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3.
Clin Pediatr (Phila) ; 61(1): 34-41, 2022 01.
Article in English | MEDLINE | ID: covidwho-1505941

ABSTRACT

In Italy, during the second epidemic wave of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapid antigenic (Ag) test at point-of-care (POCT) station were employed to quickly evaluate large numbers of swabs. We collected data of all children who underwent the Ag test in our hospital. All positive patients were recalled to perform reverse transcription polymerase chain reaction. A total of 2133 tests were collected over 1 month. Clinical data of 1941 children (median age = 3.7 years) were analyzed: 1343 (69.2%) patients complained of symptoms, 594 (30.6%) had a history of close contact with SARS-CoV-2-positive individuals. Among symptoms reported, acute rhinitis was the most frequent (67.9%), followed by cough (42.6%) and fever (31.5%). Among all tests, 95.8% resulted negative, 4.2% positive: 37/89 were confirmed. In confirmed cases, fever (56.2% vs 32.2%; P = .041) and gastrointestinal symptoms (18.8% vs 6.25%; P = .041) were significantly more frequent compared with negative children. The use of POCT for Ag test seems appropriate for SARS-CoV-2 screening in the pediatric population. In children, fever and gastrointestinal symptoms may constitute red flags of SARS-CoV-2.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , Point-of-Care Systems/standards , Adolescent , COVID-19/epidemiology , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Child , Child, Preschool , Female , Humans , Italy/epidemiology , Male , Pediatrics/methods , Point-of-Care Systems/statistics & numerical data , Young Adult
4.
PLoS One ; 16(9): e0257560, 2021.
Article in English | MEDLINE | ID: covidwho-1430541

ABSTRACT

Certain clinical indications and treatments such as the use of rasburicase in cancer therapy and 8-aminoquinolines for Plasmodium vivax malaria treatment would benefit from a point-of-care test for glucose-6-phosphate dehydrogenase (G6PD) deficiency. Three studies were conducted to evaluate the performance of one such test: the STANDARD™ G6PD Test (SD BIOSENSOR, South Korea). First, biological interference on the test performance was evaluated in specimens with common blood disorders, including high white blood cell (WBC) counts. Second, the test precision on fingerstick specimens was evaluated against five individuals of each, deficient, intermediate, and normal G6PD activity status. Third, clinical performance of the test was evaluated at three point-of-care settings in the United States. The test performed equivalently to the reference assay in specimens with common blood disorders. High WBC count blood samples resulted in overestimation of G6PD activity in both the reference assay and the STANDARD G6PD Test. The STANDARD G6PD Test showed good precision on multiple fingerstick specimens from the same individual. The same G6PD threshold values (U/g Hb) were applied for a semiquantitative interpretation for fingerstick- and venous-derived results. The sensitivity/specificity values (95% confidence intervals) for the test for G6PD deficiency were 100 (92.3-100.0)/97 (95.2-98.2) and 100 (95.7-100.0)/97.4 (95.7-98.5) for venous and capillary specimens, respectively. The same values for females with intermediate (> 30% to ≤ 70%) G6PD activity were 94.1 (71.3-99.9)/88.2 (83.9-91.7) and 82.4 (56.6-96.2)/87.6(83.3-91.2) for venous and capillary specimens, respectively. The STANDARD G6PD Test enables point-of-care testing for G6PD deficiency.


Subject(s)
Glucosephosphate Dehydrogenase Deficiency/diagnosis , Glucosephosphate Dehydrogenase/blood , Point-of-Care Systems/standards , Adolescent , Adult , Aged , Blood Specimen Collection , Child , Child, Preschool , Female , Glucosephosphate Dehydrogenase/genetics , Glucosephosphate Dehydrogenase/standards , Glucosephosphate Dehydrogenase Deficiency/complications , Hematologic Diseases/complications , Hemoglobins/analysis , Humans , Leukocyte Count , Male , Middle Aged , Reagent Kits, Diagnostic , Reference Standards , Sensitivity and Specificity , Young Adult
6.
Bioanalysis ; 13(15): 1213-1223, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1320608

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of COVID-19. Testing for SARS-CoV-2 infection is a critical element of the public health response to COVID-19. Point-of-care (POC) tests can drive patient management decisions for infectious diseases, including COVID-19. POC tests are available for the diagnosis of SARS-CoV-2 infections and include those that detect SARS-CoV-2 antigens as well as amplified RNA sequences. We provide a review of SARS-CoV-2 POC tests including their performance, settings for which they might be used, their impact and future directions. Further optimization and validation, new technologies as well as studies to determine clinical and epidemiological impact of SARS-CoV-2 POC tests are needed.


