***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To study the use and cost of bedside capillary glucose testing in a large teaching hospital . PATIENTS AND METHODS In a prospect i ve study of 40 inpatient units and 10 outpatient units at Massachusetts General Hospital , records were maintained by each unit of the date , time , operator , and results of patient and quality control tests . Cost analysis was performed using data from time studies , test tallies in logbooks , and hospital administration records . RESULTS The number of glucose meters in the hospital increased from 10 to 54 over a 2-year period . In 1992 , 67,596 tests were performed by the bedside method  , representing 30.7 % of all glucose measurements performed in the institution . The majority of tests ( 94.7 % ) were performed on in patients , and 10.2 % of all hospital admissions underwent bedside glucose testing . The impact on the number of glucose tests performed in the clinical laboratories was minimal , indicating that bedside glucose testing was added as an extra test rather than as a substitute for laboratory-based glucose measurements . The cost of bedside glucose testing  was $ 4.19 per test compared with $ 3.84 in the clinical laboratory . The cost varied from one unit to another ( median $ 5.52 , range $ 3.08 to $ 48.16 ) , an effect largely attributed to the difference in the volume of tests performed by different units . In seven high-volume units the cost per test was lower than the corresponding value in the laboratory . The cost of  bedside glucose testing  included labor ( 80.2 % ) and supplies ( 19.8 % ) . The percent of costs attributed directly to patient testing was 57.7 % , whereas the costs for all other related activities ( training , quality control , and quality assurance ) was 42.3 % . CONCLUSIONS Bedside capillary glucose testing is a rapidly exp and ing technology and is performed on a significant percentage of hospital admissions . Bedside glucose testing is not inherently more expensive than central ized laboratory measurements but implementation on inefficient care units with low utilization can add substantially to the cost . Much of the excess cost of the bedside method can be attributed to the high costs of quality control and quality assurance , training , and documentation Patients with active venous and arterial thromboembolic disorders are known to benefit from systemic anticoagulation with heparin . Clinical studies have shown , however , that therapeutic anticoagulation is rarely achieved rapidly and often is not maintained over time . Prolonged laboratory turnaround time of the activated partial thromboplastin time ( aPTT ) may contribute directly to these common problems . A total of 272 aPTT determinations were performed on 120 heparin-treated patients admitted to the coronary care unit . The time from sample collection to data availability was 126 + /- 84 minutes with st and ard laboratory aPTT testing . In contrast , a bedside coagulation device provided an aPTT within 3 minutes ( p < 0.001 ) . Subtherapeutic aPTT values ( < 65 seconds ) were documented in 21 % of all patients ; in each , the heparin dose was changed and a repeat aPTT was required . In a separate study of 33 heparinized patients r and omized to either bedside or central laboratory aPTT testing ( 264 aPTT determinations ) , the time to achieve a therapeutic state of systemic anticoagulation was 8.2 hours and 18.1 hours , respectively ( p < 0.005 ) . The time from aPTT determination to a decision regarding heparin titration adjustments was 14.5 minutes and 3 hours with bedside and laboratory testing , respectively ( p < 0.001 ) . Thus bedside coagulation monitoring provides a convenient , rapid , and accurate assessment of systemic anticoagulation among heparin-treated patients with active thromboembolic disease in the coronary care unit . This technology warrants further clinical investigation BACKGROUND Point-of-care testing ( POCT ) can provide rapid test results , but its impact on patient care is not well documented . We investigated the ability of POCT to decrease inpatient and outpatient waiting times for cardiovascular procedures . METHODS We prospect ively studied , over a 7-month period , 216 patients requiring diagnostic laboratory testing for coagulation ( prothrombin time/activated partial thromboplastin time ) and /or renal function ( urea nitrogen , creatinine , sodium , and potassium ) before elective invasive cardiac and radiologic procedures . Overall patient management and workflow were examined in the initial phase . In phase 2 , we implemented POCT but utilized central laboratory results for patient management . In phase 3 , therapeutic decisions were based on POCT results . The final phase , phase 4 , sought to optimize workflow around the availability of POCT .  