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Nursing Annotated Bibliography on Health Informatics Paper

Nursing Annotated Bibliography on Health Informatics Paper

Nursing Annotated Bibliography on Health Informatics: Point-of-Care Testing

The systems of testing in healthcare can either be centralized (central laboratory) or available at the point-of-care. Point-of-care testing refers to the rapid tests that are available within the vicinity of the patient’s bed (Gous et al., 2018). Due to the demerits associated with centralized laboratories such as delayed results, delayed initiation of treatment and the distorted specimen, point-of-care testing is a strategy to minimize the gaps. Following the potential impacts the point-of-care testing has on the quality of patient care, for example reducing the diagnostic time and ensuring a rapid initiation of treatment, I choose to explore the topic.

Reliable and recommended medical databases such as the Google Scholar, PubMed and the ProQuest are used. As part of the research process, I employed the Boolean strategy, using the operators AND, OR and NOT. Hereafter are examples of the search terms I used; point-of-care testing technology, imaging technology, blood gas analysis technology and infectious disease testing and technology. The following annotated bibliography explores the role of technology in enhancing quality of care through the point-of-care testing.

Annotated Bibliography

This article explores the use of point-of-care technology in testing for Mycobacterium tuberculosis and detecting the strains resistant to Rifampin. The article discusses a new technology that improves and replaces the existing Xpert MTB/RIF. Since its endorsement in 2010 by the World Health Organization, the Xpert MTB/RIF has been used by over 130 countries as a point-of-care testing for Tuberculosis [TB] (Chakravorty et al., 2017). However, due to its demerits such as decreased sensitivity for smear negative samples, and the decreased detection for Rifampin resistant strains, a new version, an Xpert MTB/RIF Ultra was developed.

The findings of the research reveal that the Ultra has better detection for TB as compared to the Xpert. To underpin the statement, the Ultra has a 100% detection for samples as low as 25 CFU/ml. Contrarily, the Xpert detection rate lowered to 85%, 50% and 10% for 100, 50 and 25 CFU/ml (Chakravorty et al., 2017). Additionally, the overall sensitivity for Ultra is higher (87.5%) than the Xpert with a sensitivity of 81%. The Ultra’s sensitivity for smear negative samples is also high (78.9%) as compared to the Xpert (66%). The advantage of Ultra when used as a point-of-care testing includes quick results and better detection for TB (Chakravorty et al., 2017). Therefore, treatment can be initiated rapidly, and the chances for transmission are reduced; this improves care quality.

Further, the Ultra is capable of detecting mutations that are associated with Rifampin resistance, and therefore, informs the choice for therapy. The ability to detect Rifampin resistant MTB saves the patient from a prolonged exposure to unhelpful medications and the potential adverse effects of the medications; therefore, improving the safety of patient cares. An interdisciplinary team consisting of doctors and the laboratory technicians must therefore work as a team to improve the diagnosis of MTB. Even though the tests are available, organizational factors such as training on the use of the new technologies are crucial. In conclusion, the study recommends an increased embracement of the new point of care technologies to improve the diagnosis and treatment of MTB and the Rif resistant strains.

The article provides a review about the use of point-of-care ultrasound (POCUS) for patients with pulmonary pathologies in the emergency and the critical care units. Initially, before the widespread use of POCUS, chest X-Rays and chest Computed Tomography scans were popular. However due to the technical difficulties related to chest X-Rays which ultimately led to decreased accuracy of the results, and the exposure to radiation which put patients and care providers at risk of developing neoplastic mutations, a new method was required. Besides being expensive, chest CT scans also expose patients to high amounts of radiation. To solve the problems, a POCUS has been shown to be superior to lung CT scans and chest X-rays in detecting some of the lung pathologies. A POCUS is less expensive, portable, and non-invasive, provides quick results and do not expose patients to ionizing radiation (Shrestha, Weeratunga & Baker, 2018.). A POCUS is therefore safe due to the lack of radiation, and improves patient care following quick detection of lung pathologies. According to the review, a POCUS has an accuracy of 93% and 100% as compared to CXR and chest CT scans respectively, in diagnosing and ruling out interstitial syndrome (Shrestha et al., 2018).

