Standard SARS-CoV-2 testing protocols using nasopharyngeal/throat (NP/T) swabs are invasive and require trained medical staff for reliable sampling. In addition, it has been shown that PCR is more sensitive as compared to antigen-based tests. Here we describe the analytical and clinical evaluation of our in-house RNA extraction-free saliva-based molecular assay for the detection of SARS-CoV-2. Analytical sensitivity of the test was equal to the sensitivity obtained in other Dutch diagnostic laboratories that process NP/T swabs. In this study, 955 individuals participated and provided NP/T swabs for routine molecular analysis (with RNA extraction) and saliva for comparison. Our RT-qPCR resulted in a sensitivity of 82,86% and a specificity of 98,94% compared to the gold standard. A false-negative ratio of 1,9% was found. The SARS-CoV-2 detection workflow described here enables easy, economical, and reliable saliva processing, useful for repeated testing of individuals.
LINK
Background: Clinical reasoning skills are considered to be among the key competencies a physiotherapist should possess. Yet, we know little about how physiotherapy students actually learn these skills in the workplace. A better understanding will benefit physiotherapy education.Objectives: To explore how undergraduate physiotherapy students learn clinical reasoning skills during placements.Design: A qualitative research design using focus groups and semi-structured interviews.Setting: European School of Physiotherapy, Amsterdam, the Netherlands.Participants: Twenty-two undergraduate physiotherapy students and eight clinical teachers participated in this study.Main outcome measures: Thematic analysis of focus groups and semi-structured interviews.Results: Three overarching factors appeared to influence the process of learning clinical reasoning skills: the learning environment, the clinical teacher and the student. Preclinical training failed to adequately prepare students for clinical practice, which expected them to integrate physiotherapeutic knowledge and skills into a cyclic reasoning process. Students’ basic knowledge and assessment structure therefore required further development during the placements. Clinical teachers expected a holistic, multifactorial problem-solving approach from their students. Both students and teachers considered feedback and reflection essential to clinical learning. Barriers to learning experienced by students included time constraints, limited patient exposure and patient communication.Conclusions: Undergraduate physiotherapy students develop clinical reasoning skills through comparison of and reflection on different reasoning approaches observed in professional therapists. Over time, students learn to synthesise these different approaches into their own individual approach. Physiotherapy programme developers should aim to include a wide variety of multidisciplinary settings and patient categories in their clinical placements.
Objective: To systematically review and critically appraise the literature on measurement properties of cardiopulmonary exercise test protocols for measuring aerobic capacity, VO2max, in persons after stroke. Data sources: PubMed, Embase and Cinahl were searched from inception up to 15 June 2016. A total of 9 studies were identified reporting on 9 different cardiopulmonary exercise test protocols. Study selection: VO2max measured with cardiopulmonary exercise test and open spirometry was the construct of interest. The target population was adult persons after stroke. We included all studies that evaluated reliability, measurement error, criterion validity, content validity, hypothesis testing and/ or responsiveness of cardiopulmonary exercise test protocols. Data extraction: Two researchers independently screened the literature, assessed methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and extracted data on measurement properties of cardiopulmonary exercise test protocols. Data synthesis: Most studies reported on only one measurement property. Best-evidence synthesis was derived taking into account the methodological quality of the studies, the results and the consistency of the results. Conclusion: No judgement could be made on which protocol is “best” for measuring VO2max in persons after stroke due to lack of high-quality studies on the measurement properties of the cardiopulmonary exercise test.
Organ-on-a-chip technology holds great promise to revolutionize pharmaceutical drug discovery and development which nowadays is a tremendously expensive and inefficient process. It will enable faster, cheaper, physiologically relevant, and more reliable (standardized) assays for biomedical science and drug testing. In particular, it is anticipated that organ-on-a-chip technology can substantially replace animal drug testing with using the by far better models of true human cells. Despite this great potential and progress in the field, the technology still lacks standardized protocols and robust chip devices, which are absolutely needed for this technology to bring the abovementioned potential to fruition. Of particular interest is heart-on-a-chip for drug and cardiotoxicity screening. There is presently no preclinical test system predicting the most important features of cardiac safety accurately and cost-effectively. The main goal of this project is to fabricate standardized, robust generic heart-on-a-chip demonstrator devices that will be validated and further optimized to generate new physiologically relevant models to study cardiotoxicity in vitro. To achieve this goal various aspects will be considered, including (i) the search for alternative chip materials to replace PDMS, (ii) inner chip surface modification and treatment (chemistry and topology), (iii) achieving 2D/3D cardiomyocyte (long term) cell culture and cellular alignment within the chip device, (iv) the possibility of integrating in-line sensors in the devices and, finally, (v) the overall chip design. The achieved standardized heart-on-a-chip technology will be adopted by pharmaceutical industry. This proposed project offers a unique opportunity for the Netherlands, and Twente in particular, which has relevant expertise, potential, and future perspective in this field as it hosts world-leading companies pioneering various core aspects of the technology that are relevant for organs-on-chips, combined with two world-leading research institutes within the University of Twente.
