Davies
- Healthcare Associated Infections Research Group, University of Leeds, Leeds, UK
| | - Joy A Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Micocci M, Buckle P, Hayward G, Allen AJ, Davies K, Kierkegaard P, Spilsbury K, Thompson C, Astle A, Heath R, Sharpe C, Akrill C, Lasserson D, Perera R, Body R, Gordon AL. Point of care testing using rapid automated antigen testing for SARS-COV-2 in care homes – an exploratory safety, usability and diagnostic agreement evaluation. Journal of Patient Safety and Risk Management 2021. [DOI: 10.1177/25160435211054207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Successful adoption of POCTs (Point-of-Care tests) for COVID-19 in care homes requires the identification of ideal use cases and a full understanding of the contextual and usability factors that affect test results and minimise biosafety risks. This paper presents a scoping-usability and test performance study of a microfluidic immunofluorescence assay for COVID-19 in care homes. Methods A mixed-methods evaluation was conducted in four UK care homes to scope usability and to assess the agreement with qRT-PCR. A dry run with luminescent dye was conducted to explore biosafety issues. Results The agreement analysis was conducted on 227 asymptomatic participants (159 staff and 68 residents) and 14 symptomatic participants (5 staff and 9 residents). Asymptomatic specimens showed 50% (95% CI:1.3%−98.7%) positive agreement and 96% (95% CI: 92.5%−98.1%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.911 (95% CI: 0.857−0.965). Symptomatic specimens showed 83.3% (95% CI: 35.9%−99.6%) positive agreement and 100% (95% CI: 63.1%−100%) negative agreement with overall prevalence and bias-adjusted Kappa (PABAK) of 0.857 (95% CI: 0.549−1). The dry run highlighted four main sources of contamination that led to the modification of the standard operating procedures. Simulation post-modification showed no further evidence of contamination. Conclusion Careful consideration of biosafety issues and contextual factors associated with care home are mandatory for safe use the POCT. Whilst POCT may have some utility for ruling out COVID-19, further diagnostic accuracy evaluations are needed to promote effective adoption.
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Affiliation(s)
- Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gail Hayward
- NIHR Community Healthcare Medtech and IVD cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxford, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Kerrie Davies
- Healthcare Associated Infections Research Group, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Leeds In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London, UK
- CRUK Convergence Science Centre, Institute for Cancer Research & Imperial College London, London, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, Bradford, UK
| | - Carl Thompson
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration Yorkshire and Humber, Bradford, Bradford, UK
| | | | - Ros Heath
- Landermeads Nursing Home, Nottingham, UK
| | | | - Cyd Akrill
- Formerly at Springfield Healthcare, Leeds, UK
| | - Dan Lasserson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Body
- Division of Cardiovascular Science, The University of Manchester, Manchester, UK
- Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Adam L Gordon
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands, Nottingham, UK
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Tulloch JSP, Micocci M, Buckle P, Lawrenson K, Kierkegaard P, McLister A, Gordon AL, García-Fiñana M, Peddie S, Ashton M, Buchan I, Parvulescu P. Enhanced lateral flow testing strategies in care homes are associated with poor adherence and were insufficient to prevent COVID-19 outbreaks: results from a mixed methods implementation study. Age Ageing 2021; 50:1868-1875. [PMID: 34272866 PMCID: PMC8406873 DOI: 10.1093/ageing/afab162] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Care homes have been severely affected by the SARS-CoV-2 pandemic. Rapid antigen testing could identify most SARS-CoV-2 infected staff and visitors before they enter homes. We explored implementation of staff and visitor testing protocols using lateral flow devices (LFDs). Methods An evaluation of a SARS-CoV-2 LFD-based testing protocol in 11 care homes in Liverpool, UK, including staff and visitor testing, plus a qualitative exploratory study in nine of these homes. The proportion of pilot homes with outbreaks, and outbreak size, were compared to non-pilot homes in Liverpool. Adherence to testing protocols was evaluated. Fifteen staff were interviewed, and transcript data were thematically coded using an iterative analysis to identify and categorize factors influencing testing implementation. Results In total, 1,638 LFD rapid tests were performed on 407 staff. Protocol adherence was poor with 8.6% of staff achieving >75% protocol adherence, and 25.3% achieving \documentclass[12pt]{minimal}
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}{}$\ge$\end{document}50%. Six care homes had outbreaks during the study. Compared to non-pilot care homes, there was no evidence of significant difference in the proportion of homes with outbreaks, or the size of outbreaks. Qualitative data showed difficulty implementing testing strategies due to excessive work burden. Factors influencing adherence related to test integration and procedural factors, socio-economic factors, cognitive overload and the emotional value of testing. Conclusion Implementation of staff and visitor care home LFD testing protocols was poorly adhered to and consequently did not reduce the number or scale of COVID-19 outbreaks. More focus is needed on the contextual and behavioural factors that influence protocol adherence.
