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1.
Nurs Clin North Am ; 55(1): 21-28, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32005362

RESUMEN

Nurse bedside shift report (NBSR) focuses on patient-centered care, and implementing the change starts with buy-in from management and a strong educational platform. Based on that platform, nurse champions grow to help foster education to their peers. Education and tools were provided to Registered Nurses and Certified Nursing Assistants. The pilot was implemented in 2 phases onto the Medical Oncology unit, and an incentive program ran concurrently. A prepilot revealed the following projected barriers: time to complete NBSR, concerns with the Health Insurance Portability and Accountability Act, attending to patient needs, and being able to perform NBSR.


Asunto(s)
Continuidad de la Atención al Paciente/normas , Personal de Enfermería en Hospital/normas , Pase de Guardia/normas , Seguridad del Paciente/normas , Atención Dirigida al Paciente/normas , Sistemas de Atención de Punto/normas , Guías de Práctica Clínica como Asunto , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
2.
Nurs Clin North Am ; 55(1): 29-37, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32005363

RESUMEN

The complexity and rapidly changing environment of health care places significant pressure on nurses. How nurses make decisions within this environment has been an area of inquiry in the literature. Clinical decision making is the application of distinct thinking patterns and analysis of data at hand used to make judgements about patient care. Models of clinical decision making provide a foundation for understanding how nurses make decisions. Key factors associated with clinical decision making include experience, intuition, use of information and sources, and environment. Further work is needed to increase understanding of the processes by which nurses make clinical decisions.


Asunto(s)
Competencia Clínica/normas , Toma de Decisiones Clínicas , Atención de Enfermería/normas , Personal de Enfermería en Hospital/normas , Sistemas de Atención de Punto/normas , Guías de Práctica Clínica como Asunto , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Enfermería
3.
Crit Care ; 24(1): 65, 2020 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-32093763

RESUMEN

BACKGROUND: Point-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children. METHODS: Creation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document. RESULTS: Panellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C). CONCLUSIONS: Evidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.


Asunto(s)
Cuidado Intensivo Neonatal , Sistemas de Atención de Punto , Ultrasonografía , Cuidados Críticos/métodos , Enfermedad Crítica , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/normas , Sistemas de Atención de Punto/normas , Revisiones Sistemáticas como Asunto , Ultrasonografía/métodos , Ultrasonografía/normas
4.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 50-53, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31845516

RESUMEN

OBJECTIVE: The purpose of this study was to determine if there was agreement between a new point-of-care (POC) lactate analyzer and a handheld laboratory analyzer when measuring blood lactate concentration in cats. DESIGN: Prospective observational study. SETTING: University veterinary teaching hospital. ANIMALS: Fifty-four cats that presented to an emergency service. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Lactate concentrations as measured by the handheld laboratory analyzer ranged from 0.3 to 15.4 mmol/L. Agreement analysis of the handheld laboratory analyzer and the POC lactate meter demonstrated a bias, -0.06 and limits of agreement ranging from -0.87 to 0.99 mmol/L. Regression analysis demonstrated a coefficient of determination (R2 ) of 0.98. CONCLUSION: Results of the present study indicate that the POC lactate meter provided results that are in agreement with a handheld laboratory analyzer when measuring lactate in clinically ill patients.


Asunto(s)
Análisis Químico de la Sangre/veterinaria , Enfermedades de los Gatos/sangre , Ácido Láctico/sangre , Animales , Análisis Químico de la Sangre/normas , Gatos , Servicios Médicos de Urgencia , Femenino , Hospitales de Enseñanza , Masculino , Sistemas de Atención de Punto/normas , Valor Predictivo de las Pruebas , Estudios Prospectivos , Análisis de Regresión
5.
S Afr Med J ; 109(12): 952-956, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31865958