Subject(s)
COVID-19/diagnosis , Point-of-Care Systems/standards , SARS-CoV-2/pathogenicity , COVID-19/pathology , Humans
7.
Arch Pathol Lab Med ; 145(2): 145-167, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1207907

ABSTRACT

CONTEXT.­: Point-of-care testing (POCT) is inherently spatial, that is, performed where needed, and intrinsically temporal, because it accelerates decision-making. POCT efficiency and effectiveness have the potential to facilitate antimicrobial resistance (AMR) detection, decrease risks of coinfections for critically ill patients with coronavirus infectious disease 2019 (COVID-19), and improve the cost-effectiveness of health care. OBJECTIVES.­: To assess AMR identification by using POCT, describe the United States AMR Diagnostic Challenge, and improve global standards of care for infectious diseases. DATA SOURCES.­: PubMed, World Wide Web, and other sources were searched for papers focusing on AMR and POCT. EndNote X9.1 (Clarivate Analytics) consolidated abstracts, URLs, and PDFs representing approximately 500 articles were assessed for relevance. Panelist insights at Tri•Con 2020 in San Francisco and finalist POC technologies competing for a US $20,000,000 AMR prize are summarized. CONCLUSIONS.­: Coinfections represent high risks for COVID-19 patients. POCT potentially will help target specific pathogens, refine choices for antimicrobial drugs, and prevent excess morbidity and mortality. POC assays that identify patterns of pathogen resistance can help tell us how infected individuals spread AMR, where geospatial hotspots are located, when delays cause death, and how to deploy preventative resources. Shared AMR data "clouds" could help reduce critical care burden during pandemics and optimize therapeutic options, similar to use of antibiograms in individual hospitals. Multidisciplinary health care personnel should learn the principles and practice of POCT, so they can meet needs with rapid diagnostic testing. The stakes are high. Antimicrobial resistance is projected to cause millions of deaths annually and cumulative financial loses in the trillions by 2050.


Subject(s)
COVID-19/microbiology , Coinfection/microbiology , Drug Resistance, Bacterial , Drug Resistance, Fungal , Microbial Sensitivity Tests/methods , Point-of-Care Systems , Awards and Prizes , Bacterial Infections/diagnosis , Bacterial Infections/microbiology , COVID-19/diagnosis , COVID-19/mortality , Coinfection/diagnosis , Humans , Microbial Sensitivity Tests/standards , Mycoses/diagnosis , Mycoses/microbiology , Point-of-Care Systems/standards , Spatial Analysis , United States/epidemiology
8.
Arch Pathol Lab Med ; 145(7): 797-813, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1121212

ABSTRACT

CONTEXT.­: Coronavirus disease 2019 (COVID-19) test performance depends on predictive values in settings of increasing disease prevalence. Geospatially distributed diagnostics with minimal uncertainty facilitate efficient point-of-need strategies. OBJECTIVES.­: To use original mathematics to interpret COVID-19 test metrics; assess US Food and Drug Administration Emergency Use Authorizations and Health Canada targets; compare predictive values for multiplex, antigen, polymerase chain reaction kit, point-of-care antibody, and home tests; enhance test performance; and improve decision-making. DESIGN.­: PubMed/newsprint-generated articles documenting prevalence. Mathematica and open access software helped perform recursive calculations, graph multivariate relationships, and visualize performance by comparing predictive value geometric mean-squared patterns. RESULTS.­: Tiered sensitivity/specificity comprised: T1, 90%, 95%; T2, 95%, 97.5%; and T3, 100%, ≥99%. Tier 1 false negatives exceeded true negatives at >90.5% prevalence; false positives exceeded true positives at <5.3% prevalence. High-sensitivity/specificity tests reduced false negatives and false positives, yielding superior predictive values. Recursive testing improved predictive values. Visual logistics facilitated test comparisons. Antigen test quality fell off as prevalence increased. Multiplex severe acute respiratory syndrome (SARS)-CoV-2)*influenza A/B*respiratory syncytial virus testing performed reasonably well compared with tier 3. Tier 3 performance with a tier 2 confidence band lower limit will generate excellent performance and reliability. CONCLUSIONS.­: The overriding principle is to select the best combined performance and reliability pattern for the prevalence bracket. Some public health professionals recommend repetitive testing to compensate for low sensitivity. More logically, improved COVID-19 assays with less uncertainty conserve resources. Multiplex differentiation of COVID-19 from influenza A/B-respiratory syncytial virus represents an effective strategy if seasonal flu surges next year.


