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Herane-Vives A, Espinoza S, Sandoval R, Ortega L, Alameda L, Young AH, Arnone D, Hayes A, Benöhr J. A Novel Earwax Method to Measure Acute and Chronic Glucose Levels. Diagnostics (Basel) 2020; 10:E1069. [PMID: 33321856 PMCID: PMC7764152 DOI: 10.3390/diagnostics10121069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/27/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022] Open
Abstract
Diabetes is the fourth cause of death globally. To date, there is not a practical, as well as an accurate sample for reflecting chronic glucose levels. We measured earwax glucose in 37 controls. Participants provided standard serum, glycated hemoglobin (HbA1c) and earwax samples at two time-points, one month apart. The specimens measured baseline fasting glucose, a follow-up postprandial glucose level and a between sample chronic glucose, calculated using the average level on the two occasions. The baseline earwax sample was obtained using a clinical method and the follow-up using a novel self-sampling earwax device. The earwax analytic time was significantly faster using the novel device, in comparison to the clinical use of the syringe. Earwax accurately reflected glucose at both assessments with stronger correlations than HbA1c. Follow-up postprandial concentrations were more significant than their respective fasting baseline concentrations, reflecting differences in fasting and postprandial glycemia and more efficient standardization at follow up. Earwax demonstrated to be more predictable than HbA1c in reflecting systemic fasting, postprandial and long-term glucose levels, and to be less influenced by confounders. Earwax glucose measurements were approximately 60% more predictable than HbA1c in reflecting glycemia over a month. The self-sampling device provided a sample that might accurately reflect chronic glycemia.
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Affiliation(s)
- Andrés Herane-Vives
- Institute of Cognitive Neuroscience, Clinical, Educational & Health Psychology Department, Faculty of Brain Disease, University College London, Alexandra House, 17-19 Queen Square, Bloomsbury, London WC1N 3AZ, UK
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Susana Espinoza
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Rodrigo Sandoval
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Lorena Ortega
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Larrondo 1281, 1781421 Coquimbo, Chile; (S.E.); (R.S.); (L.O.)
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK;
- Instituto de Investigación Sanitaria de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, Departamento de Psiquiatría, Universidad de Sevilla, 41013 Sevilla, Spain
- Service of General Psychiatry, Lausanne University Hospital (CHUV), 1008 Lausanne, Switzerland
| | - Allan H. Young
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Danilo Arnone
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
- Department of Psychiatry and Behavioural Science, College of Medicine and Health Sciences, United Arab Emirates University, 5MW2+PW Al Ain, Abu Dhabi, UAE
| | - Alexander Hayes
- Centre for Affective Disorders, Affective Disorders Research Group, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AF, UK; (A.H.Y.); (D.A.); (A.H.)
| | - Jan Benöhr
- Benöhr Design Creatives, Jollystrasse 5, 81545 München, Germany;
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Lang T. Minimum retesting intervals in practice: 10 years experience. ACTA ACUST UNITED AC 2020; 59:39-50. [DOI: 10.1515/cclm-2020-0660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Minimum retesting intervals (MRI) are a popular demand management solution for the identification and reduction of over-utilized tests. In 2011 Association of Clinical Biochemistry and Laboratory Medicines (ACB) published evidence-based recommendations for the use of MRI.
Aim
The aim of the paper was to review the use of MRI over the period since the introduction of these recommendations in 2011 to 2020 and compare it to previous published data between 2000-2010.
Methods
A multi-source literature search was performed to identify studies that reported the use of a MRI in the management or identification of inappropriate testing between the years prior to (2000–2010) and after implementation (2011–2020) of these recommendations.
Results
31 studies were identified which met the acceptance criteria (2000–2010 n=4, 2011–2020 n=27). Between 2000 and 2010 4.6% of tests (203,104/4,425,311) were identified as failing a defined MRI which rose to 11.8% of tests (2,691,591/22,777,288) in the 2011–2020 period. For those studies between 2011 and 2020 reporting predicted savings (n=20), 14.3% of tests (1,079,972/750,580) were cancelled, representing a total saving of 2.9 M Euros or 2.77 Euro/test. The most popular rejected test was Haemoglobin A1c which accounted for nearly a quarter of the total number of rejected tests. 13 out 27 studies used the ACB recommendations.
Conclusions
MRI are now an established, safe and sustainable demand management tool for the identification and management of inappropriate testing. Evidence based consensus recommendations have supported the adoption of this demand management tool into practice across multiple healthcare settings globally and harmonizing laboratory practice.
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Affiliation(s)
- Tim Lang
- Department of Clinical Biochemistry , University Hospital of North Durham , North Road , Durham , County Durham , DH1 5TW , UK
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Church DL, Naugler C. Essential role of laboratory physicians in transformation of laboratory practice and management to a value-based patient-centric model. Crit Rev Clin Lab Sci 2020; 57:323-344. [PMID: 32180485 DOI: 10.1080/10408363.2020.1720591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The laboratory is a vital part of the continuum of patient care. In fact, there are few programs in the healthcare system that do not rely on ready access and availability of complex diagnostic laboratory services. The existing transactional model of laboratory "medical practice" will not be able to meet the needs of the healthcare system as it rapidly shifts toward value-based care and precision medicine, which demands that practice be based on total system indicators, clinical effectiveness, and patient outcomes. Laboratory "value" will no longer be focused primarily on internal testing quality and efficiencies but rather on the relative cost of diagnostic testing compared to direct improvement in clinical and system outcomes. The medical laboratory as a "business" focused on operational efficiency and cost-controls must transform to become an essential clinical service that is a tightly integrated equal partner in direct patient care. We would argue that this paradigm shift would not be necessary if laboratory services had remained a "patient-centric" medical practice throughout the last few decades. This review is focused on the essential role of laboratory physicians in transforming laboratory practice and management to a value-based patient-centric model. Value-based practice is necessary not only to meet the challenges of the new precision medicine world order but also to bring about sustainable healthcare service delivery.
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Affiliation(s)
- Deirdre L Church
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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