RESUMEN

BACKGROUND: Major issues around the implementation of point-of-care testing (POCT) include: user type, regulatory control, ongoing quality monitoring and limited guideline adherence.59 December 2019, Print editionObjectives. To determine if there are significant differences in the results of a POC full blood count test between different levels of healthcare and non-medical 'lay' users compared with laboratory users (technologists/pathologists). METHODS: This article retrospectively reviews the technical evaluation database of the intensive care unit (ICU), Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. We searched for samples analysed by doctors, clerks and laboratory personnel. A minimum number of 60 comparisons were required. Bland-Altman plots, Spearman's correlation and Passing-Bablok fit were used to analyse the dataset. RESULTS: There were 72 comparisons for haematocrit (Hct), 98 for white cell count (WCC) and 137 for platelets (Plt) between the clerk and laboratory personnel. The correlations were 0.91, 0.96 and 0.92, respectively. All were statistically significant. Using the Bland-Altman method, there was good agreement between results of the clerk and those of the laboratory staff, with a mean bias of 0.5% (Hct), 0.1 × 109/L (WCC) and 10 × 109/L (Plt). An insufficient number of tests were performed by medical doctors for statistical comparison. CONCLUSIONS: With appropriate training, non-medical, non-healthcare lay users are able to perform a moderately complex POCT with similar accuracy as trained laboratory professionals. The focus should shift to equipment and quality management processes rather than the medical/technical qualification of the user.


Asunto(s)
Personal Administrativo/normas , Personal de Laboratorio Clínico/normas , Patología/normas , Sistemas de Atención de Punto/normas , Competencia Clínica , Hematócrito , Humanos , Unidades de Cuidados Intensivos , Recuento de Leucocitos , Recuento de Plaquetas , Reproducibilidad de los Resultados , Estudios Retrospectivos
6.
Hosp Pract (1995) ; 47(4): 177-180, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31594430

RESUMEN

Objective: We sought to determine a benchmark for our blood glucose monitoring and compare our data to published data.Methods: Natividad Medical Center is a 172-bed rural hospital located in Salinas, California.Point of care blood glucose (POC-BG) data was extracted from our EMR for all ICU patients greater than 18 years of age between January 2014 and May 2018. Patient day-weighted mean POC-BGs were calculated for each patient by calculating the average POC-BG per day for each patient. Proportion measurements for each of our measurements groups were recorded (>180 mg/dL, <70 mg/dL, >250 mg/dL and <50 mg/dL). Monthly averages were plotted for visual comparison. Benchmarks were calculated by using 2x Standard Deviation for each measurement group.Results: A total of 3164 patients were found with 21,006 POC-BG measurements. The average POC-BG was 136 mg/dL and median 119 mg/dL. Proportion measurements of monthly day-weighted mean POC-BGs ranged from 0-1.2%, 5.3-44.8%, 0-0.3% and 0.6-16.5%, respectively for less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL. A 2x Standard Deviation was used to calculate our benchmark cut offs which provides a 95% confidence interval and includes 97.5% when neglecting the lower range. Our calculated benchmark values are 1.2, 38.2, 0.19, and 13.1% respectively for measurement groups less than 70 mg/dL, greater than 180 mg/dL, less than 50 mg/dL and greater than 250 mg/dL.Conclusion: Here we present data from a small rural hospital in the Western United States. We calculated benchmarks that could be used to track our ongoing hyper/hypoglycemia improvement projects. We found that when compared to published data, our hyper/hypoglycemia data was comparable to national data.


Asunto(s)
Glucemia , Hospitales Rurales/organización & administración , Unidades de Cuidados Intensivos/organización & administración , Monitoreo Fisiológico/normas , Sistemas de Atención de Punto/normas , Hospitales Rurales/normas , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Unidades de Cuidados Intensivos/normas , Estándares de Referencia , Índice de Severidad de la Enfermedad
7.
Acta Trop ; 199: 105150, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31425672

