Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 52
Filtrar
1.
ACS Nano ; 14(12): 16180-16193, 2020 12 22.
Artículo en Inglés | MEDLINE | ID: mdl-33314910

RESUMEN

The management of the COVID-19 pandemic has relied on cautious contact tracing, quarantine, and sterilization protocols while we await a vaccine to be made widely available. Telemedicine or mobile health (mHealth) is well-positioned during this time to reduce potential disease spread and prevent overloading of the healthcare system through at-home COVID-19 screening, diagnosis, and monitoring. With the rise of mass-fabricated electronics for wearable and portable sensors, emerging telemedicine tools have been developed to address shortcomings in COVID-19 diagnostics, monitoring, and management. In this Perspective, we summarize current implementations of mHealth sensors for COVID-19, highlight recent technological advances, and provide an overview on how these tools may be utilized to better control the COVID-19 pandemic.


Asunto(s)
/métodos , /terapia , Manejo de la Enfermedad , Telemedicina/métodos , Antígenos Virales/análisis , Técnicas Biosensibles/instrumentación , /virología , Trazado de Contacto/instrumentación , Humanos , Aplicaciones Móviles/provisión & distribución , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Nanotecnología/instrumentación , Nanotecnología/métodos , Sistemas de Atención de Punto/organización & administración , Pruebas en el Punto de Atención/organización & administración , Cuarentena/organización & administración , Telemedicina/instrumentación
2.
Biochem Med (Zagreb) ; 30(3): 030403, 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33071554

RESUMEN

To fight the virus SARS-CoV-2 spread to Europe from China and to give support to the collapsed public health system, the Spanish Health Authorities developed a field hospital located in the facilities of Madrid exhibition centre (IFEMA) to admit and treat patients diagnosed with SARS-CoV-2 infectious disease (COVID-19). The Department of Laboratory Medicine of La Paz University Hospital in Madrid (LMD-HULP) was designated to provide laboratory services. Due to the emergency, the IFEMA field hospital had to be prepared for patient admission in less than 1 week and the laboratory professionals had to collaborate in a multidisciplinary group to assure that resources were available to start on time. The LMD-HULP participated together with the managers in the design of the tests portfolio and the integration of the healthcare information systems (IS) (hospital IS, laboratory IS and POCT management system). Laboratorians developed a strategy to quickly train clinicians and nurses on test requests, sample collection procedures and management/handling of the POCT blood gas analyser both by written materials and training videos. The IFEMA´s preanalytical unit managed 3782 requests, and more than 11,000 samples from March 27th to April 30th. Furthermore, 1151 samples were measured by blood gas analysers. In conclusion, laboratory professionals must be resilient and have to respond timely in emergencies as this pandemic. The lab's personnel selection, design and monitoring indicators to maintain and further improve the quality and value of laboratory services is crucial to support medical decision making and provide better patient care.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Unidades Móviles de Salud/organización & administración , Pandemias , Neumonía Viral , Ciudades , Sistemas de Información en Laboratorio Clínico/organización & administración , Infecciones por Coronavirus/epidemiología , Prestación de Atención de Salud , Necesidades y Demandas de Servicios de Salud , Capacidad de Camas en Hospitales , Sistemas de Información en Hospital/organización & administración , Hospitales Universitarios/organización & administración , Humanos , Laboratorios de Hospital/organización & administración , Personal de Hospital/educación , Neumonía Viral/epidemiología , Pruebas en el Punto de Atención/organización & administración , Garantía de la Calidad de Atención de Salud/organización & administración , España , Manejo de Especímenes
3.
Ann Biol Clin (Paris) ; 78(4): 363-382, 2020 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-32753365

RESUMEN

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.


