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walkitoutMy post on FB from last week about Siemens epoc attracted some skepticism. One person mentioned theranos. My sister expressed skepticism of its utility outside of a paramedic context.
I’m sympathetic to reflexively disbelieving something after being grifted. I really wanted to believe in Theranos, and it was a top-to-bottom, intentional scam, all the way to picking a board that included a bunch of older folks from other fields and notably government to block efforts to regulate or dismantle the scam. Some years ago, I gave money to a kickstarter for a coffee maker that you would put beans into and water into and make selections for grind and so forth and it would make coffee at a particular time starting from beans instead of from ground. They delivered a few units, very late, and the units never worked properly. Of course this is a common thing now. I could have believed the device was impossible, because of the failure and general poor communication and bad behavior of the kickstarter I funded. But I didn’t. I didn’t even need to order one of the modern versions of this device to convince myself. I saw reddit posts comparing which ones were better or worse and why and that was good enough for me.
I went over to pubmed, to find an assortment of articles about how people are using epoc in various settings. The paramedic setting is tricky, because these devices require a pretty tight temperature range and as you can imagine, that’s hard to accomplish when you are going in and out of an ambulance, people’s homes, etc. I was able to find some Canadian respiratory therapists who were making good use of the device, and my sister found that interesting. I pointed out to the theranos mentioner that epoc had all the FDA clearances that theranos conspicuously did NOT have; and also CE Mark and was authorized in the UK. If this is a scam, it is a more successful one.
Gotta take the kid in; will continue later.
ETA:
OK, I’m back, I did duolingo, and I’m eating leftover Railtrail pizza from last night and I’ve put the farm share away and have a salad made from things from the farm share. Woot! It’s a good day already. On the way to school — and we got out the door around 9:30, which is 15-30 minutes early for us — I asked A. for more fears. Yesterday on the way home, we went over the Can You Really Just Take a Single Class at a Time thing, which she truly had not believed me when I said it was possible. We also went over just how many schools there are in the Pioneer Valley, which creates lots of possibilities if the first one or few do not work for her. That was a grind of a conversation, but this morning’s conversation was light and fun. I did monster noises and said I was hungry for fear, and we made Monsters Inc jokes and We Scare Because We Care and how laughter was even more powerful etc. That’s some useful IP.
Anyway. Today’s fears included: I don’t want to do dissection. I told her I’d research whether computer simulated dissection was an option at the colleges we’ve been looking at. I’m afraid of a lab spill that burns through my PPE. We talked about safety policies and how if they don’t have one or they don’t follow it, she is to walk out and then we figure it out later. What if I get a bad lab partner. We went over Kitti’s various ideas that she might be comfortable with, with a focus on saying in a loud voice whatever it is that’s the problem, and the person in charge will likely come over and help figure it out. We also talked about how they generally don’t let noobs have dangerous chemicals in quantity or dangerous microbes at all.
This was such a wonderful conversation, and we are looking forward to doing a lot more of these. I’m going to really make an effort to keep up on the “I am afraid about” discussions so they don’t have a time to curdle and cause her to give up on things, which is usually the point I step in. I’ve been trying to create space for her to be independent and figure things out and for other people to provide meaningful / effective support, but it’s not working, so it’s time.
Back to blood gas analyzer accuracy!
https://pubmed.ncbi.nlm.nih.gov/26457784/
This is a 2016 article about testing epoc (handheld unit, costing a few thousand dollars) to existing automated lab units.
“The accuracy of the epoc analyzer was assessed by comparing patient results from the device with those obtained with the Siemens Rapidlab 1265 and Rapidpoint RP500 and Siemens Dimension Vista and Sysmex XE-2100 analyzers. The following parameters were measured: pH, pCO2, pO2, Hb (calc), Na+, K+, iCa2+, glucose, and lactate.”
While I have not been able to nail down 2016 era price points on the listed items, many of them have been discontinued. A lot of them were rapid tests (so were not faster or slower to run the test, other than trip time from the bedside to the lab and back) but standalone things on the order of a chest of drawers in terms of size. In 2016, they appear to have cost between mid tens of thousands of dollars to over $100K.
“Results: The CV% of the epoc's between-day imprecision for the various parameters varied from 0.4 to 8.6. The within-run imprecision CV% varied from 0.6 to 5.2. The squared regression coefficient (R2) between the epoc and RL1265 varied from 0.94 to 0.99, with the exception of Na+ and Ca2+ (R2≥0.82). The correlation (R2) of Na+ and K+ between epoc and Dimension Vista was 0.73 and 0.89, respectively. The correlation (R2) of Hb between the epoc and the XE-2100 analyzer was 0.94.
Conclusions: With most of the measured blood gas parameters, the epoc analyzer correlated well with reference techniques. The epoc analyzer is suitable for rapid measurement of the blood gases, the electrolytes, and the metabolites in the ICU.”
Notice that this is comparison to _other rapid tests_. In an ICU setting, time is of the essence. So even a high correlation to these automated testing units might be a further degradation vs. the “gold standard” test.
It does seem clear that the handhelds arose out of miniaturization and a desire to reduce (expensive) labor in hospital labs. As one would expect, over time this led to a vast savings in the cost of the unit as well HOWEVER it is not necessarily possible for me at this point in time to assess other cost aspects. For example, if you can get the same volume of testing through one of the standalone things as through one of the handheld, it’s pretty obvious the handheld is better. But if you can get a much higher volume of testing through the standalone thing, and you were using that throughput, comparing one unit of one to a unit of the other might be unfair. I don’t think that’s true — the very expensive standalone stuff now sells used at a discount to the handhelds which I think is telling.