In detection of lung consolidations, the POCUS has been shown to have a sensitivity of 90% and a specificity of 98% (Shrestha et al., 2018). Further, in low risk patients with pulmonary embolism, an ultrasound can be used as an alternative test in case the recommended CT pulmonary angiography is contraindicated. Moreover, a POCUS can be used to guide procedures for example thoracentesis. According to the review, an ultrasound guided thoracentesis has reduced risks for complications (pneumothorax) by 0-9.1% (Shrestha et al., 2018). This improves patient care and safety by preventing iatrogenic pneumothorax. Moreover, according to the review, care providers take at least 3 minutes to perform a POCUS test; this time is sufficient to make a diagnosis and to initiate a rapid treatment which grants quality care. Despite the efficacy of a POCUS, the organization must conduct a formal training that aims at improving the knowledge and skills of the care providers that perform the POCUS tests. In conclusion, the review recommends POCUS as an effective tool to diagnose pulmonary pathologies and to monitor and guide the treatments.

The article addresses a new rapid point-of-care technology that can be used even in low resource environments to test for COVID-19. The test is known as SHERLOCK (Specific High Sensitivity Enzymatic Reporter UnLOCKing). Before SHERLOCK, the US Food and Drug Administration approved the Cephid Gene Expert and the Abbot ID NOW as the two point-of-care tests. However, due to technical difficulties, expensive equipment and instruments, and the limited widespread use, there was a need to develop an affordable and an easy-to-use test. In this article, a simple test, the STOP (SHERLOCK testing in one pot) is discussed.

The test provides results in less than one hour and can be used to initiate a rapid therapy to minimize the spread of the infection. The limit of detection of the test is 100 copies of the viral genome in either a nasopharyngeal swab or in saliva. Further, the sample processing process of the test is minimal, and do not require complex equipment of instrumentation; therefore, it can be used at home or at low-resource settings even by lay users (Joung et al., 2020). Most patients report that they are uncomfortable during a nasopharyngeal swab; this test, however, can utilize saliva which is easily collected and has similar viral loads as the nasopharyngeal swabs.

Technology and chemistry are integrated to amplify the viral RNA and also to detect the resulting amplicon. Due to the rapid results (< 1-hour) and the comfort to patients (saliva used instead of a nasopharyngeal swab), patient care and satisfaction is improved. An organizational hindrance, including lack of finances to secure the required reagents can thoroughly delay the testing.

This article discusses a rapid and a less expensive point of care technology to measure blood ammonia levels in patients where the test is indicated. Elevated ammonia levels, hyper ammonia, can be detrimental. It causes encephalopathy which present as confusion, memory loss, mood changes and somnolence (Veltman et al., 2020). Hyper ammonia can also cause permanent neurologic sequelae such as brain damage. To avoid the adversities, there is a need for a rapid point of care test. The standard test requires a volume of 1-3ml of blood, and takes nearly 2-hours to produce the results; this delays the diagnosis of hyper ammonia, a detrimental condition (Veltman et al., 2020). Further, the phlebotomy is traumatic, and can cause significant hemorrhage which lead to anemia particularly in children. Moreover, the samples have to be transported to a central laboratory, a duration which takes long and during which samples can be distorted.

This study discusses an alternative point of care test that utilizes small volumes of blood and is portable. This method utilizes a sensor technology, which detects ammonia in gaseous state. This method generates results in less than 2-minutes therefore facilitate rapid interventions. Further, the test is inexpensive, and can be used even in low resource settings. The method has a first-generation device which can utilize up to 100microlitres of blood, and a second generation which uses 10-20 microliters of blood; this limits the risk for excessive blood loss via phlebotomy.