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Affiliation(s)
- John S P Tulloch
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool CH64 7TE, UK
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London W2 1NY, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London W2 1NY, UK
| | - Karen Lawrenson
- Public Health Department, Liverpool City Council, Liverpool L3 1DS, UK
| | - Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London W2 1NY, UK
- CRUK Convergence Science Centre, Institute for Cancer Research & Imperial College London, London SW7 2AZ, UK
| | - Anna McLister
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, London W2 1NY, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | | | - Steve Peddie
- Adults Social Care Department, Liverpool City Council, Liverpool L3 1DS, UK
| | - Matthew Ashton
- Public Health Department, Liverpool City Council, Liverpool L3 1DS, UK
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Paula Parvulescu
- Public Health Department, Liverpool City Council, Liverpool L3 1DS, UK
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Kierkegaard P, Micocci M, McLister A, Tulloch JSP, Parvulescu P, Gordon AL, Buckle P. Implementing lateral flow devices in long-term care facilities: experiences from the Liverpool COVID-19 community testing pilot in care homes- a qualitative study. BMC Health Serv Res 2021; 21:1153. [PMID: 34696803 PMCID: PMC8544628 DOI: 10.1186/s12913-021-07191-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction Antigen-based lateral flow devices (LFDs) offer the potential of widespread rapid testing. The scientific literature has primarily focused on mathematical modelling of their use and test performance characteristics. For these tests to be implemented successfully, an understanding of the real-world contextual factors that allow them to be integrated into the workplace is vital. To address this gap in knowledge, we aimed to explore staff’s experiences of integrating LFDs into routine practice for visitors and staff testing with a view to understand implementation facilitators and barriers. Methods Semi-structured interviews and thematic analysis. Results We identified two main themes and five subthemes. The main themes included: visitor-related testing factors and staff-related testing factors. Subthemes included: restoring a sense of normality, visitor-related testing challenges, staff-related testing challenges, and pre-pilot antecedent factors. Conclusion Our study demonstrates that the real-world implementation of LFDs to test visitors and staff faces significant challenges as a result of several contextual factors negatively affecting the work practice and environment. More comprehensive studies are needed to identify and inform effective implementation strategies to ensure that LFDs can be adopted in an agile way that better supports an already exhausted and morally depleted workforce.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK. .,CRUK Convergence Science Centre, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Anna McLister
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - John S P Tulloch
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Paula Parvulescu
- Public Health Department, Liverpool City Council, Liverpool, Cunard Building, Water Street, Liverpool, L3 1DS, UK
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK.,NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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Buckle P, Micocci M, Tulloch J, Kierkegaard P, Parvulescu P, Thompson C, Spilsbury K, Allen AJ, Body R, Hayward G, Buchan I, Gordon AL. COVID-19 point-of-care testing in care homes: what are the lessons for policy and practice? Age Ageing 2021; 50:1442-1444. [PMID: 33984137 PMCID: PMC8194678 DOI: 10.1093/ageing/afab101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
COVID-19 has devastated care homes. Point-of-care tests (POCTs), mainly using lateral flow devices (LFDs), have been deployed hurriedly without much consideration of their usability or impact on care workflow. Even after the pandemic, POCTs, particularly multiplex tests, may be an important control against spread of SARS-CoV-2 and other respiratory infections in care homes by enabling identification of cases. They should not, however, replace other infection control measures such as barrier methods and quarantine. Adherence to LFDs as implemented among care home staff is suboptimal. Other tests-such as point-of-care polymerase chain reaction and automated antigen tests-would also need to be accommodated into care home workflows to improve adherence. The up-front costs of POCTs are straightforward but additional costs, including staffing preparation and reporting processes and the impacts of false positive and negative tests on absence rates and infection days, are more complex and as yet unquantified. A detailed appraisal is needed as the future of testing in care homes is considered.
