POINT OF CARE DIAGNOSTICS
Near-patient diagnostics: accurate, fast and friendly
Point of Care Testing (PoCT) represents a reasonably young but continuously expanding emerging domain based on two simple concepts: perform frequent but accurate medical tests, and perform them closer to the patient’s home, both approaches leading to a better diagnostic efficiency, and to a considerable reduction of diagnostic costs. PoCT methodology encompasses different approaches from the self-monitoring of glucose or pregnancy, to more professional testing of infectious diseases or cardiac problems.
From an economical point of view the enhancing role of PoCT aims to reduce the diagnostic related expenses currently concentrated in secondary and tertiary hospitals, and increase significantly the diagnostic efforts in the places of primary care, with clear benefits for the well-being of our society and undeniable gain for the quality of healthcare.
Early diagnosis is a key factor for the successful treatment of both modest and challenging medical conditions of the patient. In case of available routine therapy, anticipating the treatment brings enormous benefits to the health of the patient and reduces the costs of medical services to the minimum. For more challenging diseases, early diagnosis and hence early therapies may even result in a full recovery or possibly stabilization of the patient's condition. In the most serious case of missing therapies, an accurate and well comprehended diagnosis represents the only possible way for the development of future cures and solutions, and catching the problem at its earliest evolution steps indubitably leads to its better understanding and facilitates clinical research with enormous benefits for society and its individuals.
Currently the diagnostic practice is still dominated by the model of consolidated centralized laboratories with automated analytical processes that are able to handle large numbers of samples at reasonably low costs. Nevertheless, the substantial and continuous growth of healthcare costs and the new demands advanced by the demographic (ageing) transformation asks for a major change of this strategy.
Relevance for the Electronic Components and Systems (ECS) industry
PoCT systems cannot exist without smart electronic solutions, except for the simplest cases of purely chemical dipstick technologies.
The key enabling components of current PoCT devices must include smart and friendly interfaces, sensors, controllers and communication systems as well as data processing and storage.
These ECS based components have to interact in a most smart and efficient way with the bio-chemical modules of PoCT systems, such as reagents and reaction cells and with the sample control/delivery system, enhancing further the role of electronics and demanding a fruitful multidisciplinary interaction at all the levels of development and utilization.
The potential of ECS industry to contribute to the development of new, and the improvement of existing PoCT solutions is enormous. What is still partly overlooked, is the major interaction with the biomedical field which should move more towards a kind of “supply and demand” scheme. Often the development of powerful and sophisticated engineering tools does not lead to a significant market success, if any, because of the do not align with established medical workflows.
Enabling technology platforms
PoCT systems are typically divided in two categories: portable devices and desktop solutions.
The ultimate configuration for a small portable system is a wearable device, communicating with the patient via smartphone.
The emerging Lab on Chip (LoC) solutions, embedding multiple sensor platforms, microfluidics and simple processing/storage elements is currently the most promising basis for the realization and development of accurate, versatile and friendly portable and wearable PoCT devices. In LoC the inspection of various patient parameters is performed directly by molecular testing or indirectly by detecting the modulation of physical signals from optical, magnetic or other functional labels.
Currently, the development of various LoC techniques is driven by desktop solutions, even though their miniaturization represents a significant trend in that area. One of the challenges for ECS community is the gradual downscaling of LoC to wearable or stripe like systems, alongside with the continuous improvement of their accuracy and versatility. Reconfigurable LoC systems, able on demand to switch to the detection of, for example, an emergent virus or microbe, may represent a powerful, if not unique defense for a society with a continuous increasing density of population.
Considering larger PoCT systems, the so called desktop solutions currently dominated by various ASSAYs and similar technologies, the efforts are mainly concentrating on their incremental improvement, considering both accuracy and versatility (multiple analyte detection) and the role of both hardware and software development is crucial and significantly open to the ECS community.
It is likely to expect that wearable solutions will represent on long term the ultimate choice for PoCT, while the more and more accurate and at the same time the more and more complicated desktop solutions will represent the second diagnostic line for a selective and ultimate diagnosis, allocated back in centralized laboratories.
MADIA (Magnetic Diagnostic Assays) – project website http://www.madia-project.eu/
BIOCBx (A miniature Bio-photonics Companion Diagnostics) – project website http://biocdx.eu/
S.K. Vashist, “Point-of-Care Diagnostics: Recent Advances and Trends,” Biosensors (Basel). 2017 Dec; 7(4): 62