The test has been proven to be rapid and accurate, conferring speed (<2-minutes). It resembles a glucometer, easy to perform and can facilitate repeatability. Rapid diagnosis and initiation of therapy, in addition to the limited trauma and blood loss reduces mortality from hyper ammonia and improves patient care, safety and satisfaction.

Conclusion

            Concerning the substitution of Xpert MTB/RIF for Ultra, better detection of MTB and Rifampin resistant strains have been reported. This has resultant effects on the diagnosis, treatment and transmission of MTB. About the use of lung ultrasound in critical care unit, the modality is inexpensive, portable, and non-invasive and have better efficacy in detecting various lung pathologies. As compared to the CXR and CT scan which expose patients to radiation, it is a safe point of care imaging modality.

The STOPCovid test confers speed (less than 1-hour); therefore, facilitating a rapid diagnosis and treatment which ultimately reduces the rate of transmission. Further, due to the detrimental nature of hyper ammonia, the portable ammonia detector (PAD) is useful in preventing the permanent neurologic sequelae of the condition. The above publications underpin the importance of technology in improving patient care and safety by improving the diagnosis and treatment of various conditions.

Despite the significance of the technologies, organizational factors play a role in their use. For example, organizations without the required technical staff experience difficulties in implementing the point-of-care technologies. Further, organizations must conduct adequate training to the staff to handle the technologies. Moreover, financial strains, as cited in the acquisition of the reagents and instruments for the SHERLOCK test derails the implementation. Even though MTB is a global health concern, the success of the point of care test is justified by the decrease in the rates of transmission. Further, reduced mortality from lung pathologies in the emergency and critical care units justifies the success of POCUS in rapid diagnosis and treatment of the pathologies. Additionally, unlike initially when the Covid-19 results would delay, the STOP-Covid test produces results in less than an hour therefore justifying its success.

References

  • Chakravorty, S., Simmons, A. M., Rowneki, M., Parmar, H., Cao, Y., Ryan, J., Banada, P. P., Deshpande, S., Shenai, S., Gall, A., Glass, J., Krieswirth, B., Schumacher, S. G., Nabeta, P., Tukvadze, N., Rodrigues, C., Skrahina, A., Tagliani, E., Cirillo, D. M., … Alland, D. (2017). The new Xpert MTB/RIF Ultra: Improving detection of Mycobacterium tuberculosis and resistance to rifampin in an assay suitable for point-of-care testing. MBio, 8(4). https://doi.org/10.1128/mBio.00812-17
  • Gous, N., Boeras, D. I., Cheng, B., Takle, J., Cunningham, B., & Peeling, R. W. (2018). The impact of digital technologies on point-of-care diagnostics in resource-limited settings. Expert Review of Molecular Diagnostics, 18(4), 385–397. https://doi.org/10.1080/14737159.2018.1460205
  • Joung, J., Ladha, A., Saito, M., Segel, M., Bruneau, R., Huang, M.-L. W., Kim, N.-G., Yu, X., Li, J., Walker, B. D., Greninger, A. L., Jerome, K. R., Gootenberg, J. S., Abudayyeh, O. O., & Zhang, F. (2020). Point-of-care testing for COVID-19 using SHERLOCK diagnostics. MedRxiv : The Preprint Server for Health Sciences. https://doi.org/10.1101/2020.05.04.20091231
  • Shrestha, G. S., Weeratunga, D., & Baker, K. (2018). Point-of-Care Lung Ultrasound in Critically ill Patients. Reviews on Recent Clinical Trials, 13(1), 15–26. https://doi.org/10.2174/1574887112666170911125750
  • Veltman, T. R., Tsai, C. J., Gomez-Ospina, N., Kanan, M. W., & Chu, G. (2020). Point-of-care analysis of blood ammonia with a gas-phase sensor. ACS Sensors, 5(8), 2415–2421. https://doi.org/10.1021/acssensors.0c00480