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Affiliation(s)
- Peter Buckle
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College London, London, UK
| | - Massimo Micocci
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College London, London, UK
| | - John Tulloch
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Patrick Kierkegaard
- NIHR London In-Vitro Diagnostics Cooperative, Imperial College London, London, UK
| | - Paula Parvulescu
- Department of Public Health, Liverpool City Council, Liverpool, UK
| | - Carl Thompson
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration–Yorkshire and Humber (YHARC), Leeds, UK
| | - Karen Spilsbury
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration–Yorkshire and Humber (YHARC), Leeds, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Body
- Division of Cardiovascular Science, The University of Manchester, Manchester, UK
- Emergency Department, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Iain Buchan
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK
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Micocci M, Gordon AL, Seo MK, Allen AJ, Davies K, Lasserson D, Thompson C, Spilsbury K, Akrill C, Heath R, Astle A, Sharpe C, Perera R, Hayward G, Buckle P. Is point-of-care testing feasible and safe in care homes in England? An exploratory usability and accuracy evaluation of a point-of-care polymerase chain reaction test for SARS-CoV-2. Age Ageing 2021; 50:1464-1472. [PMID: 33884411 PMCID: PMC8083194 DOI: 10.1093/ageing/afab072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction Reliable rapid testing for COVID-19 is needed in care homes to reduce the risk of outbreaks and enable timely care. This study aimed to examine the usability and test performance of a point of care polymerase chain reaction (PCR) test for detection of SARS-CoV-2 (POCKITTM Central) in care homes. Methods POCKITTM Central was evaluated in a purposeful sample of four UK care homes. Test agreement with laboratory real-time PCR and usability and used errors were assessed. Results No significant usability-related hazards emerged, and the sources of error identified were found to be amendable with minor changes in training or test workflow. POCKITTM Central has acceptable sensitivity and specificity based on RT-PCR as the reference standard, especially for symptomatic cases. Asymptomatic specimens showed 83.3% (95% confidence interval (CI): 35.9–99.6%) positive agreement and 98.7% negative agreement (95% CI: 96.2–99.7%), with overall prevalence and bias-adjusted kappa (PABAK) of 0.965 (95% CI: 0.932– 0.999). Symptomatic specimens showed 100% (95% CI: 2.5–100%) positive agreement and 100% negative agreement (95% CI: 85.8–100%), with overall PABAK of 1. Recommendations are provided to mitigate the frequency of occurrence of the residual use errors observed. Integration pathways were discussed to identify opportunities and limitations of adopting POCKIT™ Central for screening and diagnostic testing purposes. Conclusions Point-of-care PCR testing in care homes can be considered with appropriate preparatory steps and safeguards. Further diagnostic accuracy evaluations and in-service evaluation studies should be conducted, if the test is to be implemented more widely, to build greater certainty on this initial exploratory analysis.
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Affiliation(s)
| | - Adam L Gordon
- Address correspondence to: Adam Gordon, Room 4113, Derby Medical School, Royal Derby Hospital. Derby DE22 3NE, UK. Tel: 01332 724668; Fax: 01332 724697.
