Point-of-care testing incorporates the newest most sophisticated techniques to identify variations in the genetic sequence at the bedside – enabling clinicians to react and alter therapy based upon the results.
Traditional genetic testing involves the analysis of DNA in order to detect genotypes related to a heritable disease or phenotype of interest for clinical purposes. However, current testing methods require days to weeks before results are available limiting the clinical applicability of genetic testing in a number of circumstances.
Recently, the first point-of-care genetic test in medicine was demonstrated to be effective in identifying CYPC* carriers allowing tailoring of anti-platelet regimens to reduce high on treatment platelet reactivity. In the RAPID GENE study , Drs. Jason Roberts and Derek So from the University of Ottawa Heart Institute validated a pharmacogenomics approach in patients undergoing percutaneous coronary intervention for acute coronary syndrome or stable coronary artery disease.
This study is the first in medicine to incorporate point-of-care testing with genetics into routine clinical care and decision making.
Point-of-care testing (POCT) is defined as medical testing at or near the site of patient care. The driving notion behind POCT is to bring the test conveniently and immediately to the patient. This increases the likelihood that the patient, physician, and care team will receive the results quicker, which allows for immediate clinical management decisions to be made. POCT includes: blood glucose testing, blood gas and electrolytes analysis, rapid coagulation testing(PT/INR,Alere, Microvisk Ltd), rapid cardiac markers diagnostics(TRIAGE,Alere), drugs of abuse screening, urine strips testing, pregnancy testing, fecal occult blood analysis, food pathogens screening, hemoglobin diagnostics, infectious disease testing and cholesterol screening.
POCT is often accomplished through the use of transportable, portable, and handheld instruments (e.g., blood glucose meter, nerve conduction study device) and test kits (e.g., CRP, HBAC, Homocystein, HIV salivary assay, etc.). Small bench analyzers or fixed equipment can also be used when a handheld device is not available--the goal is to collect the specimen and obtain the results in a very short period of time at or near the location of the patient so that the treatment plan can be adjusted as necessary before the patient leaves. Cheaper, smaller, faster, and smarter POCT devices have increased the use of POCT approaches by making it cost-effective for many diseases, such as diabetes, carpal tunnel syndrome (CTS) and acute coronary syndrome.Many point-of-care test systems are realized as easy-to-use membrane-based test strips, often enclosed by a plastic test cassette. This concept often is realized in test systems for detecting pathogens. Very recently such test systems for rheumatology diagnostics have been developed, too. These tests require only a single drop of whole blood, urine or saliva, and they can be performed and interpreted by any general physician within minutes.
Major benefits are obtained when the output of a POCT device is made available immediately within an electronic medical record. Results can be shared instantaneously with all members of the medical team through the software interface enhancing communication by decreasing turn around time (TAT). A reduction in morbidity and mortality has been associated with goal-directed therapy (GDT) techniques when used in conjunction with POCT and the electronic medical record.
POCT has become established worldwide and finds vital roles in public health. Many monographs in the Thai and Indonesian languages emphasize POCT as the normal standard of care.
Potential operational benefits of POCT:More rapid decision making and triage, reduce operating times, reduce high-dependency, postoperative care time, reduce emergency room time, reduce number of outpatient clinic visits, reduce number of hospital beds required, ensure optimal use of professional time.
The term point-of-care testing or short POCT to German near-patient laboratory diagnostics referred, medical diagnostic tests that are not in a central laboratory, but in the hospital immediately on the ward, in the practice of a medical practitioner, or a public pharmacy be carried out. In certain situations, such as emergencies, a use outside of such a device is possible, for example, in the home of patients or in an ambulance.
In some studies, an application is also provided by the patient, such as when pregnancy tests , when coagulation self-management , or in the blood glucose monitoring by diabetics.
In a broader sense, the term point-of-care testing for appropriate diagnostic methods used in other application areas, such as in the food and environmental analysis. Frequently used in German names for such investigations are on-site tests or rapid tests.
Point-of-care assays have the advantage that the results are available within a short time, partly because of the transport of the samples to a specialized laboratory is eliminated and must be taken to another no account of the timing within the laboratory. The so-called turn-around-time (TAT), ie the time that elapses until the result is present, often between and minutes. It is much less than the recoverable even under optimal conditions TAT in the central laboratory.