RESUMEN

The point-of-care strip assay for the detection of the schistosome Circulating Cathodic Antigen (POC-CCA) in urine has shown to be a user-friendly and sensitive alternative to stool microscopy for the diagnosis of Schistosoma mansoni infections. However, visual scoring of the test is by definition observer dependent and leads to discussion about the qualitative interpretation, in particular in low intensity infections when test lines tend to be weak. In order to standardise visual scoring, an innovative approach for semi-quantitative interpretation of the POC-CCA cassettes, called G-scores, was developed and evaluated. Urines (n = 110) from a S. mansoni endemic area were used to evaluate this new approach. Test lines of the POC-CCA were visually compared against the G-scores, i.e. a series of artificial cassettes containing inkjet-printed strips of different intensities in order to grade the POC-CCA test line on a scale of 1 to 10. A significant positive correlation (Spearman 0.660, p < 0.001) was observed between G-scores and eggs per gram of faeces. This proof-of-concept study demonstrates the usefulness of the G-scores for standardising the visual scoring of the POC-CCA urine strip assay. Several research groups have already indicated an interest in the G-scores for their field work. Further distribution of the cassettes, in particular when provided in combination with reference standards, will assist the wider schistosomiasis community in dealing with issues like batch-to-batch differences and interpretation of trace readings.


Asunto(s)
Antígenos Helmínticos/orina , Glicoproteínas/orina , Proteínas del Helminto/orina , Sistemas de Atención de Punto , Tiras Reactivas , Esquistosomiasis mansoni/diagnóstico , Animales , Humanos , Sistemas de Atención de Punto/normas , Schistosoma mansoni/inmunología , Esquistosomiasis mansoni/orina
8.
Comp Immunol Microbiol Infect Dis ; 66: 101333, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31437689

RESUMEN

To obtain information about the occurrence and genotype distribution of G. intestinalis and C. parvum in Austrian cattle, faecal samples from diarrhoeic calves younger than 180 days of age originating from 70 farms were examined. Of the 177 faecal samples, 27.1% were positive for Giardia cysts (immunofluorescence microscopy) and 55.4% for Cryptosporidium oocysts (phase-contrast microscopy). Positive samples were characterized by nested PCR for Giardia, 83.3% (triosephosphate isomerase; tpi) and 89.6% (ß-giardin; bg) were positive, while the Cryptosporidium nested PCR returned 92.5% (60-kDa glycoprotein) positive results. Sequence analysis revealed one assemblage A-positive sample and 30 (bg) respectively 29 (tpi) assemblage E-positive samples for G. intestinalis. For C. parvum four subtypes within the IIa family (IIaA15G2R1, n = 29; IIaA19G2R2, n = 3; IIaA21G2R1, n = 2; IIaA14G1R1, n = 1) could be differentiated. Validation of two immunochromatographic point-of-care tests resulted in a sensitivity of 29.2% and 77.6%; a specificity of 98.4% and 91.1% for the detection of Giardia intestinalis and Cryptosporidium parvum, respectively. Results confirm the widespread occurrence of both protozoa in diarrhoeic calves in Austria.


Asunto(s)
Enfermedades de los Bovinos/parasitología , Cryptosporidium parvum/genética , Diarrea/veterinaria , Giardia lamblia/genética , Sistemas de Atención de Punto/normas , Factores de Edad , Animales , Austria , Bovinos , Criptosporidiosis/diagnóstico , Cryptosporidium parvum/aislamiento & purificación , Diarrea/parasitología , Heces/parasitología , Genotipo , Giardia lamblia/aislamiento & purificación , Giardiasis/diagnóstico , Giardiasis/veterinaria , Inmunoensayo/normas
9.
Haemophilia ; 25(5): 885-892, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31282024

RESUMEN

BACKGROUND: Reliable monitoring of coagulation factor replacement therapy in patients with severe haemophilia, especially those with inhibitors, is an unmet clinical need. While useful, global assays, eg thromboelastography (TEG), rotational thromboelastometry (ROTEM) and thrombin generation assay (TGA), are cumbersome to use and not widely available. OBJECTIVE: To assess the utility of a novel, point-of-care, dielectric microsensor - ClotChip - to monitor coagulation factor replacement therapy in patients with haemophilia A, with and without inhibitors. METHODS: The ClotChip Tpeak parameter was assessed using whole-blood samples from children with severe haemophilia A, with (n = 6) and without (n = 12) inhibitors, collected pre- and postcoagulation factor replacement therapy. ROTEM, TGA and chromogenic FVIII assays were also performed. Healthy children (n = 50) served as controls. RESULTS: ClotChip Tpeak values exhibited a significant decrease for samples collected postcoagulation factor replacement therapy as compared to baseline (pretherapy) samples in patients with and without inhibitors. A difference in Tpeak values was also noted at baseline among severe haemophilia A patients with inhibitors as compared to those without inhibitors. ClotChip Tpeak parameter exhibited a very strong correlation with clotting time (CT) of ROTEM, endogenous thrombin potential (ETP) and peak thrombin of TGA, and FVIII clotting activity. CONCLUSIONS: ClotChip is sensitive to coagulation factor replacement therapy in patients with severe haemophilia A, with and without inhibitors. ClotChip Tpeak values correlate very well with ROTEM, TGA and FVIII assays, opening up possibilities for its use in personalized coagulation factor replacement therapy in haemophilia.