Patient wait and timing of phlebotomy , availability of laboratory results , and therapeutic action were monitored . Split sampling allowed comparability of POCT and central laboratory results throughout the study . RESULTS In phase 1 , 44 % of central laboratory results were not available before the scheduled time for procedure ( n = 135 ) . Mean waiting times ( arrival to procedure ) were 188 + /- 54 min for patients who needed renal testing ( phase 2 ; n = 14 ) and 171 + /- 76 min for those needing coagulation testing ( n = 24 ) . For patients needing renal testing , POCT decreased patient wait times ( phases 3 and 4 combined , 141 + /- 52 min ; n = 18 ; P = 0.02 ) . For patients needing coagulation testing , wait times improved only when systematic changes were made in workflow ( phase 4 , 109 + /- 41 min ; n = 12 ; P = 0.01 ) . CONCLUSIONS Although POCT has the potential to provide beneficial patient outcomes , merely moving testing from a central laboratory to the medical unit does not guarantee improved outcomes . Systematic changes in patient management may be required BACKGROUND R and omized trials have demonstrated the importance of achieving adequate heparinization early in the course of therapy . Recently , some authors reported a pooled analysis of selected studies in the literature that suggested that there is no convincing evidence that the risk of recurrent venous thromboembolism is critically dependent on achieving a therapeutic activated partial thromboplastin time result at 24 to 48 hours . METHODS We provide the analyses of patient groups entered into our series of 3 consecutive double-blind r and omized trials evaluating initial heparin therapy for proximal deep venous thrombosis . RESULTS Logistic regression analysis of the patient groups receiving the less intense initial intravenous heparin dose of 30,000 U/24 h demonstrated that subtherapy for 24 hours predicted the onset of venous thromboembolic events . Failure to achieve a therapeutic activated partial thromboplastin time by 24 hours was associated with a 23.3 % frequency of venous thromboembolism vs 4 % to 6 % for those whose activated partial thromboplastin time exceeded the therapeutic threshold by 24 hours ( P=.02 ) . Time-to-event analysis shows the increased frequency of recurrent venous thromboembolic events during the period of study in patients who were subtherapeutic for 24 hours compared with those who were therapeutic ( P=.001 ) . CONCLUSIONS Our findings reaffirm the clinical importance of rapidly achieving therapeutic levels of heparin . Patients who failed to achieve the therapeutic threshold by 24 hours were at an increased risk of subsequent recurrent venous thromboembolism . These findings are independently supported by the results of a r and omized trial comparing different intensities of initial heparin treatment by continuous infusion Objective : Two different point-of-care ( POC ) systems for the monitoring of coagulation variables at the bedside were evaluated with regard to practicability , accuracy and costs . Design : Prospect i ve , descriptive study . Setting : Single-institutional , clinical investigation on an intensive care unit ( ICU ) of an urban , university-affiliated hospital . Patients : Eighty cardiac surgery patients were studied postoperatively . Interventions : Arterial blood sample s were drawn postoperatively on the ICU at different data points . Measurements and results : Activated partial thromboplastin time ( aPTT ) and prothrombin time ( PT ) were measured using two POC systems ( Thrombolytic Assessment System [ TAS ] and CoaguCheck Plus ° ) . At the same time coagulation parameters were measured by the central laboratory of the hospital . Measurements were carried out at different data points after cardiac surgery on the ICU . The direct and indirect costs of measuring aPTT/PT were also assessed . Bias analyses revealed good agreement of the POC-based monitoring of aPTT/PT with laboratory-based monitoring of coagulation ( e. g. aPTT CoaguCheck : bias of − 2.8 s with ± 2 SD [ limits of agreement ] of + 13.7 and −19.1 s ) . Mean turn-around time ( TAT ; time from blood sampling until availability of data for the ICU physicians ) was significantly longer for the central laboratory-based coagulation monitoring ( 130 ± 38 min ) than for the two POC systems ( aPTT-TAS : 9.6 ± 2.7 min ; aPTT-CoaguCheck : 6.5 ± 1.9 min ) . Blood sampling at unfavorable times increased the TAT for laboratory-based measurements considerably . The direct costs for measuring aPPT and PT were significantly higher using both POC systems ( aPTT-TAS : $ 4.84 ; aPTT-CoaguCheck : $ 4.34 ) than for the central laboratory ( $ 1.59 ) . Costs for transportation