Facilitators and barriers for clinical implementation of a 30-minute point-of-care test for Neisseria gonorrhoeae and Chlamydia trachomatis into clinical care: A qualitative study within sexual health services in England.

Point-of-care tests (POCTs) to diagnose sexually transmitted infections (STIs) have potential to positively impact patient management and patient perceptions of clinical services. Yet there remains a disconnect between development of new technologies and their implementation into clinical care. With the advent of new STI POCTs arriving to the global market, guidance for their successful adoption and implementation into clinical services is urgently needed. We conducted qualitative in-depth interviews with professionals prior to and post-implementation of a Chlamydia trachomatis/Neisseria gonorrhoeae POCT into clinical services in England to define key stakeholder roles and explore the process of POCT integration. Participants self-identified themselves as key stakeholders in the STI POCT adoption and/or implementation processes. Data consisted of interview transcripts, which were analysed thematically using NVIVO 11. Six sexual health services were included in the study; three of which have implemented POCTs. We conducted 40 total interviews: 31 prior to POCT implementation and 9 follow-up post-implementation. Post-implementation data showed that implementation plans required little or no change during service evaluation. Lead clinicians and managers self-identified as key stakeholders for the decision to purchase, while nurses self-identified as "change champions" for implementation. Many identified senior clinical staff as those most likely to introduce and drive change. However, participants stressed the importance of engaging all clinical staff in implementation. While the accuracy of the POCT, its positive impact on patient management and the ease of its integration within existing pathways were considered essential, costs of purchasing and utilising the technology were identified as central to the decision to purchase. Our study shows that key decision-makers for adoption and implementation require STI POCTs to have laboratory-comparable accuracy and be affordable for purchase and ongoing use. Further, successful integration of POCTs into sexual health services relies on supportive interpersonal relationships between all levels of staff.

Probing oculomotor inhibition with the minimally delayed oculomotor response task.

The ability to not execute (i.e. to inhibit) actions is important for behavioural flexibility and frees us from being slaves to our immediate sensory environment. The antisaccade task is one of several used to investigate behavioural inhibitory control. However, antisaccades involve a number of important processes besides inhibition such as attention and working memory. In the minimally delayed oculomotor response (MDOR) task, participants are presented with a simple target step, but instructed to saccade not to the target when it appears (a prosaccade response), but when it disappears (i.e. on target offset). Varying the target display duration prevents offset timing being predictable from the time of target onset, and saccades prior to the offset are counted as errors. Antisaccade error rate and latency are modified by alterations in fixation conditions produced by inserting a gap between fixation target offset and stimulus onset (the gap paradigm; error rate increases, latency decreases) or by leaving the fixation target on when the target appears (overlap paradigm; error rate decreases, latency increases). We investigated the effect of gaps and overlaps on performance in the MDOR task. In Experiment 1 we confirmed that, compared to a control condition in which participants responded to target onsets, in the MDOR task saccade latency was considerably increased (increases of 122-272 ms depending on target display duration and experimental condition). However, there was no difference in error rate or saccade latency between gap and synchronous (fixation target offset followed immediately by saccade target onset) conditions. In Experiment 2, in a different group of participants, we compared overlap and synchronous conditions and again found no statistically significant differences in error rate and saccade latency. The timing distribution of errors suggested that most were responses to target onsets, which we take to be evidence of inhibition failure. We conclude that the MDOR task evokes behaviour that is consistent across different groups of participants. Because it is free of the non-inhibitory processes operative in the antisaccade task, it provides a useful means of investigating behavioural inhibition.