Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka.
Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka.
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DOI：
10.1186/1472-6963-14-104
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发表时间：
2014-03-04
影响因子：
2.8
通讯作者：
Buckley NA
中科院分区：
文献类型：
--
作者：
Rajapakse BN;Neeman T;Buckley NA
毒理学和急救医学教科书建议在所有有症状的有机磷（OP）中毒病例中测量乙酰胆碱酯酶（AChE），但亚洲农村的实验室设施有限。床旁（POC）乙酰胆碱酯酶检测的准确性已得到证实，但仍有待证明，结果是否会受到临床医生的重视。本研究旨在评估看到乙酰胆碱酯酶POC测试结果的知识，态度和实践的医生谁经常管理OP中毒的影响。我们调查了23名临床医生，他们有不同程度的暴露于OP中毒患者的AChE水平，a）OP中毒和生物标志物解释的知识，B）对AChE指导中毒管理，肟治疗和出院决定的态度，和c）在中毒情况下订购AChE的做法。总体而言，很高比例的医生重视这项测试（68-89%）。然而，我们矛盾地发现，那些更有经验的医生看到AChE结果重视测试较少，较低的比例重视测试在指导急性中毒管理（50%，p = 0.015）和指导肟治疗（25%，p = 0.008），很明显，它通常不会被用来促进早日出院。最高比例的受访者在入院时重视它（p < 0.001）。一些答复者还提出了测试结果与临床情况缺乏相关性，以及与单独的临床观察相比，测试是浪费金钱的看法。查看AChE测试结果的更多经验与知识的增加有关（p = 0.034）。然而，与OP中毒和管理机制的知识（78-90%）相比，对生物标志物的解释和肟治疗的药理学知识（12-50%）不成比例地缺乏。我们的研究结果表明，AChE POC测试可能不受乡村医生的重视。乙酰胆碱酯酶在OP中毒管理中的实际应用是复杂的，对如何解释测试结果的理解不足可能会影响其感知效用。未来的研究应评估提供乙酰胆碱酯酶和培训的临床医生的态度和做法解释的影响。
Toxicology and Emergency medicine textbooks recommend measurement of acetylcholinesterase (AChE) in all symptomatic cases of organophosphorus (OP) poisoning but laboratory facilities are limited in rural Asia. The accuracy of point-of-care (POC) acetylcholinesterase testing has been demonstrated but it remains to be shown whether results would be valued by clinicians. This study aims to assess the effect of seeing AChE POC test results on the knowledge, attitudes and practices of doctors who frequently manage OP poisoning. We surveyed 23 clinicians, who had different levels of exposure to seeing AChE levels in OP poisoned patients, on a) knowledge of OP poisoning and biomarker interpretation, b) attitudes towards AChE in guiding poison management, oxime therapy and discharge decisions, and c) practices of ordering AChE in poisoning scenarios. An overall high proportion of doctors valued the test (68-89%). However, we paradoxically found that doctors who were more experienced in seeing AChE results valued the test less. Lower proportions valued the test in guidance of acute poisoning management (50%, p = 0.015) and guidance of oxime therapy (25%, p = 0.008), and it was apparent it would not generally be used to facilitate early discharge. The highest proportion of respondents valued it on admission (p < 0.001). A lack of correlation of test results with the clinical picture, and a perception that the test was a waste of money when compared to clinical observation alone were also comments raised by some of the respondents. Greater experience with seeing AChE test results was associated with increased knowledge (p = 0.034). However, a disproportionate lack of knowledge on interpretation of biomarkers and the pharmacology of oxime therapy (12-50%) was noted, when compared with knowledge on the mechanism of OP poisoning and management (78-90%). Our findings suggest an AChE POC test may not be valued by rural doctors. The practical use of AChE in OP poisoning management is complex, and a poor understanding of how to interpret test results may have affected its perceived utility. Future research should evaluate the impact of providing both AChE and training in interpretation on clinicians’ attitudes and practice.
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影响因子：
2.4
作者：
Lessenger, James E
通讯作者：
Lessenger, James E
影响因子：
168.9
作者：
Eddleston, Michael;Buckley, Nick A.;Eyer, Peter;Dawson, Andrew H.
通讯作者：
Dawson, Andrew H.
DOI：
10.2165/00139709-200322030-00004
发表时间：
2003-01-01
期刊：
Toxicological Reviews
影响因子：
--
作者：
Eyer, Peter
通讯作者：
Eyer, Peter
影响因子：
3.5
作者：
Thiermann, H;Szinicz, L;Zilker, T
通讯作者：
Zilker, T
影响因子：
6.2
作者：
Rajapakse, Bishan N.;Thiermann, Horst;Buckley, Nicholas A.
通讯作者：
Buckley, Nicholas A.