Asunto(s)
Pruebas de Coagulación Sanguínea/métodos , Espectroscopía Dieléctrica/métodos , Hemofilia A/terapia , Sistemas de Atención de Punto/normas , Femenino , Humanos , Masculino
10.
Pediatr Emerg Care ; 35(8): 575-578, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31290800

RESUMEN

The differential diagnosis for patients presenting in shock can be broad, making rapid diagnosis and management challenging. We present a case of a medically complex patient with presumed septic shock, diagnosed with a large pericardial effusion with evidence of tamponade using the rapid ultrasound in shock and hypotension protocol. The point-of-care ultrasound examination allowed for more timely and definitive management.


Asunto(s)
Derrame Pericárdico/diagnóstico por imagen , Sistemas de Atención de Punto/normas , Choque/etiología , Ultrasonografía/métodos , Adolescente , Ecocardiografía/métodos , Servicio de Urgencia en Hospital , Humanos , Masculino , Medicina de Urgencia Pediátrica , Derrame Pericárdico/complicaciones , Derrame Pericárdico/terapia , Pericardiocentesis/métodos , Choque/diagnóstico , Resultado del Tratamiento
11.
Clin Chim Acta ; 497: 13-19, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31271741

RESUMEN

BACKGROUND: As iodine-based contrast can cause deterioration of renal function in patients with impaired kidney function, guidelines advise to measure creatinine and calculate estimated glomerular filtration (eGFR) prior to administration. Point-of-care (POC) devices seem an attractive alternative to central laboratory testing but uncertainty regarding analytical and clinical comparability remains. METHODS: This study compared three POC devices, i-STAT (Abbott), StatSensor (Nova) and epoc (Siemens) with a central laboratory method (enzymatic creatinine, Siemens Vista 1500 platform). 120 patients were included and underwent simultaneous finger prick capillary blood analysis on the StatSensor and heparine whole blood analysis on StatSensor, i-STAT and epoc. RESULTS: All POC devices generated results which showed considerable variability around the creatinine value of the reference standard, with StatSensor having the widest (-1,12-1,11 mg/dL) and epoc the tightest (-0,49-0,49 mg/dL) 95% limits of agreement. I-STAT showed the highest clinical concordance with the reference standard (Kappa: 0,94) and had the smallest average analytical error (6%) for creatinine and eGFR compared to the reference standard, meeting the predefined criteria of 8,87% and 10%, respectively. Epoc only met criteria for eGFR. StatSensor did not meet any of the criteria. CONCLUSIONS: I-STAT and epoc were, analytically and clinically, the most performant POC devices included in this study but showed to be less user-friendly. StatSensor did not meet any of the error criteria, neither for creatinine nor for eGFR measurements, and gave more clinical major classification errors. However, it proved to be more user-friendly compared to the other POC devices.


