ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Point-of-care testing of cardiac markers has been widely introduced into clinical practice. In this study, the authors examined the analytic qualities and the feasibility of a point-of-care device—the Stratus CS STAT Fluorometric Analyzer—under clinical conditions. Measurements of myoglobin, creatine kinase–MB (CK-MB), and troponin I (TnI) were performed in 197 consecutive patients admitted to the coronary care unit because of chest pain suggestive of a myocardial infarction. Additionally, all cardiac markers were determined on the AxSYM analyzer used as a comparative device. The Stratus CS demonstrated an average analytic imprecision (or coefficient of variation [CV]) of 4.0 to 5.1% for the TnI assay, 2.9 to 5.5% for CK-MB, and 3.7 to 4.7% for myoglobin. This was superior to CVs of AxSYM measurements, in particular concerning the lower range of TnI concentrations. The method comparison showed 17 to 22% lower Stratus CS myoglobin results and 24 to 29% lower Stratus CS CK-MB results. For TnI, Stratus CS results were factor 5 or factor 10 lower compared with AxSYM measurements and showed a great dispersion of values as a result of the higher CV of the AxSYM TnI assay. The diagnostic sensitivities and specificities of all 3 markers correlated well on both test systems. In conclusion, the Stratus CS showed an overall good performance, with analytic qualities and clinical performance as least as good as those of the AxSYM analyzer.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Successful utilization of point-of-care testing (POCT) requires correlation between POCT and core laboratory values. Validation studies, including assessment of linearity and bias, precision, stability, and effectiveness as a blind check sample, establish this relationship. Traditionally, human blood has been used as the substrate for validation and proficiency materials. However, acquisition of human blood has become problematic because of increased costs of blood products and the need for institutional approval. In this study, the authors hypothesized that animal blood may provide a suitable alternative for POCT validation. They performed linearity studies on Accu-Chek Advantage glucose meters (Roche Diagnostics, Indianapolis, IN) and HemoCue B-Hemoglobin analyzers (HemoCue Inc., Lake Forest, CA) using bovine, horse, sheep, and swine blood. Using animal blood, the instruments demonstrated a linear response with close correlation to human blood. Precision calculations (human blood, n = 20; animal blood, n = 14) for HemoCue results yielded coefficients of variation between 0.5% and 2.6%. Glucose values (human blood, n = 17–20; animal blood, n = 15–20) had coefficients of variation between 2.5% and 3.9%. Using human and animal blood, blind check samples with concentrations of approximately 50 mg/dL and 175 mg/dL showed from −3.0 to 4.0 mg/dL bias for the low sample and −5.1 to 0.6% bias for the high sample between hospital unit and laboratory reference meters. Examination of hemolysis with repeated washes showed that bovine blood was the most stable of the animal blood, correlating with human blood values. Based on stability and handing characteristics, bovine blood seems to be ideally suited for POCT validation studies.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The Faculty of Medicine, Chulalongkorn University, Bangkok, sponsored a symposium on point-of-care testing (POCT). Four papers from the symposium describe the status of POCT in a university hospital, critical care, a private hospital, and networked primary care units in Thailand. The authors introduce relevant demographic trends and health economics in Thailand and Southeast Asia, and emphasize the need for collaborative teamwork in arriving at acceptable strategies to fulfill societal, economic, and medical goals. Currently, projections reveal increasing populations of skilled workers (the “demographic dividend”), who will require health care support for maximum productivity, and of elderly, whose ranks will double during the next 2 decades, thereby creating a burden on medical services. The authors recommend quickly and efficiently addressing these challenges, in part through the cost-effective and selective implementation of POCT.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Rapid test reporting is expected by physicians, especially those who work in critical care areas, for precise decision making during patient treatment. To achieve this objective, electronic data connectivity is useful to implement along with point-of-care testing (POCT). The authors surveyed staff opinion about POCT and studied rapid response POCT at Siriraj Hospital. This report focuses on 4 aspects: the role of the core laboratory, the usefulness of POCT, connectivity of the electronic network, and quality control. The authors observed that critical patient management was more efficient when diagnostic testing was completed promptly. An alternative to the consolidated core laboratory model for critical care units is POCT service. At the authors' multibuilding, multicenter university hospital, urgent tests ordered most frequently should be performed as close to the patient site as possible, because transportation and labeling of specimens generally are costly and time-consuming components of the laboratory process. The staff found it convenient to obtain laboratory results from the core laboratory. However, the authors think that POCT services in Thailand could satisfy physicians who simultaneously must make rapid decisions, reduce costs, and improve patient outcomes. Further study should be continued and results shared to benefit Thai health care systems.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