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Micocci M, Borsci S, Thakerar V, Walne S, Manshadi Y, Edridge F, Mullarkey D, Buckle P, Hanna GB. Attitudes towards Trusting Artificial Intelligence Insights and Factors to Prevent the Passive Adherence of GPs: A Pilot Study. J Clin Med 2021; 10:jcm10143101. [PMID: 34300267 PMCID: PMC8303875 DOI: 10.3390/jcm10143101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/21/2021] [Accepted: 07/09/2021] [Indexed: 01/18/2023] Open
Abstract
Artificial Intelligence (AI) systems could improve system efficiency by supporting clinicians in making appropriate referrals. However, they are imperfect by nature and misdiagnoses, if not correctly identified, can have consequences for patient care. In this paper, findings from an online survey are presented to understand the aptitude of GPs (n = 50) in appropriately trusting or not trusting the output of a fictitious AI-based decision support tool when assessing skin lesions, and to identify which individual characteristics could make GPs less prone to adhere to erroneous diagnostics results. The findings suggest that, when the AI was correct, the GPs’ ability to correctly diagnose a skin lesion significantly improved after receiving correct AI information, from 73.6% to 86.8% (X2 (1, N = 50) = 21.787, p < 0.001), with significant effects for both the benign (X2 (1, N = 50) = 21, p < 0.001) and malignant cases (X2 (1, N = 50) = 4.654, p = 0.031). However, when the AI provided erroneous information, only 10% of the GPs were able to correctly disagree with the indication of the AI in terms of diagnosis (d-AIW M: 0.12, SD: 0.37), and only 14% of participants were able to correctly decide the management plan despite the AI insights (d-AIW M:0.12, SD: 0.32). The analysis of the difference between groups in terms of individual characteristics suggested that GPs with domain knowledge in dermatology were better at rejecting the wrong insights from AI.
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Affiliation(s)
- Massimo Micocci
- NIHR London In-Vitro Diagnostics Cooperative, London W2 1PE, UK; (S.B.); (S.W.); (P.B.); (G.B.H.)
- Department of Surgery and Cancer, Imperial College London, London W2 1PE, UK
- Correspondence: ; Tel.: +44-(0)20-3312-6532
| | - Simone Borsci
- NIHR London In-Vitro Diagnostics Cooperative, London W2 1PE, UK; (S.B.); (S.W.); (P.B.); (G.B.H.)
- Department of Surgery and Cancer, Imperial College London, London W2 1PE, UK
- Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, 7522 NB Enschede, The Netherlands
| | - Viral Thakerar
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK;
| | - Simon Walne
- NIHR London In-Vitro Diagnostics Cooperative, London W2 1PE, UK; (S.B.); (S.W.); (P.B.); (G.B.H.)
- Department of Surgery and Cancer, Imperial College London, London W2 1PE, UK
| | - Yasmine Manshadi
- Skin Analytics Limited, London EC2A 4PS, UK; (Y.M.); (F.E.); (D.M.)
| | - Finlay Edridge
- Skin Analytics Limited, London EC2A 4PS, UK; (Y.M.); (F.E.); (D.M.)
| | - Daniel Mullarkey
- Skin Analytics Limited, London EC2A 4PS, UK; (Y.M.); (F.E.); (D.M.)
| | - Peter Buckle
- NIHR London In-Vitro Diagnostics Cooperative, London W2 1PE, UK; (S.B.); (S.W.); (P.B.); (G.B.H.)
- Department of Surgery and Cancer, Imperial College London, London W2 1PE, UK
| | - George B. Hanna
- NIHR London In-Vitro Diagnostics Cooperative, London W2 1PE, UK; (S.B.); (S.W.); (P.B.); (G.B.H.)
- Department of Surgery and Cancer, Imperial College London, London W2 1PE, UK
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Micocci M, Gordon AL, Allen AJ, Hicks T, Kierkegaard P, McLister A, Walne S, Hayward G, Buckle P. COVID-19 testing in English care homes and implications for staff and residents. Age Ageing 2021; 50:668-672. [PMID: 33481986 PMCID: PMC7929459 DOI: 10.1093/ageing/afab015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Care home residents are at high risk of dying from coronavirus disease 2019 (COVID-19). Regular testing, producing rapid and reliable results is important in this population because infections spread quickly, and presentations are often atypical or asymptomatic. This study evaluated current testing pathways in care homes to explore the role of point-of-care tests (POCTs). METHODS A total of 10 staff from eight care homes, purposively sampled to reflect care organisational attributes that influence outbreak severity, underwent a semi-structured remote videoconference interview. Transcripts were analysed using process mapping tools and framework analysis focussing on perceptions about, gaps within and needs arising from current pathways. RESULTS Four main steps were identified in testing: infection prevention, preparatory steps, swabbing procedure and management of residents. Infection prevention was particularly challenging for mobile residents with cognitive impairment. Swabbing and preparatory steps were resource-intensive, requiring additional staff resource. Swabbing required flexibility and staff who were familiar to the resident. Frequent approaches to residents were needed to ensure they would participate at a suitable time. After-test management varied between sites. Several homes reported deviating from government guidance to take more cautious approaches, which they perceived to be more robust. CONCLUSION Swab-based testing is organisationally complex and resource-intensive in care homes. It needs to be flexible to meet the needs of residents and provide care homes with rapid information to support care decisions. POCT could help address gaps but the complexity of the setting means that each technology must be evaluated in context before widespread adoption in care homes.