Asunto(s)
Técnicas de Laboratorio Clínico , Medios de Contraste , Creatinina/sangre , Pruebas de Función Renal/métodos , Imagen por Resonancia Magnética , Sistemas de Atención de Punto , Insuficiencia Renal Crónica/sangre , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Receptores ErbB/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto/normas , Insuficiencia Renal Crónica/diagnóstico , Adulto Joven
12.
Medicina (Kaunas) ; 55(7)2019 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-31324028

RESUMEN

Background and objectives: In this study, the accuracy of point-of-care ultrasonography (POCUS) was compared to radiography (XR) in the diagnosis of fractures, the determination of characteristics of the fractures, and treatment selection of fractures in patients admitted to the emergency department (ED) due to trauma and suspected long bone (LB) fractures. Materials and Methods: The patients were included in the study, who were admitted to ED due to trauma, and had physical examination findings suggesting the presence of fractures in LB (humerus, radius, ulna, femur, tibia, and fibula). The patients were evaluated by two emergency physicians (EP) in ED. The first EP examined LBs with POCUS and the second EP examined them with XR. LBs were evaluated on the anterior, posterior, medial, and lateral surfaces and from the proximal joint to the distal one (shoulder, elbow, wrist, hip, knee, and ankle joint) in both longitudinal and transverse axes with POCUS. Results: A total of 205 patients with suspected LB fractures were included in the study. LB fractures were determined in 99 patients with XR and in 105 patients with POCUS. The sensitivity, specificity, positive predictive value, negative predictive value of POCUS in determining the fractures were 99%, 93%, 93%, and 99%, respectively, compared to XR. Compared to XR, POCUS was able to determine 100% of fissure type fractures (kappa (κ) value: 0.765), 83% of linear fractures (κ: 0.848), 92% of fragmented fractures(κ: 0.756), 67% of spiral fractures (κ:0.798), 75% of avulsion type fractures (κ: 0.855), and 100% of full separation type fractures (κ: 0.855). Conclusions: This study has demonstrated that POCUS has a high sensitivity in diagnosing LB fractures. POCUS has a high sensitivity in identifying fracture characteristics. POCUS can be used as an alternative imaging method to XR in the diagnosis of LB fractures and in the determination of fracture characteristics.


Asunto(s)
Fracturas Óseas/diagnóstico , Radiografía/normas , Ultrasonografía/normas , Adolescente , Adulto , Animales , Niño , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Fémur/lesiones , Peroné/lesiones , Humanos , Húmero/lesiones , Masculino , Persona de Mediana Edad , Sistemas de Atención de Punto/normas , Estudios Prospectivos , Radiografía/métodos , Tibia/lesiones , Ultrasonografía/métodos
13.
Parasit Vectors ; 12(1): 298, 2019 Jun 13.
Artículo en Inglés | MEDLINE | ID: mdl-31196145

RESUMEN

BACKGROUND: Urinary schistosomiasis, caused by Schistosoma haematobium, remains a significant public health problem worldwide, despite years of efforts to control it. Haematuria is one of the notable indirect indicators of S. haematobium infection and is commonly assessed along with other routine screens using a urinary dipstick test. A portable "field friendly" electronic analyser would offer an automated and thus more objective read-out compared to visual-read dipstick methods. METHODS: Within the framework of a Phase 2 praziquantel dose finding study in preschool- and school-aged children infected with S. haematobium, in southern Côte d'Ivoire, we compared a visual-read of the urine dipstick strips (Multistix PRO, Siemens Healthcare Diagnostics) to an automated reader (CLINITEK Status+ analyser™ Siemens Healthcare Diagnostics). Urine samples were collected from 148 pre-school aged and 152 school-aged children for urinalysis. Values were compared using a linear weighted kappa statistic and Bland-Altman analysis. RESULTS: A very good correlation between the two methods for nitrites and haematuria was observed (κ coefficient of 0.88 and 0.82, respectively), while a good correlation was observed for leukocytes (κ coefficient of 0.63) A moderate to fair correlation was calculated (κ coefficient ≤ 0.6) for all other parameters. When the results were stratified according to infection intensity, the agreements were stronger from the high infection intensity sample measurements, for most of the parameters. CONCLUSION: Our results demonstrate the device's utility in detecting haematuria and nitrites but underline the need for further development of this tool in order to improve its performance in the field.


