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The Precision Medicine Approach in Oncology
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Overall, there is widespread agreement that miniaturization of the various technologies into “micro-devices” would greatly facilitate their transition into clinical practice. In addition, the processing time and sensitivity of the technologies need to be enhanced if they are to find widespread use in rapid early diagnosis, and treatment staging and monitoring. Although technologies such as CellSearchTM need only 7.5 ml of a blood sample for efficient CTC isolation and detection, progress has been made in the development of CTC-detecting microchips which should be easier to use in a clinical setting. The vision for the future is to produce miniaturized low-cost chip-based devices validated to work with very small blood volumes (e.g., a finger prick sample). Such devices could be used for Point-of-Care testing in a doctor’s surgery, or perhaps be available as consumer products for self-testing. This would not only benefit individuals in terms of early diagnosis and a greater chance of successful treatment and prolonged survival if the presence of cancer is detected, but could also save healthcare systems significant amounts of funding through a reduced burden of late-stage cancer treatments. An example of a chip-based device that can physically capture CTCs without the involvement of antibodies is shown in Figure 11.10.
Innovating tuberculosis diagnostics for the point of care
Published in Helen Macdonald, Ian Harper, Understanding Tuberculosis and Its Control, 2019
A different definition of point-of-care testing has been put forward that centres less on specific products but puts the spotlight on diagnostic processes. The aim of point-of-care testing is to complete diagnostic cycles (test and treat) for each patient who accesses the healthcare system and to do so rapidly. Such a point-of-care continuum is ensured when a patient visits a healthcare facility and leaves with a decision that guides further care of that patient, for instance treatment initiation, referral or follow-up testing based on a diagnostic test result within one encounter—while the patient waits, or at least the same day (N. Pant Pai, Vadnais, Denkinger, Engel & Pai, 2012).
Breathomics and its Application for Disease Diagnosis: A Review of Analytical Techniques and Approaches
Published in Raquel Cumeras, Xavier Correig, Volatile organic compound analysis in biomedical diagnosis applications, 2018
David J. Beale, Oliver A. H. Jones, Avinash V. Karpe, Ding Y. Oh, Iain R. White, Konstantinos A. Kouremenos, Enzo A. Palombo
Furthermore, breath analysis is a tool which can potentially be used for human exposure assessment. Although efforts have been made to optimize breath analysis methods, there is still a need for more research demonstrating their suitability before these methods can be used routinely (validation studies). These studies should involve the standardization of collection methods and profiling via the various detection platforms available. Multiple efficient devices have also been developed which have shown potential. However, there are still issues involving leakage, adsorption and transfer processes. Lastly, the use of more sensitive and portable methods should allow for accurate identification and quantitation within a clinical environment, thus facilitating effective point-of-care testing.
Point-of-care COVID-19 testing in the emergency department: current status and future prospects
Published in Expert Review of Molecular Diagnostics, 2021
Larissa May, Nam Tran, Nathan A. Ledeboer
The SARS-CoV-2 pandemic has expanded the rise of point-of-care (POC) testing in the emergency department (ED) to improve patient flows and provide results in a timely manner. Point-of-care testing is defined as medical testing at or near the site of patient care and improving outcomes by accelerating the time from test administration to treatment (i.e. therapeutic turnaround time). Point-of-care testing is performed by clinical staff in the ED and result in under 1 hour, whereas near POC tests are performed in the laboratory by trained laboratory personnel and result in under 2 hours. Principles of development of new POC devices have been driven through the World Health Organization guidelines, known as the ASSURED guidelines. The guidelines call for affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and test results that are delivered to the end-users [9].
Evaluation of venous plasma glucose measured by point-of-care testing (Accu-Chek Inform II) and a hospital laboratory hexokinase method (Cobas c701) in oral glucose tolerance testing during pregnancy – a challenge in diagnostic accuracy
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Eva Landberg, Sofia Nevander, Mohammed Hadi, Marie Blomberg, Anna Norling, Bertil Ekman, Caroline Lilliecreutz
For the last decade, the main use of point-of-care testing (POCT) has been in situations where frequent monitoring of glucose is important, e.g. in the management of diabetes mellitus. The performance of most POCT devices in monitoring plasma glucose (P-Glucose) has been evaluated in various clinical settings showing sufficient accuracy and acceptable agreement to glucose results obtained by instruments at the central hospital laboratory [1–4]. However, the use of POCT for the diagnostic purpose is still controversial and some POCT instruments are currently considered to be insufficiently accurate, but can be acceptable after proper recalibration [5]. Haematocrit dependency, interfering substances and lot-lot variation are also factors that may contribute to decreased diagnostic performance [6]. In later years, improved technology has led to increased reliability of some POCT devises. The measuring technique of Accu-Chek Inform II, used in this study, has been improved and now includes compensation for haematocrit and temperature and detection of adequate sample volume, using alternating current impedance. The device is intended for use with venous blood in addition to capillary samples, but not for diagnostic purposes [7]. However, there are studies indicating that the performance of Accu-Chek Inform II fulfils the Swedish requirements for a method to be used for diagnostic purposes [8], that is, a deviation less than 10% for 95% of the results compared to a verified hospital method, or a reference method [4,9].
C-Reactive protein testing to guide antibiotic prescribing for COPD exacerbations (PACE study): Discussions from @respandsleepjc (#rsjc)
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2020
Alina J. Blazer, Anju Anand, Matthew B. Stanbrook
Our discussion generated several interesting questions. Regarding the study’s inclusion criteria, we wondered about the choice of using patients with physician-diagnosed COPD as opposed to having a spirometry-confirmed COPD diagnosis, especially given that 240 of 649 patients included in the study had missing spirometry data.2 Dr. Butler clarified that this represented a real-world population who were being treated as COPD patients, regardless of the possibility of an alternate diagnosis such as asthma. In addition, he explained that the goal was to conduct a pragmatic study that fitted well into usual care and was generalizable to most primary care practices. Given that spirometry is time intensive and not readily available in a general practice setting, it was not practical to guide enrollment. Additionally, he indicated the CRP point-of-care testing takes only a few minutes and could easily be accomplished over the course of a 10-minute appointment.3