Population-based surveys commonly use point-of-care (POC) methods with capillary blood samples for estimating Hb concentrations; these estimates need to be validated by comparison with reference methods using venous blood. In a cross-sectional study in 748 participants (17–86 years, 708 women, Hb: 5·1 to 18·2 g/dl) from Hyderabad, India, we validated Hb measured from a pooled capillary blood sample by a POC autoanalyser (Horiba ABX Micros 60OT, Hb-C-AA) by comparison with venous blood Hb measured by two reference methods: POC autoanalyser (Hb-V-AA) and cyanmethemoglobin method (Hb-V-CM). These comparisons also allowed estimation of blood sample-related and equipment-related differences in the Hb estimates. We also conducted a longitudinal study in 426 participants (17–21 years) to measure differences in the Hb response to iron folate (IFA) treatment by the capillary blood POC method compared with the reference methods. In the cross-sectional study, Bland–Altman analyses showed trivial differences between source of blood (Hb-C-AA and Hb-V-AA; mean difference, limits of agreement: 0·1, −0·8 to 1·0 g/dl) and between analytical methods (Hb-V-AA and Hb-V-CM; mean difference, limits of agreement: < 0·1, −1·8 to 1·8 g/dl). Cross-sectional anaemia prevalence estimated using Hb-C-AA did not differ significantly from Hb-V-CM or Hb-V-AA. In the longitudinal study, the Hb increment in response to IFA intervention was not different when using Hb-C-AA (1·6 ± 1·7 g/dl) compared with Hb-V-AA (1·7 ± 1·7 g/dl) and Hb-V-CM (1·7 ± 1·7 g/dl). The pooled capillary blood–autoanalyzer method (Hb-C-AA) offers a practical and accurate way forward for POC screening of anaemia.

This article reviews the use of portable microscopes in published science from Antonie van Leeuwenhoek's letters to the Royal Society to a recent paper on the phylogeny of the phorid fly by Hartop et al. [1]. The portability of a pocket microscope is a clear benefit, yet bulky compound microscopes remain the mainstay of field research and diagnosis. There is a growing interest in the impact of climate change, which drives researchers to investigate the smallest, most fragile life in remote places such as Antarctica, Mount Everest, and the Amazon Rainforest. Are pocket microscopes ready to produce publication-standard images?

Non-communicable disease diagnosis frequently relies on biochemical measurements but laboratory infrastructure in low-income settings is often insufficient and distances to clinics may be vast. We present a model for point of care (POC) epidemiology as used in our study of chronic disease in the Haiti Health Study, in rural and urban Haiti. Point of care testing (POCT) of creatinine, cholesterol, and hemoglobin A1c as well as physical measurements of weight, height, and waist circumference allowed for diagnosis of diabetes, chronic kidney disease, dyslipidemias, and obesity. Methods and troubleshooting techniques for the data collection of this study are presented. We discuss our method of community-health worker (CHW) training, community engagement, study design, and field data collection. We also discuss the machines used and our quality control across CHWs and across geographical regions. Pitfalls tended to include equipment malfunction, transportation issues, and cultural differences. May this paper provide information for those attempting to perform similar diagnostic and screening studies using POCT in resource poor settings.

Introduction: Point of care ultrasound (POCUS) has many applications in Emergency Medicine which are proven to improve patient outcomes. Training programs and guidelines for its use are available but its utilization metrics across Canadian Emergency Departments are unknown. This study aims to provide a comprehensive national assessment of POCUS usage, with a key component comparing training with patterns of use. Methods: A survey was distributed via email to all staff adult emergency physician members of the Canadian Association of Emergency Physicians (CAEP). The survey included questions related to training, attitudes towards POCUS, POCUS utilization, and barriers to POCUS use. Standard descriptive statistics were calculated, and differences in mean POCUS usage between groups were measured using a one-way analysis of variance (ANOVA). Results: The survey received 189 responses from emergency physicians from across Canada, 81% of which viewed POCUS as “useful and essential”. Respondents indicated that on average, POCUS was used during 71% (SD 29%) of shifts and on 23% (SD 17%) of patients. POCUS was most commonly used for basic applications, including thoracoabdominal trauma (FAST), cardiac assessment in arrest (trans-abdominal), and assessing for pericardial effusion. The most commonly cited barrier to wider POCUS adoption was a lack of training, with 41% of respondents identifying this as an issue. Correspondingly, formal POCUS training and certification were associated with significantly higher POCUS usage: usage rates ranged from 11.5% (SD 10.5%) of patients for those with formal training but no certification to 39.5% (SD 16.4%) of patients for those with a POCUS fellowship (p <0.001). Conclusion: The presented results from this survey provide an initial overview of the current state of POCUS usage in Canadian Emergency Departments. In summary, a higher level of training was associated with higher POCUS usage, and over a third of the respondents cited lack of training as a barrier to adoption; this suggests that efforts to facilitate POCUS utilization should focus on improving access to formal training and certification. Future work will involve further evaluation of additional barriers preventing POCUS usage in the ED, with the goal of providing information that will encourage changes that support widespread POCUS adoption.

Introduction: Literature suggests that up to 25% of people with HIV in North America are unaware of their status and are at risk to transmit the virus unknowingly. A high proportion of HIV patients are diagnosed when the disease is more advanced, with CD4 counts < 200. This study examined the rates of HIV testing, detection, and treatment of clients at an inner city shelter and detoxification centre after the introduction of a point of care testing (POCT) program by on-site community paramedics (CP). Methods: In 2013, in collaboration with a regional HIV program, CP received training and instituted an HIV POCT program and post-test counselling initiative. A retrospective electronic database review from October 16, 2013 to October 15, 2014 of adult patients who received testing was performed. Demographic and testing details of each patient encounter were abstracted and select variables were compared to a historic population who received POC HIV testing at an inner city emergency department (ED) in the same city. Results: 1,207 HIV POC tests were performed on 997 patients during the pilot. 57% of the patients tested were less than 40 years of age (range 18-73 years) compared to 55% in the historic ED population. A total of 9 reactive cases were identified in the study population including 3 new cases, 5 previously known cases, and 1 false reactive result. The mean age of the new cases was 47 years, vs 44 in the historical control. All 3 new cases were referred to a local HIV clinic for further care and treatment. New HIV cases represented 0.25% of total tests performed, which is less than the expected prevalence rate of 1% for this population, as well as the rate of 1.4% found in the ED population. Conclusion: Despite lower than expected reactive rates, the large scale implementation of a CP HIV POCT program in an inner city shelter and detoxification centre is feasible. All patients with new reactive tests were immediately connected to care. Future research will focus on risk factors and barriers to testing.