Asunto(s)
Técnicas de Laboratorio Clínico , Salud Global , Laboratorios/estadística & datos numéricos , Laboratorios/normas , Pruebas en el Punto de Atención , Acreditación , Servicios de Laboratorio Clínico/normas , Servicios de Laboratorio Clínico/estadística & datos numéricos , Técnicas de Laboratorio Clínico/normas , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Francia/epidemiología , Salud Global/normas , Salud Global/estadística & datos numéricos , Historia del Siglo XXI , Humanos , Internacionalidad , Ensayos de Aptitud de Laboratorios/normas , Pandemias , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Sistemas de Atención de Punto/normas , Sistemas de Atención de Punto/estadística & datos numéricos , Pruebas en el Punto de Atención/organización & administración , Pruebas en el Punto de Atención/normas , Pruebas en el Punto de Atención/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/organización & administración , Encuestas y Cuestionarios
4.
Med Teach ; 42(11): 1310-1312, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32726155

RESUMEN

Bedside skills have been declining over the last two decades, with multiple studies reporting increasing reliance on investigations and technology in making diagnostic decisions. During the Covid-19 crisis, even less time is spent at the bedside, and physical examinations seem markedly truncated or non-existent. It is possible that cost of health care, doctor-patient relationships, and the clinical reasoning skills could be seriously impacted by ongoing decrease in bedside skills and the teaching of these skills. Careful history taking and hypothesis-driven physical examination still form the backbone of clinical reasoning and lead to parsimonious investigations. Overreliance on investigations could drive up costs of healthcare if every diagnosis depends on a head to toe scan. In this paper, we describe strategies for bedside teaching that are relevant and applicable even during the pandemic and an era of physical distancing. These strategies are categorised as: before, during and after patient interactions at the bedside. These strategies can be adapted to normal clinical teaching situations as well as challenging situations such as the current pandemic when physical distancing is mandated.


Asunto(s)
Betacoronavirus , Competencia Clínica , Infecciones por Coronavirus/diagnóstico , Relaciones Médico-Paciente , Neumonía Viral/diagnóstico , Pruebas en el Punto de Atención/organización & administración , Actitud del Personal de Salud , Infecciones por Coronavirus/terapia , Humanos , Capacitación en Servicio , Pandemias , Habitaciones de Pacientes/organización & administración , Examen Físico/métodos , Neumonía Viral/terapia
5.
PLoS One ; 15(6): e0235471, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32603374

RESUMEN

INTRODUCTION: High rates of pre-treatment loss to care among persons diagnosed with HIV persist. Linkage to care can be improved through active digitally-based surveillance. Currently, record-keeping for HIV diagnoses in South Africa is paper-based. Aggregated testing data are reported routinely, and only discordant findings result in a specimen being tested at a laboratory and digitised. The Western Cape Province in South Africa has a Provincial Health Data Centre (PHDC) where person-level routine electronic data are consolidated in a single database, leveraging the existence of a unique patient identifier. To facilitate improved HIV surveillance, a pre-carbonated point-of-care test (PoCT) form was piloted, where one copy was routed to a central point and digitised for PHDC inclusion. METHODS: We evaluated the utility of the intervention using cross-sectional and retrospective cohort analyses, as well as comparisons with aggregate data. Data were linked to the Patient Master Index of the PHDC using unique identifiers. Prior evidences of HIV within the PHDC were used to differentiate newly diagnosed patients and those retesting, as well as linkage to care and treatment. RESULTS: From May 2017 to June 2018, 11337 digitised point-of-care HIV testing records were linked to the PHDC. Overall, 96% of records in the aggregate dataset were digitised, with 97% linked to the PHDC. Of those tested, 79% were female (median age 27 years). Linkage demonstrated that 51.3% (95% CI 48.4-54.1%) of patients testing HIV-positive were retesting. Of those newly diagnosed, 81% (95% CI 77.9-84.3%) were linked to HIV care and 25% (95% CI 21.6-28.7%) were initiated on antiretroviral therapy immediately. CONCLUSION: Digitisation of PoCT results provides individuated HIV testing data to assist in linkage to care and in differentiating newly diagnosed patients from positive patients retesting. Actionable and accurate data can improve the measurement of performance towards the UNAIDS 90-90-90 targets.