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Affiliation(s)
- Massimo Micocci
- Address correspondence to: Massimo Micocci, Department of Surgery and Cancer, 10th Floor, Room 1064, QEQM Building, St Mary’s Campus, Praed Street, London W2 1PE, UK. Tel: +44 (0)20 3312 6532;
| | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, UK
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - Anna McLister
- NIHR London In Vitro Diagnostics Co-operative, London, UK
| | - Simon Walne
- NIHR London In Vitro Diagnostics Co-operative, London, UK
| | - Gail Hayward
- NIHR Community Healthcare MedTech and IVD CO-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, London, UK
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10
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Graziadio S, Urwin SG, Cocco P, Micocci M, Winter A, Yang Y, Price DA, Messenger M, Allen AJ, Shinkins B. Unmet clinical needs for COVID-19 tests in UK health and social care settings. PLoS One 2020; 15:e0242125. [PMID: 33180807 PMCID: PMC7660574 DOI: 10.1371/journal.pone.0242125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/27/2020] [Indexed: 12/30/2022] Open
Abstract
There is an urgent requirement to identify which clinical settings are in most need of COVID-19 tests and the priority role(s) for tests in these settings to accelerate the development of tests fit for purpose in health and social care across the UK. This study sought to identify and prioritize unmet clinical needs for COVID-19 tests across different settings within the UK health and social care sector via an online survey of health and social care professionals and policymakers. Four hundred and forty-seven responses were received between 22nd May and 15th June 2020. Hospitals and care homes were recognized as the settings with the greatest unmet clinical need for COVID-19 diagnostics, despite reporting more access to laboratory molecular testing than other settings. Hospital staff identified a need for diagnostic tests for symptomatic workers and patients. In contrast, care home staff expressed an urgency for screening at the front door to protect high-risk residents and limit transmission. The length of time to test result was considered a widespread problem with current testing across all settings. Rapid tests for staff were regarded as an area of need across general practice and dental settings alongside tests to limit antibiotics use.
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Affiliation(s)
- Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle-upon-Tyne Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Samuel G. Urwin
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle-upon-Tyne Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Paola Cocco
- NIHR Leeds In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Massimo Micocci
- NIHR London In Vitro Diagnostics Co-operative, Imperial College London, London, United Kingdom
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle-upon-Tyne Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Yaling Yang
- NIHR Community Healthcare MedTech and In Vitro Diagnostics Co-operative Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - D. Ashley Price
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle-upon-Tyne Hospitals Foundation Trust, Newcastle, United Kingdom
| | - Mike Messenger
- NIHR Leeds In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Centre for Personalised Health and Medicine, University of Leeds, Leeds, United Kingdom
| | - A. Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, United Kingdom
| | - Bethany Shinkins
- NIHR Leeds In Vitro Diagnostics Co-operative, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Test Evaluation Group, Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
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11
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Cirilli R, Costi R, Di SR, Ferretti R, La TF, Angiolella L, Micocci M. Analytical and semipreparative enantiomeric separation of azole antifungal agents by high-performance liquid chromatography on polysaccharide-based chiral stationary phases. Application to in vitro biological studies. J Chromatogr A 2002; 942:107-14. [PMID: 11822375 DOI: 10.1016/s0021-9673(01)01401-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [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: 11/22/2022]
Abstract
High-performance liquid chromatography (HPLC) was used for the enantiomeric separation of chiral imidazole derivatives endowed with antimycotic activity. Enantioselective columns, containing carbamates of cellulose and amylose, were used. The influence of the nature and content of an alcoholic modifier in the mobile phase was studied. The isolated enantiomers, separated on semipreparative columns, were submitted to in vitro biological investigations.
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Affiliation(s)
- R Cirilli
- Istituto Superiore di Sanità, Laboratorio di Chimica del Farmaco, Rome, Italy
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