I’m sympathetic to reflexively disbelieving something after being grifted. I really wanted to believe in Theranos, and it was a top-to-bottom, intentional scam, all the way to picking a board that included a bunch of older folks from other fields and notably government to block efforts to regulate or dismantle the scam. Some years ago, I gave money to a kickstarter for a coffee maker that you would put beans into and water into and make selections for grind and so forth and it would make coffee at a particular time starting from beans instead of from ground. They delivered a few units, very late, and the units never worked properly. Of course this is a common thing now. I could have believed the device was impossible, because of the failure and general poor communication and bad behavior of the kickstarter I funded. But I didn’t. I didn’t even need to order one of the modern versions of this device to convince myself. I saw reddit posts comparing which ones were better or worse and why and that was good enough for me.
I went over to pubmed, to find an assortment of articles about how people are using epoc in various settings. The paramedic setting is tricky, because these devices require a pretty tight temperature range and as you can imagine, that’s hard to accomplish when you are going in and out of an ambulance, people’s homes, etc. I was able to find some Canadian respiratory therapists who were making good use of the device, and my sister found that interesting. I pointed out to the theranos mentioner that epoc had all the FDA clearances that theranos conspicuously did NOT have; and also CE Mark and was authorized in the UK. If this is a scam, it is a more successful one.
Gotta take the kid in; will continue later.
ETA:
OK, I’m back, I did duolingo, and I’m eating leftover Railtrail pizza from last night and I’ve put the farm share away and have a salad made from things from the farm share. Woot! It’s a good day already. On the way to school — and we got out the door around 9:30, which is 15-30 minutes early for us — I asked A. for more fears. Yesterday on the way home, we went over the Can You Really Just Take a Single Class at a Time thing, which she truly had not believed me when I said it was possible. We also went over just how many schools there are in the Pioneer Valley, which creates lots of possibilities if the first one or few do not work for her. That was a grind of a conversation, but this morning’s conversation was light and fun. I did monster noises and said I was hungry for fear, and we made Monsters Inc jokes and We Scare Because We Care and how laughter was even more powerful etc. That’s some useful IP.
Anyway. Today’s fears included: I don’t want to do dissection. I told her I’d research whether computer simulated dissection was an option at the colleges we’ve been looking at. I’m afraid of a lab spill that burns through my PPE. We talked about safety policies and how if they don’t have one or they don’t follow it, she is to walk out and then we figure it out later. What if I get a bad lab partner. We went over Kitti’s various ideas that she might be comfortable with, with a focus on saying in a loud voice whatever it is that’s the problem, and the person in charge will likely come over and help figure it out. We also talked about how they generally don’t let noobs have dangerous chemicals in quantity or dangerous microbes at all.
This was such a wonderful conversation, and we are looking forward to doing a lot more of these. I’m going to really make an effort to keep up on the “I am afraid about” discussions so they don’t have a time to curdle and cause her to give up on things, which is usually the point I step in. I’ve been trying to create space for her to be independent and figure things out and for other people to provide meaningful / effective support, but it’s not working, so it’s time.
Back to blood gas analyzer accuracy!
https://pubmed.ncbi.nlm.nih.gov/26457784/
This is a 2016 article about testing epoc (handheld unit, costing a few thousand dollars) to existing automated lab units.
“The accuracy of the epoc analyzer was assessed by comparing patient results from the device with those obtained with the Siemens Rapidlab 1265 and Rapidpoint RP500 and Siemens Dimension Vista and Sysmex XE-2100 analyzers. The following parameters were measured: pH, pCO2, pO2, Hb (calc), Na+, K+, iCa2+, glucose, and lactate.”
While I have not been able to nail down 2016 era price points on the listed items, many of them have been discontinued. A lot of them were rapid tests (so were not faster or slower to run the test, other than trip time from the bedside to the lab and back) but standalone things on the order of a chest of drawers in terms of size. In 2016, they appear to have cost between mid tens of thousands of dollars to over $100K.
“Results: The CV% of the epoc's between-day imprecision for the various parameters varied from 0.4 to 8.6. The within-run imprecision CV% varied from 0.6 to 5.2. The squared regression coefficient (R2) between the epoc and RL1265 varied from 0.94 to 0.99, with the exception of Na+ and Ca2+ (R2≥0.82). The correlation (R2) of Na+ and K+ between epoc and Dimension Vista was 0.73 and 0.89, respectively. The correlation (R2) of Hb between the epoc and the XE-2100 analyzer was 0.94.
Conclusions: With most of the measured blood gas parameters, the epoc analyzer correlated well with reference techniques. The epoc analyzer is suitable for rapid measurement of the blood gases, the electrolytes, and the metabolites in the ICU.”
Notice that this is comparison to _other rapid tests_. In an ICU setting, time is of the essence. So even a high correlation to these automated testing units might be a further degradation vs. the “gold standard” test.
It does seem clear that the handhelds arose out of miniaturization and a desire to reduce (expensive) labor in hospital labs. As one would expect, over time this led to a vast savings in the cost of the unit as well HOWEVER it is not necessarily possible for me at this point in time to assess other cost aspects. For example, if you can get the same volume of testing through one of the standalone things as through one of the handheld, it’s pretty obvious the handheld is better. But if you can get a much higher volume of testing through the standalone thing, and you were using that throughput, comparing one unit of one to a unit of the other might be unfair. I don’t think that’s true — the very expensive standalone stuff now sells used at a discount to the handhelds which I think is telling.