increased the laboratory-based monitoring considerably ( $ 3.77 ) . Conclusions : Both POC analyzers may reduce the potential for pre-analytical errors associated with coagulation measurements at the central laboratory , hasten TAT significantly and may improve patient therapy by reducing inappropriate administration of blood products Individual aspects of heparin or protamine dosing have been better controlled than previously as useful tests have become available . Although many variables including drug potency , drug source , and individual patient response have been separately identified , there has not been an attempt to integrate them into a single management strategy . This study was undertaken to learn whether more precise control of drug variables and patient response would affect blood loss and transfusion requirements .  Adult patients having primary cardiac operations were prospect ively r and omized into two groups . A control group received heparin and protamine by conventional methods . The test group received heparin and protamine according to in vitro predictive tests integrating drugs , tests , and patient response . Supplemental protamine was given in this group only if heparin was specifically found by testing . Anticoagulation in all patients was maintained at an activated coagulation time greater than 400 seconds , and any other treatment for bleeding was at the discretion of the clinical team caring for the patients . Testing and treatment for both groups followed routine practice after patient arrival in the intensive care unit . Test patients received slightly more heparin and a markedly lower dose of protamine than the control patients . Testing identified patients with decreased heparin sensitivity ( preoperative heparin therapy ) and correctly predicted the effective heparin dose . Supplemental protamine was given twice as often to control patients and frequently when no heparin was detectable ( retrospectively ) . Test patients exhibited less 24-hour chest tube drainage ( 671 ml versus 1298 ml ) and fewer patients received transfusion ( 9/22 versus 18/24 ) with fewer donor exposures ( 22/22 versus 101/24 ) . The management strategy used for heparin and protamine added accuracy and precision , which was associated with improved hemostasis . Although the observation is valid , the mechanism or mechanisms are not completely clear . Nevertheless , it is reasonable to apply basic pharmacologic principles and establishment of consistent , predictable protocol s that are beneficial . It is against this background that the efficacy of additional drugs or equipment should be assessed . It is quite possible that only marginal if any improvement in hemostasis may be found in patients having primary , uncomplicated cardiac operation with the addition of more costly drugs or equipment During 1966 to 1968 , 64 of 459 ( 13.9 % ) prospect ively monitored , digoxin‐treated patients at Massachusetts General Hospital suffered adverse reactions to the drug . Measurements of  serum digoxin concentrations  for therapeutic guidance began at Massachusetts General Hospital in 1969 , and trom Gctober , 1970 , to June , 1972 , they were performed on 40 % of all  digoxin recipients . During that same period , only 15 of 2.53 ( 5.9 % ) monitored , digoxin‐treated patients became  digitoxic  . At 7 other monitored hospitals the frequency of adverse reactions to  digoxin in 2,425 digoxin‐treated patients ranged from 13.1 % to 19.4 % . Detailed comparison of patients treated with digoxin during 1970 to 1972 at Massachusetts General Hospital and Peter Bent Brigham Hospital , 2 very similar Harvard Medical School teaching hospitals , showed the risk of aigitoxicity to be 2.12 times greater at the latter where serum digoxin assays were not commonly performed . These findings suggest that the use of serum digoxin determinations for ad;ustment of digoxin dosage reduces the frequency of digoxin toxicity 
    Output:
    
All studies have incorporated point-of-care testing with changes in the way patient care is delivered and have shown significant improvements when this approach is taken .
The cost of point-of-care testing is greater than traditional laboratory testing , but the increased cost may be offset by improvements in the management of patient care , improvements in patient outcomes , and decreased utilization of the healthcare system .
Point-of-care testing has been used successfully by pharmacists in disease management programs .
Various government regulations and legislation impact the use of point-of-care testing .
: Limited data indicate that point-of-care testing , when combined with changes in healthcare delivery systems , may improve patient outcomes and decrease the overall cost of health care .