Subject(s)
COVID-19 Testing/standards , COVID-19/diagnosis , Point-of-Care Systems/standards , Uncertainty , COVID-19/epidemiology , COVID-19 Testing/methods , Canada/epidemiology , False Negative Reactions , False Positive Reactions , Humans , Predictive Value of Tests , Prevalence , Reproducibility of Results , Sensitivity and Specificity , United States/epidemiology
9.
Crit Care ; 24(1): 702, 2020 12 24.
Article in English | MEDLINE | ID: covidwho-992527

ABSTRACT

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.


Subject(s)
COVID-19/diagnostic imaging , Consensus , Echocardiography/standards , Expert Testimony/standards , Internationality , Point-of-Care Systems/standards , COVID-19/therapy , Echocardiography/methods , Expert Testimony/methods , Humans , Lung/diagnostic imaging , Thromboembolism/diagnostic imaging , Thromboembolism/therapy , Triage/methods , Triage/standards , Ultrasonography/standards
10.
J Transl Med ; 18(1): 488, 2020 12 21.
Article in English | MEDLINE | ID: covidwho-992499

ABSTRACT

BACKGROUND: The easy access to a quick diagnosis of coronavirus disease 2019 (COVID-19) is a key point to improve the management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to contain its spread. Up to now, laboratory real-time PCR is the standard of care, but requires a fully equipped laboratory and significant infrastructure. Consequently, new diagnostic tools are required. METHODS: In the present work, the diagnostic accuracy of the point-of-care rapid test "bKIT Virus Finder COVID-19" (Hyris Ltd) is evaluated by a retrospective and a prospective analysis on SARS CoV-2 samples previously assessed with an FDA "authorized for the emergency use-EUA" reference method. Descriptive statistics were used for the present study. RESULTS: Results obtained with the Hyris Kit are the same as that of standard laboratory-based real time PCR methods for all the analyzed samples. In addition, the Hyris Kit provides the test results in less than 2 h, a significantly shorter time compared to the reference methods, without the need of a fully equipped laboratory. CONCLUSIONS: To conclude, the Hyris kit represents a promising tool to improve the health surveillance and to increase the capacity of SARS-CoV-2 testing.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/diagnosis , Point-of-Care Systems , COVID-19/epidemiology , COVID-19/virology , COVID-19 Nucleic Acid Testing/standards , COVID-19 Nucleic Acid Testing/statistics & numerical data , Early Diagnosis , Humans , Italy/epidemiology , Limit of Detection , Pandemics , Point-of-Care Systems/standards , Point-of-Care Systems/statistics & numerical data , Prospective Studies , Reference Standards , Retrospective Studies , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Sensitivity and Specificity
11.
Ann Clin Lab Sci ; 50(6): 852-854, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-984501

ABSTRACT

Due to the COVID-19 pandemic, the Food and Drug Administration issued an Emergency Use Authorization to permit developers of certain serological tests to market their product prior to a comprehensive review. Nonetheless, the reliability of these assays is of great importance in order to be useful as a tool in estimating the relative proportions of different populations that have been exposed to SARS-CoV-2. We provide a sampling of 145 individuals from an ambulatory setting simultaneously tested with a qualitative point of care rapid finger prick Lateral Wave® IgM and IgG assay and a sample for the Mayo Clinic enzyme linked immunosorbent assay (ELISA) IgM/IgG antibody assay. Significant discrepancies did exist between the purported antibody responses as demonstrated by each assay.


Subject(s)
Antibodies, Viral/blood , COVID-19/diagnosis , Enzyme-Linked Immunosorbent Assay/methods , Immunoglobulin G/blood , Immunoglobulin M/blood , Point-of-Care Systems/standards , SARS-CoV-2/isolation & purification , Biological Assay , COVID-19/blood , COVID-19/virology , Humans , Serologic Tests/methods
12.
Echocardiography ; 38(2): 329-342, 2021 02.
Article in English | MEDLINE | ID: covidwho-979838

ABSTRACT

In the midst of the COVID-19 pandemic, unprecedented pressure has been added to healthcare systems around the globe. Imaging is a crucial component in the management of COVID-19 patients. Point-of-care ultrasound (POCUS) such as hand-carried ultrasound emerges in the COVID-19 era as a tool that can simplify the imaging process of COVID-19 patients, and potentially reduce the strain on healthcare providers and healthcare resources. The preliminary evidence available suggests an increasing role of POCUS in diagnosing, monitoring, and risk-stratifying COVID-19 patients. This scoping review aims to delineate the challenges in imaging COVID-19 patients, discuss the cardiopulmonary complications of COVID-19 and their respective sonographic findings, and summarize the current data and recommendations available. There is currently a critical gap in knowledge in the role of POCUS in the COVID-19 era. Nonetheless, it is crucial to summarize the current preliminary data available in order to help fill this gap in knowledge for future studies.