Asunto(s)
Infecciones por VIH/epidemiología , Pruebas en el Punto de Atención/organización & administración , Adulto , Estudios de Cohortes , Estudios Transversales , Exactitud de los Datos , Sistemas de Administración de Bases de Datos , Femenino , Infecciones por VIH/diagnóstico , Humanos , Masculino , Tamizaje Masivo , Estudios Retrospectivos , Sudáfrica/epidemiología , Adulto Joven
6.
Lancet Haematol ; 7(7): e534-e540, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32589979

RESUMEN

BACKGROUND: Sickle cell disease is highly prevalent in sub-Saharan Africa, where it accounts for substantial morbidity and mortality. Newborn screening is paramount for early diagnosis and enrolment of affected children into a comprehensive care programme. Up to now, this strategy has been greatly impaired in resource-poor countries, because screening methods are technologically and financially intensive; affordable, reliable, and accurate methods are needed. We aimed to test the feasibility of implementing a sickle cell disease screening programme using innovative point-of-care test devices into existing immunisation programmes in primary health-care settings. METHODS: Building on a routine immunisation programme and using existing facilities and staff, we did a prospective feasibility study at five primary health-care centres within Gwagwalada Area Council, Abuja, Nigeria. We systematically screened for sickle cell disease consecutive newborn babies and infants younger than 9 months who presented to immunisation clinics at these five centres, using an ELISA-based point-of care test (HemoTypeSC). A subgroup of consecutive babies who presented to immunisation clinics at the primary health-care centres, whose mothers gave consent, were tested by the HemoTypeSC point-of-care test alongside a different immunoassay-based point-of-care test (SickleSCAN) and the gold standard test, high-performance liquid chromatography (HPLC). FINDINGS: Between July 14, 2017, and Sept 3, 2019, 3603 newborn babies and infants who presented for immunisation were screened for sickle cell disease at five primary health-care centres using the ELISA-based point-of-care test. We identified 51 (1%) children with sickle cell anaemia (HbSS), four (<1%) heterozygous for HbS and HbC (HbSC), 740 (21%) with sickle cell trait (HbAS), 34 (1%) heterozygous for HbA and HbC (HbAC), and 2774 (77%) with normal haemoglobin (HbAA). Of the 55 babies and infants with confirmed sickle cell disease, 41 (75%) were enrolled into a programme for free folic acid and penicillin, of whom 36 (88%) completed three visits over 9 months (median follow-up 226 days [IQR 198-357]). The head-to-head comparison between the two point-of-care tests and HPLC showed concordance between the three testing methods in screening 313 newborn babies, with a specificity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC, and a sensitivity of 100% with HemoTypeSC, 100% with SickleSCAN, and 100% by HPLC. INTERPRETATION: Our pilot study shows that the integration of newborn screening into existing primary health-care immunisation programmes is feasible and can rapidly be implemented with limited resources. Point-of-care tests are reliable and accurate in newborn screening for sickle cell disease. This feasibility study bodes well for the care of patients with sickle cell disease in resource-poor countries. FUNDING: Doris Duke Charitable Foundation, Imperial College London Wellcome Trust Centre for Global Health Research, and Richard and Susan Kiphart Family Foundation.


Asunto(s)
Anemia de Células Falciformes/diagnóstico , Prestación Integrada de Atención de Salud/organización & administración , Tamizaje Neonatal , Pruebas en el Punto de Atención/organización & administración , Estudios de Factibilidad , Femenino , Humanos , Programas de Inmunización/organización & administración , Recién Nacido , Masculino , Tamizaje Neonatal/métodos , Tamizaje Neonatal/organización & administración , Nigeria , Proyectos Piloto , Estudios Prospectivos
8.
Anesth Analg ; 131(2): 351-364, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32433248

RESUMEN

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.


Asunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/terapia , Cuidados Críticos/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Recursos en Salud/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Control de Infecciones/organización & administración , Neumonía Viral/terapia , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Necesidades y Demandas de Servicios de Salud/organización & administración , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Evaluación de Necesidades/organización & administración , Exposición Profesional/efectos adversos , Exposición Profesional/prevención & control , Salud Laboral , Pandemias , Grupo de Atención al Paciente/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Neumonía Viral/virología , Sistemas de Atención de Punto/organización & administración , Pruebas en el Punto de Atención/organización & administración , Factores de Riesgo , Índice de Severidad de la Enfermedad
9.
Otolaryngol Head Neck Surg ; 163(2): 265-270, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32452746

RESUMEN

OBJECTIVE: To highlight emerging preoperative screening protocols and document workflow challenges and successes during the early weeks of the COVID-19 pandemic. METHODS: This retrospective cohort study was conducted at a large urban tertiary care medical center. Thirty-two patients undergoing operative procedures during the COVID-19 pandemic were placed into 2 preoperative screening protocols. Early in the pandemic a "high-risk case protocol" was utilized to maximize available resources. As information and technology evolved, a "universal point-of-care protocol" was implemented. RESULTS: Of 32 patients, 25 were screened prior to surgery. Three (12%) tested positive for COVID-19. In all 3 cases, the procedure was delayed, and patients were admitted for treatment or discharged under home quarantine. During this period, 86% of operative procedures were indicated for treatment of oncologic disease. There was no significant delay in arrival to the operating room for patients undergoing point-of-care screening immediately prior to their procedure (P = .92). DISCUSSION: Currently, few studies address preoperative screening for COVID-19. A substantial proportion of individuals in this cohort tested positive, and both protocols identified positive cases. The major strengths of the point-of-care protocol are ease of administration, avoiding subsequent exposures after testing, and relieving strain on "COVID-19 clinics" or other community testing facilities. IMPLICATIONS FOR PRACTICE: Preoperative screening is a critical aspect of safe surgical practice in the midst of the widespread pandemic. Rapid implementation of universal point-of-care screening is possible without major workflow adjustments or operative delays.


Asunto(s)
Betacoronavirus , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Pruebas en el Punto de Atención , Cuidados Preoperatorios , Chicago , Infecciones por Coronavirus/epidemiología , Humanos , Tamizaje Masivo , Otolaringología/métodos , Pandemias , Neumonía Viral/epidemiología , Pruebas en el Punto de Atención/organización & administración , Estudios Retrospectivos , Centros de Atención Terciaria
10.
Sex Transm Infect ; 96(5): 342-347, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32241905