Asunto(s)
Hematuria/diagnóstico , Sistemas de Atención de Punto/normas , Juego de Reactivos para Diagnóstico/normas , Esquistosomiasis Urinaria/diagnóstico , Urinálisis/instrumentación , Animales , Niño , Ensayos Clínicos Fase II como Asunto , Costa de Marfil/epidemiología , Femenino , Humanos , Masculino , Schistosoma haematobium/aislamiento & purificación , Esquistosomiasis Urinaria/orina , Urinálisis/normas
14.
PLoS One ; 14(6): e0218369, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31246963

RESUMEN

BACKGROUND: Point of-care (POC) HIV-1 RNA tests which are accurate and easy to use with limited infrastructure are needed in resource-limited settings (RLS). We systematically reviewed evidence of POC test performance compared to laboratory-based HIV-1 RNA assays and the potential utility of these tests for diagnosis and care in RLS. METHODS: Studies published up to July 2018 were identified by a search of PUBMED, EMBASE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials. Studies evaluating the use of POC HIV-1 RNA testing for early infant diagnosis (EID), acute HIV infection (AHI) diagnosis, or viral load monitoring (VL), compared to centralized testing, were included. Separate search strategies were used for each testing objective. RESULTS: 197 abstracts were screened and 34 full-text articles were assessed, of which 32 met inclusion criteria. Thirty studies evaluated performance and diagnostic accuracy of POC tests compared to standard reference tests. Two of the thirty and two additional studies with no comparative testing reported on clinical utility of POC results. Five different POC tests (Cepheid GeneXpert HIV-1 Quantitative and Qualitative assays, Alere q HIV-1/2 Detect, SAMBA, Liat HIV Quant and Aptima HIV-1 Quant) were used in 21 studies of VL, 11 of EID and 2 of AHI. POC tests were easy to use, had rapid turnaround times, and comparable accuracy and precision to reference technologies. Sensitivity and specificity were high for EID and AHI but lower for VL. For VL, lower sensitivity was reported for whole blood and dried blood spots compared to plasma samples. Reported error rates for Cepheid GeneXpert Qual (2.0%-5.0%), GeneXpert Quant (2.5%-17.0%) and Alere q HIV-1/2 Detect (3.1%-11.0%) were higher than in WHO prequalification reports. Most errors resolved with retesting; however, inadequate sample volumes often precluded repeat testing. Only two studies used POC results for clinical management, one for EID and another for VL. POC EID resulted in shorter time-to-result, rapid ART initiation, and better retention in care compared to centralised testing. CONCLUSIONS: Performance of POC HIV-1 RNA tests is comparable to reference assays, and have potential to improve patient outcomes. Additional studies on implementation in limited-resources settings are needed.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/virología , VIH-1/genética , Pruebas en el Punto de Atención , ARN Viral , Factores de Edad , Infecciones por VIH/tratamiento farmacológico , VIH-1/clasificación , Humanos , Sistemas de Atención de Punto/normas , Pruebas en el Punto de Atención/normas , Reacción en Cadena de la Polimerasa , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Carga Viral/métodos
15.
Nurs Leadersh (Tor Ont) ; 32(SP): 42-57, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31099746

RESUMEN

Background: Integrated bedside terminals (IBTs) were implemented at Humber River Hospital with the goal of supporting patient independence and autonomy and improving nursing workflows. The IBTs provide access to a range of convenience and entertainment services as well as access to personal health information. Due to the novelty of the technology, there is a paucity of empirical data on patients' use of, satisfaction with and perceptions of bedside terminals. Aim: The purpose of this study was to evaluate the impact of IBTs on patient empowerment and nursing workflows. Methods: A mixed methods design was employed using a cross-sectional patient survey and semi-structured interviews with nurses. The patient survey assessed patient empowerment and satisfaction with the range of services offered through the IBT. Patient scores were summarized using descriptive statistics. Additionally, face-to-face interviews with nurses were used to illicit feedback regarding the IBTs' impacts on nursing workflows. Results: In total, 113 patients and 11 nurses participated in the study. Analysis of patient satisfaction surveys indicated that the IBTs enhanced the patient experience and increased self-care management. Nurses reported that the IBTs helped patients feel comfortable and entertained and helped enhance the nurse-patient relationship. However, nurses also expressed concern that elderly patients were less inclined to use the IBT. Conclusion: The results from the present study suggest that the IBT system has the potential to empower patients and decrease demands on nurses. Patients' notes incorporated into the IBT may provide the necessary level of involvement to garner a greater sense of patient empowerment. The IBT does not replace the need for nurses to deliver information to patients in a manner that supports their trust.


