scholarly journals Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101596 ◽  
Author(s):  
Christoffer Bugge ◽  
Erik Magnus Sether ◽  
Andreas Pahle ◽  
Sigrun Halvorsen ◽  
Ivar Sonbo Kristiansen
Keyword(s):  
Heart Failure ◽  
Clinical Diagnosis ◽  
Point Of Care ◽  
Adult Population ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Sensitivity Analyses ◽  
Tree Model ◽  
Diagnostic Strategies ◽  
Point Of Care Test

BackgroundAfflicting 1–2% of the adult population, heart failure (HF) is a condition with considerable morbidity and mortality. While echocardiography may be considered the gold standard diagnostic test, GPs have relied on symptoms and clinical findings in diagnosing the condition.AimThe aim of this study was to estimate 1-year health outcome and costs of three diagnostic strategies: 1) history and clinical findings ('clinical diagnosis'); 2) clinical diagnosis supplemented with NTproBNP point-of-care test ('POC test') in the GP’s surgery; or (3) in hospital laboratory ('hospital test').Design & settingA decision tree model was developed to simulate 1-year patient courses with each strategy in Norway.MethodSensitivity and specificity of clinical diagnosis (56% and 68%), and of N-terminal pro B-type natriuretic peptide test ([NT-proBNP] 90% and 65%), were based on published literature. The probabilities of referral to hospital were based on a survey of Norwegian GPs (n = 103). The costs were based on various Norwegian fee schedules. Sensitivity analyses were conducted to examine the uncertainty of the results.ResultsThe 1-year per person societal costs were €543, €505, and €607 for clinical diagnosis, POC test, and hospital test, respectively. Even though POC entails higher laboratory costs, the total primary care costs were lower because of fewer re-visits with the GP and less use of spirometry. While 38% of patients had a delayed diagnosis with clinical diagnosis, the proportions were 22% with both POC test and hospital test. Results were most sensitive to the probability of use of spirometry.ConclusionPOC testing results in earlier diagnosis and lower costs than the other diagnostic modalities.

scholarly journals Accuracy, user-friendliness and usefulness of the Cobas h232 point-of-care test for NT-proBNP in primary care

2017 ◽  
Vol 71 (6) ◽  
pp. 539-545 ◽  
Author(s):  
Chiel Hex ◽  
Miek Smeets ◽  
Joris Penders ◽  
Viviane Van Hoof ◽  
Jan Verbakel ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Linear Regression Analysis ◽  
Clinical Decision ◽  
User Friendliness ◽  
Point Of Care Test ◽  
Percentage Difference ◽  
Difference Plot

AimsN-terminal pro-B-type natriuretic peptide (NT-proBNP) has been shown to be useful for ruling out heart failure in primary care. In this study, we examined the accuracy of the Cobas h232 point-of-care (POC) instrument in primary care compared with an in-hospital measurement. Furthermore, we investigated the user-friendliness and usefulness of the POC device.MethodsFive general practitioner (GP) groups were asked to evaluate adult patients who were suspected of having heart failure and to test NT-proBNP with the Cobas h232. The samples were subsequently delivered to and analysed at a central hospital laboratory by the Cobas e602 using conventional transport and storage. Difference between the paired measurements was analysed using a percentage difference plot, and correlation was assessed using Passing-Bablok linear regression analysis. User-friendliness and usefulness were assessed using semistructured questionnaires.ResultsNineteen GPs studied 94 patients. Passing-Bablok analysis showed a slope of 1.05 (95% CI 1.00 to 1.11) (R2=0.97). The percentage difference plot showed a mean difference of 15.7% (95% CI −46.0% to –77.4%). User-friendliness and usefulness had median scores of 4 or 5 on a five-point Likert scale. Eighteen out of 19 GPs confirmed that the device influenced their clinical practice. During the study, GPs’ confidence in using NT-proBNP increased significantly from a mean score of 4.4 (95% CI 3.2 to 5.6) to 7.6 out of 10 (95% CI 7.1 to 8.2).ConclusionsThe Cobas h232 NT-proBNP POC test proved to be an accurate, user-friendly and useful test in primary care. Nearly all participating GPs were convinced that the test could benefit clinical decision making.

α-Defensin point-of-care test for diagnosis of prosthetic joint infections: neglected role of laboratory and clinical pathologists

2017 ◽  
Vol 56 (1) ◽  
Author(s):  
Lorenzo Drago ◽  
Marco Toscano ◽  
Lorenza Tacchini ◽  
Giuseppe Banfi
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Point Of Care ◽  
Joint Infection ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Microbial Infection ◽  
Point Of Care Test ◽  
Orthopedic Surgeons ◽  
Prosthetic Joint Infections

AbstractPeriprosthetic joint infection (PJI) is a serious complication that may occur after native joint replacement leading to a severe health and economic burden. Currently, due to several confounding factors, PJI is difficult to diagnose. Today, a multidisciplinary approach is indispensable to correctly define a periprosthetic joint infection; indeed, tissue histology, microbiology cultures and clinical findings are used together to achieve this goal. Analysis of α-defensin is commonly used for PJI diagnosis, as it allows the rapid detection of α-defensin present in the synovial fluid following a microbial infection. Currently, a point-of-care testing (POCT) assay able to detect the presence of human α-defensins 1–3 in synovial fluid of patients is aimed directly at orthopedic surgeons. However, many orthopedic surgeons lack experience and training in quality laboratory practices, often failing to appreciate the significance of quality control and proper documentation when using POCT assays. To guarantee the highest quality diagnostic services, the α-defensin test should be used together with other biochemical and microbiological criteria commonly used for PJI diagnosis. Additionally, the close cooperation and communication between laboratory, pathologists and physicians is of fundamental importance in the correct diagnosis of PJI.