RESUMEN

OBJECTIVES: In 2016, WHO estimated 376 million new cases of the four main curable STIs: gonorrhoea, chlamydia, trichomoniasis and syphilis. Further, an estimated 290 million women are infected with human papillomavirus. STIs may lead to severe reproductive health sequelae. Low-income and middle-income countries carry the highest global burden of STIs. A large proportion of urogenital and the vast majority of extragenital non-viral STI cases are asymptomatic. Screening key populations and early and accurate diagnosis are important to provide correct treatment and to control the spread of STIs. This article paints a picture of the state of technology of STI point-of-care testing (POCT) and its implications for health system integration. METHODS: The material for the STI POCT landscape was gathered from publicly available information, published and unpublished reports and prospectuses, and interviews with developers and manufacturers. RESULTS: The development of STI POCT is moving rapidly, and there are much more tests in the pipeline than in 2014, when the first STI POCT landscape analysis was published on the website of WHO. Several of the available tests need to be evaluated independently both in the laboratory and, of particular importance, in different points of care. CONCLUSION: This article reiterates the importance of accurate, rapid and affordable POCT to reach universal health coverage. While highlighting the rapid technical advances in this area, we argue that insufficient attention is being paid to health systems capacity and conditions to ensure the swift and rapid integration of current and future STI POCT. Unless the complexity of health systems, including context, institutions, adoption systems and problem perception, are recognised and mapped, simplistic approaches to policy design and programme implementation will result in poor realisation of intended outcomes and impact.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/tratamiento farmacológico , Infecciones por Chlamydia/prevención & control , Infecciones por Chlamydia/transmisión , Femenino , Gonorrea/diagnóstico , Gonorrea/tratamiento farmacológico , Gonorrea/prevención & control , Gonorrea/transmisión , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Ciencia de la Implementación , Masculino , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/prevención & control , Infecciones por Mycoplasma/transmisión , Mycoplasma genitalium , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/transmisión , Enfermedades de Transmisión Sexual/tratamiento farmacológico , Enfermedades de Transmisión Sexual/prevención & control , Enfermedades de Transmisión Sexual/transmisión , Sífilis/diagnóstico , Sífilis/tratamiento farmacológico , Sífilis/prevención & control , Sífilis/transmisión , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/tratamiento farmacológico , Vaginitis por Trichomonas/prevención & control , Vaginitis por Trichomonas/transmisión
11.
AIDS Behav ; 24(2): 450-466, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30982103

RESUMEN

The aim of this study was to establish 'proof of concept' for a novel approach to HIV and STI testing at a sex on premises venue (SOPV) for gay and bisexual and other men who have sex with men (GBMSM) during late night group sex theme parties. A mixed-methods approach was used, and the study aimed to: (1) Build upon existing SOPV funded service delivery and establish 'proof of concept' for this unique setting within an SOPV; (2) evaluate the uptake and feasibility/acceptability of routine HIV/STI testing for GBMSM during theme parties in SOPV; and (3) identify beliefs/perceptions regarding this health promotion activity and venue suitability. The characteristics of patrons utilising PoCT (Point of Care Testing) were established to help further reach potentially stigmatised, highly sexually adventurous GBMSM. The findings support further PoCT endeavours within MSM communities to target harder to reach communities to reduce the rate of new transmissions of HIV. Findings can inform future health promotion, screening and interventions, as well as to identify a successful method to engage harder to reach GBMSM that need further focused targeting for HIV and STI testing to reduce transmission.


Asunto(s)
Bisexualidad , Infecciones por VIH/diagnóstico , Homosexualidad Masculina , Aceptación de la Atención de Salud , Pruebas en el Punto de Atención/organización & administración , Enfermedades de Transmisión Sexual/diagnóstico , Adolescente , Adulto , Anciano , Coito , Estudios de Factibilidad , Infecciones por VIH/prevención & control , Promoción de la Salud/métodos , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Grupo Paritario , Desarrollo de Programa , Conducta Sexual , Enfermedades de Transmisión Sexual/prevención & control , Estereotipo
14.
Rev. lab. clín ; 12(3): e47-e56, jul.-sept. 2019. tab, graf
Artículo en Español | IBECS | ID: ibc-187164

RESUMEN

El avance tecnológico en el campo del diagnóstico clínico ha generado una diversidad de pruebas de laboratorio aplicables en el lugar de asistencia al paciente (POCT), y ha permitido contar con una mayor calidad analítica de los procedimientos implementados. La elaboración de un cuadro de mando integral es una herramienta útil para el éxito en la gestión de un proceso trasversal, complejo e interdisciplinario, como es el de obtener resultados analíticos fiables, transferibles de forma inmediata mediante sistemas POCT. Para la elaboración de un cuadro de mando integral se deben considerar cuatro perspectivas: la de los clientes (pacientes, médicos, grupos de interés), la financiera (inversores privados o públicos), la de los procesos operativos internos (sistemas, procesos) y la de los profesionales (cultura organizativa). El objeto de este documento es establecer recomendaciones para la elaboración de un cuadro de mando integral para gestionar los sistemas POCT disponibles en una institución


