Core 3 - Rapid Multipathogen Detection For POCT and Natioal Disaster Readiness

核心 3 - 用于 POCT 和国家灾难准备的快速多病原体检测

• 批准号: 8306090
• 负责人: GERALD JOSEPH KOST
• 金额: $ 1.85万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8306090
• 关键词: Altitude; American; Area; Asia; Book Chapters; California; Caring; Cessation of life; Clinical; Clinical Pathology; Communication; Community Hospitals; Contracts; Country; Critical Care; Data; Data Analyses; Detection; Development; Devices; Diagnostic; Diagnostic tests; Disaster Planning; Disasters; Education; Educational process of instructing; Educational workshop; Electronic Mail; Emergency Care; Emergency Situation; Engineering; Environment; Equipment; Europe; Evidence Based Medicine; Future; Generations; Geographic Distribution; Goals; Health Personnel; Healthcare; Heating; Human Resources; Humidity; Hurricane; Hyperglycemia; Hypoglycemia; Information Systems; Internet; Interview; Journals; Language; Leadership; Life; Medical; Medical Assistance; Military Personnel; Monograph; Multimedia; Needs Assessment; Online Systems; Pathogen detection; Patient Care; Peer Review; Population Distributions; Public Health; Publications; Quality Control; Questionnaires; Readiness; Reagent; Registries; Reporting; Research; Research Infrastructure; Resources; Role; Sampling; Scientist; Services; Shipping; Ships; Shock; Simulate; Site; Stream; Survey Personnel; Surveys; Techniques; Technology; Telemedicine; Telephone; Terrorism; Testing; Thailand; Training; Triage; Tsunami; United States; Whole Blood; Work; blood gas analyzer; demographics; design; diabetic; digital; experience; field survey; glucose monitor; instrument; member; programs; response; standard of care; tool; translational study; web site; Altitude; American; Area; Asia; Book Chapters; California; Caring; Cessation of life; Clinical; Clinical Pathology; Communication; Community Hospitals; Contracts; Country; Critical Care; Data; Data Analyses; Detection; Development; Devices; Diagnostic; Diagnostic tests; Disaster Planning; Disasters; Education; Educational process of instructing; Educational workshop; Electronic Mail; Emergency Care; Emergency Situation; Engineering; Environment; Equipment; Europe; Evidence Based Medicine; Future; Generations; Geographic Distribution; Goals; Health Personnel; Healthcare; Heating; Human Resources; Humidity; Hurricane; Hyperglycemia; Hypoglycemia; Information Systems; Internet; Interview; Journals; Language; Leadership; Life; Medical; Medical Assistance; Military Personnel; Monograph; Multimedia; Needs Assessment; Online Systems; Pathogen detection; Patient Care; Peer Review; Population Distributions; Public Health; Publications; Quality Control; Questionnaires; Readiness; Reagent; Registries; Reporting; Research; Research Infrastructure; Resources; Role; Sampling; Scientist; Services; Shipping; Ships; Shock; Simulate; Site; Stream; Survey Personnel; Surveys; Techniques; Technology; Telemedicine; Telephone; Terrorism; Testing; Thailand; Training; Triage; Tsunami; United States; Whole Blood; Work; blood gas analyzer; demographics; design; diabetic; digital; experience; field survey; glucose monitor; instrument; member; programs; response; standard of care; tool; translational study; web site

CORE 3. CLINICAL NEEDS ASSESSMENT AND DISSEMINATION Leadership in POCT Education and Dissemination. Our overall theme is criticalemergencv- disaster care. We will perform needs assessment of POCT with this theme as the unifying concept. In parallel, we will implement an interactive website to disseminate information effectively to technology developers, scientists, engineers, clinicians, rescue services, and DMATs (Disaster Medical Assistance Teams). Modern existing digital information systems, such as telemedicine, podcasting, online discussion sites, and live streaming video for web casting at the new UCDMC Education Building, which has state-of-the-art teaching suites, will allow us to accomplish these goals effectively with immediate start-up