scholarly journals The sensitivity, specificity, and agreement of a point of care method: an assessment of the diagnostic accuracy

2019 ◽  
Vol 24 (11) ◽  
pp. 4297-4305
Author(s):  
Erika da Silva Maciel ◽  
Fernando Rodrigues Peixoto Quaresma ◽  
Francisco Winter dos Santos Figueiredo ◽  
Jonathan Souza Sarraf ◽  
Taynah Putty Luis ◽  
...  
Keyword(s):  
New Technologies ◽  
Point Of Care ◽  
Adult Population ◽  
Laboratory Method ◽  
Reference Laboratory ◽  
Point Of Care Test ◽  
Good Ability ◽  
Metered Dose ◽  
Level Of Significance ◽  
Sensitivity Specificity

Abstract The use of new technologies can improve screening in communities with difficult access to health. This article aims to evaluate the sensitivity, specificity, and agreement of a point of care test in comparison to laboratory methods for the determination of glucose (GLI), triglyceride (TG), and total cholesterol (TC) concentrations. This prospective study used data from the remaining adult population of quilombolas in Brazil. Laboratory tests using conventional methods for the analysis of venipuncture samples were used as a standard method to measure the concentrations of GLI (mg/dL), TG (mg/dL), and TC (mg/dL) and compared to the metered dose from the collection of fingertip capillary blood (point of care). Contingency tables (2x2) were used to estimate the sensitivity and specificity of the methods. Lin and Bland & Altman coefficients were used to statistically assess agreement, the level of significance was 5%. There was substantial agreement between the methods for measuring TG and poor agreement for of TC and GLI. Analysis of the Bland & Altman coefficients revealed that the fingertip method did not produce good measures. The point of care method did not offer a good ability to measure compared to that of the reference laboratory method.

Testing for resistance: Point-of-care testing as a communicational tool in antibiotic prescribing

2018 ◽  
Vol 14 (3) ◽  
pp. 229-240
Author(s):  
Johanna Lindell
Keyword(s):  
Point Of Care ◽  
Rapid Test ◽  
Antibiotic Use ◽  
Treatment Recommendation ◽  
Antibiotic Prescribing ◽  
Communicative Practices ◽  
Effective Strategies ◽  
Reactive Protein ◽  
Point Of Care Test ◽  
Test Result

As antibiotic resistance becomes a growing health emergency, effective strategies are needed to reduce inappropriate antibiotic use. In this article, one such strategy – communicative practices associated with the C-reactive protein point-of care test – is investigated. Building on a collection of 31 videorecorded consultations from Danish primary care, and using conversation analysis, this study finds that the rapid test can be used throughout the consultation to incrementally build the case for a nonantibiotic treatment recommendation, both when the test result is forecast and reported. The study also finds that the format of reports of elevated results differs from that of ‘normal’ results, resulting in a subtle shift of authority from doctor to test.

Novel High Sensitivity Tuberculosis Point-of-Care Test for People Living with HIV

2018 ◽  
Author(s):  
Tobias Broger ◽  
Bianca Sossen ◽  
Elloise du Toit ◽  
Andrew D. Kerkhoff ◽  
Charlotte Schutz ◽  
...  
Keyword(s):  
Point Of Care ◽  
High Sensitivity ◽  
People Living With Hiv ◽  
Point Of Care Test ◽  
Living With Hiv

scholarly journals Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status

2021 ◽  
pp. 1-13
Author(s):  
Abhilash Koratala ◽  
Amir Kazory
Keyword(s):  
Heart Failure ◽  
Point Of Care ◽  
Objective Assessment ◽  
Prognostic Significance ◽  
Volume Status ◽  
Lung Water ◽  
Ultrasound Evaluation ◽  
Reliable Assessment ◽  
Poor Outcomes ◽  
Point Of Care Ultrasonography

<b><i>Background:</i></b> Lingering congestion portends poor outcomes in patients with heart failure (HF) and is a key target in their management. Studies have shown that physical exam has low yield in this setting and conventional methods for more precise assessment and monitoring of volume status (e.g., body weight, natriuretic peptides, and chest radiography) have significant inherent shortcomings. <b><i>Summary:</i></b> Point of care ultrasonography (POCUS) is a noninvasive versatile bedside diagnostic tool that enhances the sensitivity of conventional physical examination to gauge congestion in these patients. It also aids in monitoring the efficacy of decongestive therapy and bears prognostic significance. In this narrative review, we discuss the role of focused sonographic assessment of the heart, venous system, and extravascular lung water/ascites (i.e., the pump, pipes, and the leaks) in objective assessment of fluid volume status. <b><i>Key Messages:</i></b> Since each of the discussed components of POCUS has its limitations, a combinational ultrasound evaluation guided by the main clinical features would be the key to reliable assessment and effective management of congestion in patients with HF.

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