Technological development of in vitro diagnostics has led to a diversity of new tests for point-of-care testing (POCT) and at the same time provides quality in the process. Construction of a balanced scorecard is a useful tool for the success in the management of a cross-sectional, complex and interdisciplinary process, as well as to obtain reliable analytical results for immediately use with POCT systems. In constructing a balanced scorecard, four perspectives should be considered: Customer (patients, doctors), Financial (private or public investors), Operating procedures (systems, processes), and Professionals (organisational culture). The aim of this document is to establish the recommendations for the development of an adequate balanced scorecard to manage a point-of-care network in a healthcare system


Asunto(s)
Humanos , Sistemas de Atención de Punto/organización & administración , Pruebas en el Punto de Atención/organización & administración , Manejo de Especímenes/métodos , Métodos Analíticos de la Preparación de la Muestra/métodos , Técnicas de Laboratorio Clínico/métodos , Manejo de Atención al Paciente/métodos , Gestión de la Calidad , Técnicas de Apoyo para la Decisión , Seguridad del Paciente
15.
J Gen Intern Med ; 34(10): 2062-2067, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31388904

RESUMEN

BACKGROUND: Venous thromboembolism includes deep vein thrombosis (DVT) and pulmonary embolism. Compression ultrasonography is the most common way to evaluate DVT and is typically performed by sonographers and interpreted by radiologists. Yet there is evidence that ultrasound examinations can be safely and accurately performed by clinicians at the bedside. OBJECTIVE: To measure the operating characteristics of hospital medicine providers performing point-of-care ultrasound (POCUS) for evaluation of DVT. DESIGN: This is a prospective cohort study enrolling a convenience sample of patients. Hospital medicine providers performed POCUS for DVT and the results were compared with the corresponding formal vascular study (FVS) interpreted by radiologists. PARTICIPANTS: Hospitalized non-ICU patients at four tertiary care hospitals for whom a DVT ultrasound was ordered. MAIN MEASURES: The primary outcomes were the sensitivity, specificity, and predictive values of the POCUS compression ultrasound compared with a FVS. The secondary outcome was the elapsed time between order and the POCUS study compared with the time the FVS was ordered to when the formal radiology report was finalized. KEY RESULTS: One hundred twenty-five limbs from 73 patients were scanned. The prevalence of DVT was 6.4% (8/125). The sensitivity of POCUS for DVT was 100% (95% CI 74-100%) and specificity was 95.8% (95% CI 91-98%) with a positive predictive value of 61.5% (95% CI 35-84%) and a negative predictive value of 100% (95% CI 98-100%). The median time from order to POCUS completion was 5.8 h versus 11.5 h median time from order until the radiology report was finalized (p = 0.001). CONCLUSION: Hospital medicine providers can perform compression-only POCUS for DVT on inpatients with accuracy similar to other specialties and settings, with results available sooner than radiology. The observed prevalence of DVT was lower than expected. POCUS may be reliable in excluding DVT but further study is required to determine how to incorporate a positive POCUS DVT result into clinical practice.


Asunto(s)
Médicos Hospitalarios/normas , Pruebas en el Punto de Atención/organización & administración , Ultrasonografía/métodos , Trombosis de la Vena/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Factores de Tiempo
16.
N Z Med J ; 132(1499): 56-63, 2019 07 26.
Artículo en Inglés | MEDLINE | ID: mdl-31352475

RESUMEN

Point-of-care testing (POCT) devices are in vitro diagnostic devices used in hospitals, primary care and at home to provide rapid medical test results to support decision making. Most POCT devices are not regulated in New Zealand and there is no requirement for public or private hospital providers who use POCT devices to meet minimum accreditation standards for POCT. This article describes a regulatory framework for POCT devices, which is consistent with the principles of the draft Therapeutic Products Bill 2018. The proposed framework includes thorough evaluation, laboratory validation and approval processes for devices, improved traceability, accreditation for POCT and an adverse event management system; in the interests of patient safety.