Subject(s)
COVID-19/diagnosis , Lung/diagnostic imaging , Pandemics , Point-of-Care Systems/standards , Ultrasonography/methods , COVID-19/epidemiology , Humans
13.
Crit Care ; 24(1): 676, 2020 12 07.
Article in English | MEDLINE | ID: covidwho-962957

ABSTRACT

BACKGROUND: There is emerging evidence for enhanced blood coagulation in coronavirus 2019 (COVID-19) patients, with thromboembolic complications contributing to morbidity and mortality. The mechanisms underlying this prothrombotic state remain enigmatic. Further data to guide anticoagulation strategies are urgently required. METHODS: We used viscoelastic rotational thromboelastometry (ROTEM) in a single-center cohort of 40 critically ill COVID-19 patients. RESULTS: Clear signs of a hypercoagulable state due to severe hypofibrinolysis were found. Maximum lysis, especially following stimulation of the extrinsic coagulation system, was inversely associated with an enhanced risk of thromboembolic complications. Combining values for maximum lysis with D-dimer concentrations revealed high sensitivity and specificity of thromboembolic risk prediction. CONCLUSIONS: The study identifies a reduction in fibrinolysis as an important mechanism in COVID-19-associated coagulopathy. The combination of ROTEM and D-dimer concentrations may prove valuable in identifying patients requiring higher intensity anticoagulation.


Subject(s)
COVID-19/complications , Fibrinolysis/physiology , Thrombelastography/methods , Thromboembolism/diagnosis , Blood Coagulation/physiology , Blood Coagulation Tests/methods , Blood Coagulation Tests/standards , COVID-19/diagnostic imaging , COVID-19/physiopathology , Cohort Studies , Critical Illness/epidemiology , Critical Illness/therapy , Female , Humans , Male , Middle Aged , Point-of-Care Systems/standards , Point-of-Care Systems/statistics & numerical data , Thromboembolism/diagnostic imaging , Viscoelastic Substances/analysis , Viscoelastic Substances/therapeutic use
14.
J Transl Med ; 18(1): 451, 2020 11 30.
Article in English | MEDLINE | ID: covidwho-949113

ABSTRACT

BACKGROUND: During the coronavirus disease-2019 (COVID-19) pandemic, Italian hospitals faced the most daunting challenges of their recent history, and only essential therapeutic interventions were feasible. From March to April 2020, the Laboratory of Advanced Cellular Therapies (Vicenza, Italy) received requests to treat a patient with severe COVID-19 and a patient with acute graft-versus-host disease with umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Access to clinics was restricted due to the risk of contagion. Transport of UC-MSCs in liquid nitrogen was unmanageable, leaving shipment in dry ice as the only option. METHODS: We assessed effects of the transition from liquid nitrogen to dry ice on cell viability; apoptosis; phenotype; proliferation; immunomodulation; and clonogenesis; and validated dry ice-based transport of UC-MSCs to clinics. RESULTS: Our results showed no differences in cell functionality related to the two storage conditions, and demonstrated the preservation of immunomodulatory and clonogenic potentials in dry ice. UC-MSCs were successfully delivered to points-of-care, enabling favourable clinical outcomes. CONCLUSIONS: This experience underscores the flexibility of a public cell factory in its adaptation of the logistics of an advanced therapy medicinal product during a public health crisis. Alternative supply chains should be evaluated for other cell products to guarantee delivery during catastrophes.