Asunto(s)
Participación del Paciente/métodos , Sistemas de Atención de Punto/normas , Flujo de Trabajo , Adulto , Anciano , Distribución de Chi-Cuadrado , Terminales de Computador/normas , Terminales de Computador/tendencias , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Relaciones Enfermero-Paciente , Atención de Enfermería/métodos , Ontario , Satisfacción del Paciente , Sistemas de Atención de Punto/tendencias , Encuestas y Cuestionarios
16.
BMC Med ; 17(1): 76, 2019 04 08.
Artículo en Inglés | MEDLINE | ID: mdl-30961588

RESUMEN

BACKGROUND: Warfarin is a widely used oral anticoagulant. Determining the correct dose required to maintain the international normalised ratio (INR) within a therapeutic range can be challenging. In a previous trial, we showed that a dosing algorithm incorporating point-of-care genotyping information ('POCT-GGD' approach) led to improved anticoagulation control. To determine whether this approach could translate into clinical practice, we undertook an implementation project using a matched cohort design. METHODS: At three clinics (implementation group; n = 119), initial doses were calculated using the POCT-GGD approach; at another three matched clinics (control group; n = 93), patients were dosed according to the clinic's routine practice. We also utilised data on 640 patients obtained from routinely collected data at comparable clinics. Primary outcome was percentage time in target INR range. Patients and staff from the implementation group also provided questionnaire feedback on POCT-GGD. RESULTS: Mean percentage time in INR target range was 55.25% in the control group and 62.74% in the implementation group; therefore, 7.49% (95% CI 3.41-11.57%) higher in the implementation group (p = 0.0004). Overall, patients and staff viewed POCT-GGD positively, suggesting minor adjustments to allow smooth implementation into practice. CONCLUSIONS: In the first demonstration of the implementation of genotype-guided dosing, we show that warfarin dosing determined using an algorithm incorporating genetic and clinical factors can be implemented smoothly into clinic, to ensure target INR range is reached sooner and maintained. The findings are like our previous randomised controlled trial, providing an alternative method for improving the risk-benefit of warfarin use in daily practice.


Asunto(s)
Anticoagulantes/administración & dosificación , Coagulación Sanguínea/genética , Cálculo de Dosificación de Drogas , Pruebas Genéticas/métodos , Pruebas en el Punto de Atención , Warfarina/administración & dosificación , Anciano , Anciano de 80 o más Años , Algoritmos , Anticoagulantes/farmacocinética , Coagulación Sanguínea/efectos de los fármacos , Estudios de Casos y Controles , Estudios de Cohortes , Relación Dosis-Respuesta a Droga , Femenino , Genotipo , Humanos , Ciencia de la Implementación , Masculino , Persona de Mediana Edad , Pruebas de Farmacogenómica , Sistemas de Atención de Punto/organización & administración , Sistemas de Atención de Punto/normas , Reino Unido/epidemiología , Warfarina/farmacocinética
17.
Exp Parasitol ; 201: 21-25, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31029698

RESUMEN

Anaplasma phagocytophilum, the bacterial pathogen responsible for tick-borne fever and human granulocytic anaplasmosis, can seriously affect the health of humans and a wide range of other mammals. In this study, we developed a recombinase polymerase amplification (RPA) assay to detect A. phagocytophilum in clinical samples. Following alignment of the relevant DNA sequences, a pair of specific primers based on the 16S rRNA gene was designed to specifically detect A. phagocytophilum. The assay was performed at a constant temperature of 38 °C for 30 min, with a final primer concentration of 0.4 µM. The specificity of the primers was confirmed when DNA from A. phagocytophilum was used as the positive control, and DNA from other related pathogens were used as the negative controls, with ddH2O acting as the blank control. The results showed that the primers did not cross-react with DNA from the other related pathogens. The assay's detection limit was 1.77 × 10-5 ng/µl, a 10 × higher sensitivity level than that determined for nested PCR. The RPA assay's performance was evaluated using 44 clinical samples, and the prevalence results for A. phagocytophilum were found to not differ significantly between the RPA assay and the nested PCR. Thus, we have developed a specific, sensitive, rapid and cost-effective RPA method, requiring only a water bath, for the detection of A. phagocytophilum. The assay should be especially useful in resource-limited areas where access to laboratory equipment is limited.