This time advantage is especially important in areas where quick decisions must be made on the basis of laboratory results. POCT is therefore mainly due to intensive care units and in the anesthesia , but also in outpatient clinics or in the dialysis used. In general, there are so-called emergency parameters such as electrolytes , blood gas - and blood coagulation , renal function , cardiac enzymes, and other readings. But urine tests, creating a blood count or the rapid detection of pathogens , or autoimmune diseases such as rheumatoid arthritis are using point-of-care methods possible.
Disadvantages of Point-of-care testing is primarily to higher reagent costs and often methodologically induced lower analytical sensitivity (sensitivity) and specificity (accuracy). Also, the sample throughput is typically much lower than for the corresponding laboratory methods. In addition, only some parameters are appropriate rapid test methods.
A test at the point-of-care (POCT) is defined as medical analysis carried out in the vicinity of the site of care and patient care. The driving concept behind the POCT is to bring in and test the most convenient and immediate to the patient. This increases the likelihood that the patient, the doctor and the care team to receive the results more quickly. This implies that the diagnostic and therapeutic decisions and further analysis to be carried out are carried out with a greater immediacy. The tests POCT are often made through the use of instruments transportable, portable and handheld (for example, the glucometer in the blood ) and test kits (eg, PCR , HbAc, homocysteine , HIV test salivary and others).
When a device handheld is not available analyzers can be used to counter small or even to fixed equipment. The objective is to collect the sample and get results in a very short period of time and in the immediate area or clinic where the patient is. In this way, the treatment plan and the initial care may be provided with rapid and appropriate corrections based on data from laboratory , before the patient is transferred to a specialist department or other hospital most suitable.
POCT devices cheaper, smaller, faster, more reliable, have increased the use of POCT approaches. In some cases this approach for many diseases (diabetes, carpal tunnel syndrome) , acute coronary syndrome) has been shown to also cost-effective.
The various types of POCT include: proof of blood sugar , determination of ' blood gas analysis , determination of electrolytes , tests of coagulation fast (PT / INR, Alere), rapid diagnosis of cardiac markers (TRIAGE, Alere), screening for drugs of abuse, routine testing of urine , pregnancy test , determination of fecal occult blood (SOF), determination of hemoglobin , screening cholesterol , screening tests for food pathogens, tests for infectious diseases.
Many systems for testing POCT are made of plastic material and are based on test strips. This traditional approach is that they are based on the most recently glucometer and also some diagnostic systems of rheumatology (determination of PCR, anti-streptolysin O, rheumatoid factor). These tests require only a drop of whole blood, urine or saliva , and can be performed and interpreted by any doctor in a few minutes.
The main advantages are obtained when the results of a POCT device is available immediately through the export of data to an EHR. In this way the results can be instantly shared with all members of the medical team thanks to the software and thereby to reduce the so-called turn around time (TAT), ie the travel time of a request needed to obtain the result or the response of the report. According to some studies, a reduction in morbidity and mortality was observed using techniques of goal-directed therapy, GDT (early therapy directed to the goal) used in combination with POCT and the electronic medical record.
POCT tests have now established worldwide and play a vital role in the organization of public health services. There are some scientific papers and monographs, especially reports from Thailand and Indonesia , who point out that the POCT should be considered a normal standard of care (NB: the limitation of these works is that they are the same author).
The POCT presenterebbero potential benefits: the triage and decision-making process would be faster, would reduce the operating time, reducing the time of post-operative care, reduction of time spent in the emergency room, reducing the number of outpatient visits, reduction of hospitalizations.
The main disadvantage of a POCT is represented by a fundamental incompatibility with the results of the central laboratory. Also you must be aware of other possible disadvantages, usually caused by a bad design of POCT.
Point of care testing (POCT) is a method for a laboratory test run alongside or near the bed of the patient. In English it is sometimes called bedside testing. The operations are performed outside the laboratory by trained nurses or technicians. The responsibility for the quality of the tests is to the clinical chemist.
Point of care testing is increasingly used in the hospital at times when rapid results are required and can not wait to transport the material to the laboratory because direct intervention of the doctor may be necessary. The meter is the best known example.