The Precision Medicine Approach in Oncology
David E. Thurston, Ilona Pysz in 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.
Breathomics and its Application for Disease Diagnosis: A Review of Analytical Techniques and Approaches
Raquel Cumeras, Xavier Correig in Volatile organic compound analysis in biomedical diagnosis applications, 2018
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.
Common Viral Infections
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
A number of diagnostic techniques including RT-PCR, immunofluorescent assay (IFA), and enzyme immunoassay (EIA) on direct patient specimens have been developed and offer same-day results. Although both sensitive and specific, RT-PCR is expensive and is not widely commercially available. Rapid tests for the direct detection of influenza viral proteins although not as sensitive as culture or RT-PCR are appealing because results can be available in < 1 hr and are easy to perform (Table 2) (1,6). Sensitivity of commercial tests in elderly inpatients is approximately 50%, yet specificity remains good and results can be used to guide antiviral therapy and appropriate isolation. Rapid testing has been evaluated in the nursing home setting and when used in combination with viral culture is associated with lower institutional attack rates than when viral culture alone is used for diagnosis. The use of rapid testing followed by viral culture on negative specimens provides rapid results without sacrificing sensitivity. Point-of-care testing can now be done in outpatient settings, and questions have arisen regarding the cost-effectiveness of this practice. Outpatient influenza testing should be individualized according to the complexity of the patient and the degree of influenza activity in the community.
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].
The potential value of rapid, cloud-enabled onsite testing for the diagnosis of rheumatoid arthritis in the United States
Published in Journal of Medical Economics, 2018
Katalin Bognar, Jason Shafrin, Michelle Brauer, Lauren Zhao, Rick Hockett, Michael O’Neil, Anupam Jena
To address these delays, during the last few decades, point-of-care testing was introduced as an approach to improve diagnostic and evaluative processes and facilitate continuity in patient care. Point-of-care testing deviates from traditional, centralized laboratory testing by incorporating a heightened element of convenience for the patient. Although convenient, point-of-care testing has faced challenges in quality assurance3. Because point-of-care testing is generally conducted by clinical staff as opposed to laboratory-trained personnel, technical errors are common4. As a result, point-of-care testing has been used predominantly, and almost exclusively, for low complexity diagnostic testing, i.e. glucose monitoring1. The restricted use of point-of-care testing suggests the benefits of decentralized testing and high quality evaluation were not previously available in any existing technology on the market.
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].
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