Diagnostic and economic evaluation of a point-of-care test for respiratory syncytial virus.

Respiratory syncytial virus is a common cause of bronchiolitis. Historically, point-of-care tests have involved antigen detection technology with limited sensitivity. The aim of this study was to prospectively evaluate the diagnostic accuracy and model the economic impact of the Roche cobas® Liat® point-of-care influenza A/B and respiratory syncytial virus test. The "DEC-RSV" study was a multi-centre, prospective, observational study in children under 2 years presenting with viral respiratory symptoms. A nasopharyngeal aspirate sample was tested using the point-of-care test and standard laboratory-based procedures. The primary outcome was accuracy of respiratory syncytial virus detection. The cost implications of adopting a point-of-care test were modelled using study data. A total of 186 participants were recruited, with both tests performed on 177 samples. The point-of-care test was invalid for 16 samples (diagnostic yield 91%) leaving 161 available for primary analysis. After resolving discrepancies, the cobas® Liat® respiratory syncytial virus test had 100.00% (95% CI 96.07%-100.00%) sensitivity and 98.53% (95% CI 92.08%-99.96%) specificity. Median time to result was 0.6 h (interquartile range (IQR) 0.5-1) for point-of-care testing and 28.9 h (IQR 26.3-48.1) for standard laboratory testing. Estimated non-diagnostic cost savings for 1000 patients, based on isolation decision-making on point-of-care test result, were £57 010, which would increase to £94 847 when cohort nursing is used. In young children the cobas® Liat® point-of-care respiratory syncytial virus test has high diagnostic accuracy using nasopharyngeal aspirates (currently an off-licence sample type). Time to result is clinically important and was favourable compared to laboratory-based testing. The potential exists for cost savings when adopting the point-of-care test.

An in vitro study of electrically active hydroxyapatite-barium titanate ceramics using Saos-2 cells.

Electrically active ceramics are of interest as bone graft substitute materials. This study investigated the ferroelectric properties of hydroxyapatite-barium titanate (HABT) composites and the behaviour of osteoblast-like cells seeded on their surfaces. A piezoelectric coefficient (d(33)) of 57.8 pCN(-1) was observed in HABT discs prepared for cell culture. The attachment, proliferation, viability, morphology and metabolic activity of cells cultured on unpoled HABT were comparable to those observed on commercially available hydroxyapatite at all time points. No indication of the cytotoxicity of HABT was detected. At one day after seeding, cell attachment was modified on both the positive and negative surfaces of poled HABT. After longer incubations, all parameters observed were comparable on poled and unpoled ceramics. The results indicate that HABT ceramics are biocompatible in the short term in vitro and that further investigation of cell responses to these materials under mechanical load and at longer incubation times is warranted.