in the first year. The POCT*CTR and Its Role in Critical-Emergency-Disaster Care. POCT is defined as diagnostic testing at or near the site of patient care (Kost 2002A). POCT evolved during the 1970's. Early key concepts of POCT were developed by Dr. Kost (Kost 1999, Kost 2002A). During the 1980's, Dr. Kost conducted extensive invited talks and educational speaking tours on POCT in the United States, followed by presentations and workshops in Europe. Next, he was invited to speak, educate, and train in Asia as smaller and less expensive technologies became available worldwide (Tran 2006). Presentations focused on national development of key POCT concepts and included multimedia products such as educational PowerPoint programs, video, and country- and language-specific monographs (Kost 2003C, Kost 2006H, Kost 2006I). Over the past decade alone, the POCT¿CTR has conducted more than twenty translational studies. These studies generated forty-nine peer-reviewed journal publications and book chapters, many of them dealing with critical and emergency care. An additional set established the national standard of care for critical values for diagnostic tests. In 2006 alone, the POCT¿CTR produced seventeen publications on POCT, public health, and disaster readiness. Included was an original article in the American Journal of Clinical Pathology on how POCT was used during Hurricane Katrina and the tsunami (Kost 2006E). Those disasters proved, in a limited fashion, the feasibility of using POCT and identified key needs for future deployment of on-site testing in field rescue. However, Hurricane Katrina also proved that current generations of POC technologies are not able to withstand the harsh conditions encountered (see Core 2) in a disaster. Needs Assessment Following Hurricane Katrina and the 2004 Tsunami. We are already experienced at needs assessment for POCT. Dr. Kost's US and Thai research teams conducted field surveys, personal interviews, and data analyses shortly following these two disasters (Kost 2006E). Although countries differed greatly in their demographics and resources, results showed similar substantial deficiencies including lack of availability of POCT instruments for triage in community hospitals and in field sites where victims first appeared. Typically, there were no devices for rapid pathogen detection (see Core 1) in either the US or SE Asia. Even in the US, of the 100,000 diabetics who were without access to glucose meters and test strips during Hurricane Katrina, Cefalu et al. (2006) reported that uncontrolled hyperglycemia and hypoglycemia may have contributed to excess deaths. Despite the response to Katrina by US civilian and military organizations, we discovered a significant absence of fieldrobust POCT instruments. Although the military were equipped with handheld whole-blood analyzers, for the most part used on ships and in stable temporary environments, these devices would not have worked properly under the field conditions observed in Thailand or New Orleans. We have simulated these conditions in the research report by Sumner et al. (2007). We describe preliminary results in Core 2. Needs Assessment for Critical-Emergency-Disaster-Care¿DMATs. We will survey personnel from fifty National Disaster Medical Assistant Teams (DMATs) in the US in our needs assessment plan. We will determine the geographic distribution, medical resources, and capabilities of DMATs. These teams must be assessed because they represent professional medical personnel trained to provide care when existing healthcare infrastructure is overwhelmed by disasters or terrorism (NDMS website). They support the local healthcare infrastructure. We will contact the DMAT personnel directly by telephone and personal interview, similar to survey techniques Dr. Kost has used in several studies of critical limits (critical values) in the US. Direct contacts assure high response rate. We also will use email and web-based survey tools We plan to assess the needs of DMATs