After the economic crisis in 1997, the Thai government introduced a new policy for health care promotion and prevention called the30-Baht policy.This policy opened up new dimensions for health care management. Health services in rural areas, which represent a large portion of Thailand, have been reorganized to implement this new concept of primary health care networks. Large downtown hospitals in major cities are designated as centers of the networks for satellite units called primary care units (PCUs). Central hospitals subsidize fiscal budgets of the satellite PCUs. To emphasize social needs for PCUs under the 30-Baht program and to implement point-of-care testing in PCU diagnostic services, a model of the PCU laboratory service in Nakornrajsima was studied and analyzed. The authors focus on four issues: evaluation of the precision and accuracy of the Reflotron Plus analyzer (the laboratory instrument chosen for use in the PCU), PCU testing performance and personnel, PCU service performance and patient characteristics, and the diagnostic testing costs in the context of the PCU network. The authors demonstrated acceptable accuracy and precision of instruments. The point-of-care testing approach was accepted well by most personnel working in PCUs and by patients. Diagnostic testing costs at PCU sites were lower than those incurred when the central laboratory was used. Further study is needed using unit costs to obtain data that will help in management decisions and in the reduction of overall health delivery expenses in the future.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

To promote appropriate point-of-care testing (POCT) in private Thai hospitals, the authors evaluated a model of POCT operations in Phyathai Two Hospital, a medium-size private hospital with a 350-bed capacity and approximately 1500 outpatient visits per day. They started POCT for blood glucose testing in all clinical areas including critical care. They then added blood gas analysis and activated clotting time in the cardiac care unit and operating room. They also provided hematocrit in the intensive care unit. All POCT instruments were registered and tested for precision and accuracy before implementation. They provided all the sites with a standard operating procedure, together with the reporting and billing system, written quality control manual, personnel training, and maintenance scheduling. Laboratory coordinators were arranged to visit every POCT site periodically and as needed. The authors found that their POCT model was easy to manage and beneficial in providing rapid, precise, and accurate test results for therapeutic decisions. However, POCT needed a well-organized team and required the cooperation of doctors, nurses, and laboratory personnel. Laboratory personnel have to provide training for nurses and visit POCT sites periodically for daily quality control and maintenance. The authors suggest that doctors request POCT only when medically necessary. Nurses are required to perform tests and report the results to doctors. In addition, the authors established the need for a POCT committee composed of doctors, nurses, laboratory personnel, and an executive administrator. Furthermore, medical and economic efficiency should be studied.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

A principal goal of point-of-care testing (POCT) is to speed clinician decision making for medically and economically efficacious treatment. To establish appropriate future plans and goals, a needs assessment survey was designed using a questionnaire and interviews. This study demonstrates the ongoing need for continuous improvements in quality control, standardization and harmonization, integrated informatics, instrument maintenance, POC training, and billing systems. The authors propose a new management team—the laboratory service committee. The hospital deputy director of development and planning chairs the team, which provides leadership for participating laboratories and stakeholders. The 30-Baht health care policy initiated by the Thai government for the whole country within the last 2 years forces the health care system to become more efficient. To achieve POCT objectives consistent with this policy, the organization's structure and its administration should be revised. The authors recommend that additional career clinical pathologists and laboratory personnel develop specialty emphasis on POCT. In summary, POCT in Thailand is progressing toward international practice standards for this new field.

ISSN:1533-029X    

出版商:OVID    

年代:2003

数据来源: OVID