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Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 11/16/2017 - If people with celiac disease hope to avoid complications, then it's important for their gut mucosa to heal. However, besides biopsy, there is currently no good way for doctors to assess that a patient has healed enough to experience full remission. A team of researchers recently set out to assess the role of a point-of-care test (POCT) based on IgA/IgG-deamidated gliadin peptide, in detecting persistent villous atrophy in celiac disease. The research team included Michelle S Lau, Peter D Mooney, William L White, Michael A Rees, Simon H Wong, Matthew Kurien, Nick Trott, Daniel A Leffler, Marios Hadjivassiliou and David S Sanders. They are affiliated with the Academic Department of Gastroenterology at Royal Hallamshire Hospital, Sheffield Teaching Hospitals, in Sheffield, UK, and with the Celiac Center and Division of Gastroenterology at Beth Israel Deaconess Medical Center in Boston, Massachusetts, USA. The research team recruited celiac disease patients undergoing endoscopy for the assessment of histological remission. All patients had IgA-endomysial (EMA) antibodies, IgA-tissue transglutaminase (TTG) antibodies, received a POCT, and completed a validated dietary questionnaire. All patients received a gastroscopy, with four biopsies taken from the second part of the duodenum and one from the duodenal bulb. The research team then compared the diagnostic performance of the surrogate markers against duodenal histology as the reference standard. From 2013 to 2017, the team evaluated a total of 217 celiac disease patients. 70% of patients were female, ranging in age from 16–83 years, with an average age of 53 years. Patients had been on a gluten-free diet for an average of 6 years when recruited. Eighty-five (39.2%) patients had persistent villous atrophy. The sensitivities of the POCT, TTG, EMA, and the adherence score in detecting villous atrophy were 67.1%, 44.7%, 37.7%, and 24.7% respectively (P=0.0005). The combination of the POCT and adherence score only marginally increased the sensitivity to 70.6% (59.7–80.0%). The POCT showed a higher sensitivity than the other markers in predicting villous atrophy. A POCT may help doctors get a quick, accurate assessment of mucosal healing levels during simple follow-up office visits. Source: The American Journal of Gastroenterology , (10 October 2017). doi:10.1038/ajg.2017.357
Jefferson Adams posted an article in Celiac Disease & Gluten Intolerance ResearchCeliac.com 01/19/2015 - A team of researchers set out to determine what factors might influence dissemination of a new and validated commercial Point-of-Care Test (POCT) for celiac disease, in the Mediterranean area, when used in settings where it was designed to be administered, especially in countries with poor resources. The research team included S. Costa, L. Astarita, M. Ben-Hariz, G. Currò, J. Dolinsek, A. Kansu, G. Magazzu, S. Marvaso, D. Micetic-Turku, S. Pellegrino, G. Primavera, P. Rossi, A. Smarrazzo, F. Tucci, C. Arcidiaco, and L. Greco. For their study, the team relied on family pediatricians in Italy, and nurses and pediatricians in Slovenia and Turkey, to look for celiac disease in 3,559 children aged 1-14 years, 1,480 (ages 14-23 years) and 771 (1-18 years) asymptomatic subjects, respectively. This was done at pediatrician offices, schools and university primary care centers The team used a new POCT that detects IgA-tissue antitransglutaminase antibodies and IgA deficiency in a finger-tip blood drop. Subjects with positive screens and those suspected of having celiac disease were referred to a Celiac Centre to confirm the diagnosis. The team then estimated POCT Positive Predictive Value (PPV) at tertiary care (with Negative Predictive Value) and in primary care settings, and POCT and celiac disease rates per thousand in primary care. At tertiary care setting, PPV of the POCT and 95% CI were 89.5 (81.3-94.3) and 90 (56-98.5) with Negative Predictive Value 98.5 (94.2-99.6) and 98.7% (92-99.8) in children and adults, respectively. In primary care settings of different countries where POCT was performed by a different number of personnel, PPV ranged from 16 to 33%, and the celiac disease rates per thousand ranged from 4.77 to 1.3, while and POCT rates ranged from 31.18 to 2.59, respectively. This study shows that interpretation of POCT results by different personnel may influence the performance of POC, but that use of POCT is an urgent priority for diagnosing celiac disease among people of countries with limited resources, such as rural populations and school children. Source: BMC Gastroenterol. 2014 Dec 18;14(1):219.
Jefferson Adams posted an article in Celiac Disease Diagnosis, Testing & TreatmentCeliac.com 10/23/2013 - Celiac disease remains seriously under diagnosed in adults and, in many places, often takes years and even decades to diagnose. A team of researchers recently evaluated the usefulness of an on-site rapid fingertip whole blood point-of-care test (POCT) that would help primary workers to spot patients who might benefit from further diagnostic tests for celiac disease. The research team included Alina Popp, Mariana Jinga, Ciprian Jurcut, Vasile Balaban, Catalina Bardas, Kaija Laurila, Florina Vasilescu, Adina Ene, Ioana Anca and Markku Mäki. They are affiliated with the University of Medicine and Pharmacy “Carol Davila,” the Institute for Mother and Child Care “Alfred Rusescu,” Central University Emergency Military Hospital “Dr. Carol Davila,” Str. Mircea Vulcanescu, in Bucharest, Romania and with theTampere Center for Child Health Research, University of Tampere and Tampere University Hospital, in Tampere, Finland. Because celiac disease often runs in families, the team tested 148 healthy relatives of 70 Romanian index cases with biopsy-proven celiac disease, for a total of 87% of all first-degree family members, with a median age 36 years, for the presence of circulating autoantibodies. In addition to using the POCT to measures blood erythrocyte self-TG2-autoantibody complexes on site, the team took blood samples for later evaluation of serum IgA-class endomysial antibodies (EMA). The then tested all EMA-positive samples for transglutaminase 2 antibodies (TG2-IgA). They conducted blind analysis of all serological parameters in a centralized laboratory with no knowledge of the on site POCT result. The team recommended endoscopic small intestinal biopsies for all POCT- or EMA-test positive subjects. Overall, 12 of 148 (8%) first-degree relatives showed positive results for the POCT, and all twelve tested serum EMA-positive. Only one other test subject showed a positive EMA test result. All remaining 135 healthy first-degree relatives showed negative results for both POCT and EMA. Four subjects who tested positive for both POCT and EMA were negative for TG2-IgA. Ten out of thirteen of the antibody-positive subjects consented to endoscopy. In all, eight out of nine first-degree relatives with celiac-type mucosal lesions of grade Marsh 2 (n = 3) or Marsh 3 (n = 6) showed positive results with the POCT. The three POCT-positive subjects refused endoscopy tested positive for both EMA and TG2-IgA. The fingertip whole blood rapid POCT could be a simple and cheap way to spot biomarkers and promote further testing for faster diagnosis of celiac disease. The team is calling for further studies in adult case-finding in specialized outpatient clinics and in primary care. Source: BMC Gastroenterology 2013, 13:115. doi:10.1186/1471-230X-13-115