Asunto(s)
Anaplasma phagocytophilum/aislamiento & purificación , Ehrlichiosis/veterinaria , Reacción en Cadena de la Polimerasa/veterinaria , Enfermedades de las Ovejas/microbiología , Anaplasma phagocytophilum/genética , Animales , Análisis Costo-Beneficio , ADN Bacteriano/sangre , ADN Bacteriano/química , ADN Bacteriano/aislamiento & purificación , ADN Polimerasa Dirigida por ADN , Ehrlichiosis/diagnóstico , Ehrlichiosis/microbiología , Sistemas de Atención de Punto/economía , Sistemas de Atención de Punto/normas , Reacción en Cadena de la Polimerasa/economía , Reacción en Cadena de la Polimerasa/normas , ARN Ribosómico 16S/genética , Recombinasas , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Ovinos , Enfermedades de las Ovejas/diagnóstico , Factores de Tiempo
18.
Diagn Microbiol Infect Dis ; 94(4): 342-343, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30971360

RESUMEN

The Alere-i™ Influenza A&B (Abbott), a nicking endonuclease amplification reaction test, has recently been improved in order to deliver results in a few minutes. Our field observation highlights two problems with this new version: improper interpretation of a test as valid despite improper reagent hydration and falsely influenza B positive results. We advise users of the new system to check reagent hydration prior to reporting a result and to systematically confirm positive influenza B results.


Asunto(s)
Virus de la Influenza B/aislamiento & purificación , Gripe Humana/diagnóstico , Técnicas de Diagnóstico Molecular/normas , Juego de Reactivos para Diagnóstico/normas , Adulto , Reacciones Falso Positivas , Francia , Humanos , Virus de la Influenza B/genética , Masculino , Técnicas de Amplificación de Ácido Nucleico/normas , Sistemas de Atención de Punto/normas , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad
19.
JMIR Mhealth Uhealth ; 7(4): e12551, 2019 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-30973339

RESUMEN

BACKGROUND: Nurses are increasingly spending time on computers, and providing them with a tailored tool to access clinical information and perform documentation at the bedside could help to improve their efficiency. Designing an app to support nurses' work at the bedside is a challenging task, given the complexity of the care process. OBJECTIVE: This study aimed to present the design, development, and testing of a smartphone app for nurses guided by an adapted software development life cycle model that takes into consideration the complexity and constraints of a health care setting. METHODS: The model drives us through an iterative development process intersected by 3 stages of formative evaluation of growing ecological validity. RESULTS: The initial requirements identification stage included 11 participants who helped us select the most important functionalities to integrate into the tool. Starting with a usability evaluation allowed for the identification of design issues that could have caused misuse. Then, making on-site evaluations under the supervision of an investigator helped to understand the adequacy of the tool with limited risks. Finally, the on-site evaluation allowed us to validate the acceptance of the app by caregivers. CONCLUSIONS: The interpretation of the collected evaluation confirms the necessary involvement of end users early in the process to help address the heterogeneity of the nursing workflow processes in the different wards. We also highlight the delicate balance between high-security measures to protect access to patient data and maintaining ease of access for efficiency and usability. Although a close collaboration with clinicians throughout the entire project facilitated the development of a tailored solution, it was also important to involve all stakeholders, in particular, the information technology (IT) security officers.


Asunto(s)
Aplicaciones Móviles/normas , Atención de Enfermería/normas , Sistemas de Atención de Punto/normas , Diseño de Software , Adulto , Femenino , Grupos Focales/métodos , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/estadística & datos numéricos , Atención de Enfermería/métodos , Atención de Enfermería/estadística & datos numéricos , Sistemas de Atención de Punto/estadística & datos numéricos , Investigación Cualitativa , Evaluación de la Tecnología Biomédica/métodos , Telemedicina/instrumentación , Telemedicina/métodos
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