Subject(s)
COVID-19/therapy , Delivery of Health Care/organization & administration , Dry Ice , Mesenchymal Stem Cell Transplantation , Mesenchymal Stem Cells/cytology , Point-of-Care Systems/organization & administration , Transportation , Acute Disease , COVID-19/epidemiology , COVID-19/pathology , Cell Proliferation , Cell Survival , Cells, Cultured , Cord Blood Stem Cell Transplantation/adverse effects , Delivery of Health Care/standards , Equipment and Supplies, Hospital/standards , Equipment and Supplies, Hospital/supply & distribution , Graft vs Host Disease/etiology , Graft vs Host Disease/pathology , Graft vs Host Disease/therapy , Humans , Italy/epidemiology , Materials Management, Hospital/organization & administration , Materials Management, Hospital/standards , Mesenchymal Stem Cell Transplantation/methods , Mesenchymal Stem Cell Transplantation/standards , Mesenchymal Stem Cells/physiology , Organization and Administration/standards , Pandemics , Phenotype , Point-of-Care Systems/standards , SARS-CoV-2/physiology , Severity of Illness Index , Transportation/methods , Transportation/standards
15.
Bioanalysis ; 12(20): 1449-1458, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-892489

ABSTRACT

Aim: Current blood monitoring methods require sample collection and testing at a central lab, which can take days. Point of care (POC) devices with quick turnaround time can provide an alternative with faster results, allowing for real-time data leading to better treatment decisions for patients. Results/Methodology: An assay to measure monoclonal antibody therapeutic-A was developed on two POC devices. Data generated using 75 serum samples (65 clinical & ten spiked samples) show correlative results to the data generated using Gyrolab technology. Conclusion: This case study uses a monoclonal antibody therapeutic-A concentration assay as an example to demonstrate the potential of POC technologies as a viable alternative to central lab testing with quick results allowing for real-time decision-making.


Subject(s)
Antibodies, Monoclonal/immunology , Point-of-Care Systems/standards , Humans
17.
Ann Biol Clin (Paris) ; 78(4): 363-382, 2020 08 01.
Article in French | MEDLINE | ID: covidwho-709296

ABSTRACT

The point-of-care tests (POCT) are subject to accreditation. A national inventory survey provides a synthesis of knowledge. The survey distributed 31 questions in 2019. 147 responses were received (75% biologists, 49% CHU, 42% CHG). Only 20.41% are accredited ISO22870, the majority for <50% of the medical departments; 70% say they are going there at the end of 2019 or in 2020. The maps are unknown for 32% (EBMD) and 82% (TROD). Visibility is poor with: medical establishment committee (40%), IT department (31%). Connection is necessary for 87-95% depending on the criterion (QC, authorizations, etc.) and 66% of answers highlight that less than 50% of connexion is effective. The major advantage is the delay of the result (62.5%), then the relationship with the health teams (33.3%). The disadvantages: difficulty of the quality approach (45%), cost of tests (34.3%). Human resource requirements are identified for technicians (82%) and biologists (76%). The multiplicity of sites, devices and operators means that it is difficult to set up and maintain. Biology outside the laboratories, under biological responsibility, must meet a rigorous imperative quality approach.


Subject(s)
Clinical Laboratory Techniques , Global Health , Laboratories/statistics & numerical data , Laboratories/standards , Point-of-Care Testing , Accreditation , COVID-19 , COVID-19 Testing , Clinical Laboratory Services/standards , Clinical Laboratory Services/statistics & numerical data , Clinical Laboratory Techniques/standards , Clinical Laboratory Techniques/statistics & numerical data , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , France/epidemiology , Global Health/standards , Global Health/statistics & numerical data , History, 21st Century , Humans , Internationality , Laboratory Proficiency Testing/standards , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Point-of-Care Systems/standards , Point-of-Care Systems/statistics & numerical data , Point-of-Care Testing/organization & administration , Point-of-Care Testing/standards , Point-of-Care Testing/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Surveys and Questionnaires
19.
J Am Assoc Nurse Pract ; 32(6): 416-418, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-594928

ABSTRACT

Our health care landscape is rapidly changing. With the aging population and seemingly increasing outbreak of communicable diseases, it is expected that there will be a continued demand for inpatient/critical care providers. The current COVID-19 pandemic provides a glimpse of a health care system in severe provider shortage. Adult-gerontology acute nurse practitioners (GACNPs) can play a vital part in relieving that shortage. But with the increased role, there is an increased responsibility and need for expansion of AGACNP skill set. This includes the training and utilization of point-of-care ultrasound (POCUS). The case reports and data available from countries that have already combated COVID-19 outbreak show POCUS can play a key part in managing critically ill patients on isolation precautions. This article provides my perspective on POCUS training and competency achievement for AGACNPPs.


Subject(s)
Clinical Competence/standards , Geriatric Nursing/standards , Nurse Practitioners/education , Point-of-Care Systems/standards , Ultrasonography/standards , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Critical Care/standards , Geriatric Assessment/statistics & numerical data , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2
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