because properly equipped teams with environmentally robust POCT will be better prepared to practice evidence-based medicine during field rescues. DMATs are designed to provide rapid response that supplements local medical care until other federal or contracted resources can be mobilized. For example, two DMATs at UCDMC responded to Hurricane Katrina. Typically, our teams plan for three days of field service, but may stay one week. The teams carry two ordinary handheld blood gas analyzers with limited test menus, but no other POCT equipment. Storage and transport are routine like other supplies. There are no special devices, reagents, quality control, or containers that will endure environmental extremes of heat, cold, humidity, shock, altitude, or other factors. Nonetheless, team members we interviewed recognize the need for accurate diagnostic data on site during field rescues. Hence, DMATs would benefit from small, portable, and environmentally robust POC devices. We will conduct the survey starting with seven DMATs in the State of California, followed by remaining teams distributed across the US. Our goal is to achieve at least a 70% response rate from all DMATs identified in the US through official registries. DMATs are required to register and establish communication networking in order to be called to emergencies. The current contingency of DMATs in the United States is thought to provide geographical and statistical representation of population distributions. Hence, survey sampling will reflect similar demographic features. However, we recognize that some areas in the US may be deficient in these disaster response resources. Therefore, when we identify such deficiencies, we will survey regional healthcare resources to determine if they have incorporated POCT in disaster planning. We are working on the survey questionnaire currently. Below are examples of survey questions¿

核心3。临床需求评估和传播 POCT教育和传播领域的领导。我们的总体主题是Criedemergencv- 灾难护理。我们将以此主题对POCT进行需求评估 统一概念。同时，我们将实施一个交互式网站来传播信息 有效地向技术开发人员，科学家，工程师，临床医生，救援服务和 DMAT（灾难医疗援助团队）。现代现有的数字信息系统，例如 作为远程医疗，播客，在线讨论网站和网络播放的实时流媒体视频 拥有最先进的教学套房的新型UCDMC教育大楼将使我们能够 第一年有效地实现这些目标。 POCT*ctr及其在关键 - 紧急污水剂护理中的作用。 POCT定义 作为患者护理部位或附近的诊断测试（Kost 2002a）。 POCT在 1970年代。 POCT的早期关键概念由Kost博士（Kost 1999，Kost 2002a）开发。 在1980年代，科斯特博士进行了广泛的邀请会谈和教育演讲之旅 在美国的POCT，其次是欧洲的演讲和讲习班。接下来，他是 被邀请在亚洲讲话，教育和培训，因为较小且较低的技术成为 在全球范围内可用（Tran 2006）。介绍的重点是主要POCT的国家发展 概念，包括多媒体产品，例如教育PowerPoint程序，视频， 以及特定于国家和语言的专着（Kost 2003c，Kost 2006H，Kost 2006i）。超过 仅在过去的十年中，POCTTOCTR就进行了二十多次翻译研究。 这些研究产生了49个同行评审的期刊出版物和书籍章节，许多 他们中的关键和紧急护理。另外一组建立了国家 诊断测试的关键值的护理标准。仅在2006年，Poct就就生产了 关于POCT，公共卫生和灾难准备就绪的十七篇出版物。包括一个 《美国临床病理杂志》中有关POCT如何使用的原始文章 卡特里娜飓风和海啸（Kost 2006e）。这些灾难以有限的方式提供了 使用POCT并确定了将来在现场测试中部署的关键需求的可行性 现场救援。但是，卡特里娜飓风也证明了当前的POC 技术无法承受遇到的危害条件（请参阅核心2） 灾难。 卡特里娜飓风和2004年海啸后的需求评估。我们是 POCT的需求评估已经经验丰富。科斯特博士的美国和泰国研究团队 进行了现场调查，个人访谈和数据分析，不久之后 灾难（Kost 2006e）。尽管各国的人口统计差异很大， 资源，结果显示出类似的实质性缺陷，包括缺乏POCT 在社区医院和首次出现惊喜的野外景点中进行分类的仪器。 通常，在美国或 亚洲。即使在美国，也没有使用葡萄糖仪的100,000名糖尿病患者 以及卡特里娜飓风期间的测试条，Cefalu等。 （2006年）报道了不受控制的 高血糖和低血糖可能导致过量死亡。尽管有反应 我们在美国平民和军事组织的卡特里娜飓风中，发现了大量的野外景象 POCT乐器。尽管军方配备了手持全血 分析仪，大部分用于船舶和稳定的临时环境中，这些设备 在泰国或新的现场条件下无法正常工作 奥尔良。我们在Sumner等人的研究报告中模拟了这些条件。 （2007）。 我们描述了核心2中的初步结果。 对关键施加 - 污水处理措施的需求评估。我们将调查 在我们需要的美国五十个国家灾难医疗助理团队（DMAT）的人员 评估计划。我们将确定地理分布，医疗资源和 DMAT的功能。这些团队必须进行评估，因为它们代表专业 现有医疗保健基础设施是 灾难或恐怖主义不知所措（NDMS网站）。他们支持当地的医疗保健 基础设施。我们将通过电话和个人面试直接与DMAT人员联系， 与Kost博士的调查技术类似于临界限制（临界值）的多项研究 在美国。直接接触确保高响应率。我们还将使用电子邮件和基于网络的 调查工具 我们计划评估DMAT的需求，因为与 环境强大的POCT将为练习循证医学做好准备 在现场响应中。 DMAT旨在提供快速响应，以补充本地 医疗保健直到可以动员其他联邦或合同资源为止。例如，两个 UCDMC的DMAT对卡特里娜飓风做出了回应。通常，我们的团队计划三天 现场服务，但可能会停留一周。团队携带两个普通的手持式血液气 测试菜单有限的分析仪，但没有其他POCT设备。存储和运输是 像其他用品一样的例行程序。没有特殊的设备，试剂，质量控制或容器 这将忍受热，寒冷，湿度，冲击，高度或其他因素的极端环境。 但是，我们采访的团队成员认识到需要准确的诊断数据 现场营救期间的地点。因此，DMAT将从小型，便携式和 环境强大的POC设备。 我们将从加利福尼亚州的七个DMAT开始进行调查，然后 通过剩余的团队分发在美国。我们的目标是至少达到70％的回应 通过官方注册机构在美国确定的所有DMAT的费用。需要DMAT 注册并建立通信网络，以便被召唤到紧急情况下。 人们认为，当前DMAT的偶然性被认为提供了地理和 人口分布的统计表示。因此，调查抽样将反映出相似的 人口特征。但是，我们认识到美国某些地区可能缺乏 这些灾难响应资源。因此，当我们发现这种缺陷时，我们将 调查区域医疗保健资源以确定他们是否已将POCT纳入灾难 规划。我们目前正在研究调查问卷。以下是调查的示例 问题