Asunto(s)
Pruebas en el Punto de Atención , Garantía de la Calidad de Atención de Salud , Humanos , Modelos Organizacionales , Nueva Zelanda , Pruebas en el Punto de Atención/organización & administración , Pruebas en el Punto de Atención/normas , Garantía de la Calidad de Atención de Salud/organización & administración , Garantía de la Calidad de Atención de Salud/normas
17.
J Clin Virol ; 116: 44-48, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31102924

RESUMEN

Respiratory tract infections are a common cause of visits to emergency departments and outpatient settings. Infections with influenza viruses A and B in particular, are responsible for significant morbidity and mortality in both pediatric and adult populations worldwide. A significant number of influenza diagnoses occur in the emergency departments with many being performed using rapid influenza diagnostic tests (RIDT) which have sensitivities as low as 30% depending on the specific RIDT and patient population. More recently, rapid molecular tests for the detection of influenza viruses A and B have become commercially available as point-of-care platforms. In the United States, several of these new tests are approved by the Food and Drug Administration as CLIA-waived tests. In this report, we review the data on the analytical and clinical performance of RIDTs and CLIA-waived molecular tests, present and discuss potential key challenges and opportunities for implementation of CLIA-waived molecular tests at or near point of care in the emergency departments and outpatient settings.


Asunto(s)
Pruebas Diagnósticas de Rutina/normas , Gripe Humana/diagnóstico , Técnicas de Diagnóstico Molecular , Pruebas en el Punto de Atención/normas , Instituciones de Atención Ambulatoria , Pruebas Diagnósticas de Rutina/clasificación , Servicio de Urgencia en Hospital , Humanos , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/aislamiento & purificación , Técnicas de Diagnóstico Molecular/normas , Pruebas en el Punto de Atención/organización & administración , Juego de Reactivos para Diagnóstico/clasificación , Juego de Reactivos para Diagnóstico/normas
18.
Lab Med ; 50(3): e50-e55, 2019 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-30953076

RESUMEN

BACKGROUND: Point of care (POC) testing is rapidly evolving. POC testing is often managed by POC coordinators (POCC), but this role is relatively new and has not been characterized. OBJECTIVES: To characterize the background, responsibilities, and job satisfaction of POCCs. METHODS: Structured interviews were conducted with 15 POCCs. On the basis of these interviews, a 38-item questionnaire was developed and administered as a web-based survey. RESULTS: The respondents (N = 98) were mostly female (87%) and had a bachelor's degree (79%). About half the respondents were older than 55 years and were in supervisory positions. Overall, respondents indicated high job satisfaction, but women were significantly less satisfied than men. POCCs were infrequently involved in decisions regarding the implementation of new tests. The number of tests managed by each POCC varied widely (median, 6.0; range, 1-30). CONCLUSIONS: The POCC role is in flux. There is consensus regarding some aspects of the job, but there are significant differences in the way that hospitals organize the POCC function.


Asunto(s)
Actitud del Personal de Salud , Pruebas en el Punto de Atención/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Entrevistas como Asunto , Perfil Laboral , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad
19.
Int J Health Care Qual Assur ; 32(1): 262-272, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30859885

RESUMEN

PURPOSE: The purpose of this paper is to determine associations between initially recorded deviations in individual bedside vital parameters that contribute to total Modified Early Warning Score (MEWS) levels 2 or 3 and further clinical deterioration (MEWS level=4). DESIGN/METHODOLOGY/APPROACH: This was a prospective study in which 27,504 vital parameter values, corresponding to a total MEWS level⩾2, belonging to 1,315 adult medical and surgical inpatient patients admitted to a 90-bed study setting at a university hospital, were subjected to binary logistic and COX regression analyses to determine associations between vital parameter values initially corresponding to total MEWS levels 2 or 3 and later deterioration to total MEWS level ⩾4, and to evaluate corresponding time intervals. FINDINGS: Respiratory rate, heart rate and patient age were significantly ( p=0.012, p<0.001 and p=0.028, respectively) associated with further deterioration from a total MEWS level 2, and the heart rate also ( p=0.009) from a total MEWS level 3. Within 24 h from the initially recorded total MEWS levels 2 or 3, 8 and 17 percent of patients, respectively, deteriorated to a total MEWS level=4. Patients initially scoring MEWS 2 had a 27 percent 30-day mortality rate if they later scored MEWS level=4, and 8.7 percent if they did not. PRACTICAL IMPLICATIONS: It is important to observe all patients closely, but especially elderly patients, if total MEWS levels 2 or 3 are tachypnoea and/or tachycardia related. ORIGINALITY/VALUE: Findings might contribute to patient safety by facilitating appropriate clinical and organizational decisions on adequate time spans for early warning scoring in general ward patients.


Asunto(s)
Progresión de la Enfermedad , Mortalidad Hospitalaria , Hospitales Universitarios , Pruebas en el Punto de Atención/organización & administración , Signos Vitales , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Dinamarca , Femenino , Humanos , Pacientes Internos , Tiempo de Internación , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Suecia , Factores de Tiempo
20.
PLoS One ; 14(2): e0211498, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30811407

RESUMEN

INTRODUCTION: Several supply chain components are important to sustain point-of-care (POC) testing services in rural settings. To evaluate the availability of POC diagnostic tests in rural Ghana's primary healthcare (PHC) clinics, we conducted an audit of the supply chain management for POC diagnostic services in rural Upper East Region's (UER) PHC clinics, Ghana to determine the reasons/causes of POC tests deficiencies. MATERIAL AND METHODS: We conducted a review of accessible POC diagnostics in 100 PHC clinics in UER, Ghana from February to March 2018. We used a monitoring audit tool adopted from the World Health Organization and Management Science for Health guidelines for supply chain management of diagnostics for compliance. We determined a clinic's compliance with the stipulated guidelines, and a composite compliant score was defined as a percentage rating of 90 to 100%. We used univariate logistic regression analysis in Stata 14 to determine the level of association between supply chain management and the audit variables. RESULTS: Overall, the composite compliant score of supply chain management for existing POC tests was at 81% (95%CI: 79%-82%). The mean compliance with distribution guidelines was at 93.8% (95%CI: 91.9%-95.6%) the highest score, whilst inventory management scored the lowest, at 53.5% (95%CI: 49.5%-57.5%) compliance. Of the 13 districts in the region, the results showed complete stock-out of blood glucose test in all selected PHC clinics in seven (53.8%) districts, haemoglobin and hepatitis B virus test in three (23.1%), and urine protein test in two (15.4%) districts. Based on our univariate logistics regression models, stock-out of tests at the Regional Medical and District Health Directorates stores in the region, high clinic attendance, lack of documentation of expiry date/expired tests, poor documentation of inventory level, poor monitoring of monthly consumption level, and failure to document unexplained losses of the various POC tests were significant predictors of complete test stock-out in most of the clinics in the Upper East Region. DISCUSSION: There is poor supply chain management of POC diagnostic tests in UER's PHC clinics. Improvement in inventory management and human resource capacity for POC testing is critical to ensure accessibility and sustainability of POC diagnostic services in resource-limited settings PHC clinics.


Asunto(s)
Pruebas en el Punto de Atención/organización & administración , Juego de Reactivos para Diagnóstico/provisión & distribución , Servicios de Salud Rural/provisión & distribución , Estudios Transversales , Ghana , Modelos Logísticos , Pruebas en el Punto de Atención/normas , Atención Primaria de Salud , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...