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Al-Hasani W, Ranasinghe R, Rogers H, Spanier W, Spears K, Gayle C, Long L, Dimitriadis GK, Hunt KF, Vincent RP. Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study. BJOG 2024; 131:1270-1278. [PMID: 38497098 DOI: 10.1111/1471-0528.17811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN Prospective cohort study. SETTING Antenatal clinics at King's College Hospital. POPULATION Women screened for GDM between March and June 2020. METHODS The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.
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Affiliation(s)
- Wiaam Al-Hasani
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Ruvini Ranasinghe
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - William Spanier
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
| | - Katie Spears
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Carol Gayle
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics, King's College Hospital NHS Foundation Trust, London, UK
| | - Georgios K Dimitriadis
- Department of Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Katharine F Hunt
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry (Synnovis), King's College Hospital NHS Foundation Trust, London, UK
- School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Shahrzad S, Balasubramaniam K, Kousgaard MB, Thilsing T, Søndergaard J, Overbeck G. Implementing PCR testing in general practice-a qualitative study using normalization process theory. BMC Health Serv Res 2023; 23:1325. [PMID: 38037044 PMCID: PMC10687998 DOI: 10.1186/s12913-023-10355-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic brought attention to a need for rapid testing of large populations. Experiences from community-based testing settings show that there can be workload difficulties, logistical challenges and socioeconomic downsides to large scale Polymerase Chain Reaction (PCR) testing. Alternative testing arenas have therefore been considered. Rapid point-of-care (POC) PCR test methods have since been developed and could have potential to surveille viral respiratory infections. It is, however, unknown if PCR testing can be successfully implemented routinely in general practice. The aim of this study was to assess factors that enable and inhibit the implementation of point-of-care PCR testing for acute respiratory tract infection in general practice. METHODS Fourteen general practices in the east Zealand area in Denmark were included in the study and given access to POC PCR testing equipment during a flu season. The participating clinics were initially trained in the use of a POC PCR testing device and then spent 6 weeks testing it. We conducted qualitative interviews with general practitioners (GPs) and their staff, before and after the testing period, specifically focusing on their clinical decision-making and internal collaboration in relation to POC PCR testing. We used normalization process theory to design the interview guides and to analyze the data. RESULTS Professionals reported no clinical need for a POC PCR testing device in a non-pandemic clinical setting. Results were delivered faster, but this was only timesaving for the patient and not the GP, who had to perform more tasks. CONCLUSION In its current form, the added diagnostic value of using POC PCR testing in general practice was not sufficient for the professionals to justify the increased work connected to the usage of the diagnostic procedure in daily practice. TRIAL REGISTRATION n/a.
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Affiliation(s)
- Sinead Shahrzad
- Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark
- Department of Public Health, University of Copenhagen, Center for General Practice, Copenhagen, Denmark
| | - Kirubakaran Balasubramaniam
- Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark
| | - Marius Brostrøm Kousgaard
- Department of Public Health, University of Copenhagen, Center for General Practice, Copenhagen, Denmark
| | - Trine Thilsing
- Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark
| | - Jens Søndergaard
- Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark
| | - Gritt Overbeck
- Department of Public Health, University of Southern Denmark, Research Unit of General Practice, Odense, Denmark.
- Department of Public Health, University of Copenhagen, Center for General Practice, Copenhagen, Denmark.
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Andrade MV, de Souza Noronha KVM, Santos AS, Maia JX, Nogueira LT, Cimini CCR, Furtado ME, Coelho L, Marcolino MS, Ribeiro ALP. HBA1C point-of-care testing for diabetes control in a low-income population: A before and after study and cost-parity analysis HbA1c point-of-care testing for diabetes control. Prim Care Diabetes 2023; 17:447-453. [PMID: 37543526 DOI: 10.1016/j.pcd.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/14/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To evaluate the results of a program that offered access to HbA1c POC tests for the glycemic control of patients with diabetes in small and poor municipalities of Minas Gerais, Brazil. METHODS Using a before and after study, we compared four groups: patients submitted to (i) POC tests; (ii) conventional tests; (iii) both tests; and (iv) neither test. The analysis considered three periods: before the program; before the pandemic; and during the pandemic. A cost comparison was conducted under the societal perspective and a cost-parity model was designed. RESULTS 1349 patients previously diagnosed with diabetes were included in the analysis. The rate of consultations and the rate of HbA1c testing were significantly different between all periods and groups. Group iii had a much higher consultation and testing rate. The costs were around 89.45 PPP-USD for POC tests and between 32.44 and 54.66 PPP-USD for conventional tests. Cost-parity analysis suggests that the technology would be acceptable if the annual number of tests was between 247 and 771. CONCLUSION Using POC devices improved access to HbA1c testing but not glycemic control. Even in small towns, the number of tests necessary to achieve cost-parity is low enough to enable their incorporation into the public health system.
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Affiliation(s)
- Mônica Viegas Andrade
- Department of Economics, Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901 Belo Horizonte, Brazil.
| | - Kenya Valéria Micaela de Souza Noronha
- Department of Economics, Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901 Belo Horizonte, Brazil
| | - André Soares Santos
- Department of Economics - Center for Development and Regional Planning (CEDEPLAR), Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Pampulha, CEP 31.270-901, Belo Horizonte, Brazil; Center for Health Technology Assessment of the UFMG Teaching Hospital (NATS-HC/UFMG) -Universidade Federal de Minas Gerais, Av. AlfredoBalena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Junia Xavier Maia
- Centro de Telessaúde Hospital das Clínicas UFMG - Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Lucas Tavares Nogueira
- Universidade Presidente Antônio Carlos (UNIPAC), R. Eng. Célso Murta, 600, Olga Correa, CEP 39803-087 Teófilo Otoni, MG, Brazil
| | - Christiane Correa Rodrigues Cimini
- School of Medicine - Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371, Teófilo Otoni, MG, Brazil
| | - Maria Eduarda Furtado
- Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371 Teófilo Otoni, MG, Brazil
| | - Laryssa Coelho
- School of Medicine - Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Rua do Cruzeiro, no 01, Jardim São Paulo, CEP 39803-371, Teófilo Otoni, MG, Brazil
| | - Milena Soriano Marcolino
- Professor at Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, CEP30.130-100 Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil
| | - Antônio Luiz Pinho Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas da Universidade Federal de Minas Gerais, Av. Alfredo Balena, 110, Santa Efigênia, CEP 30.130-100 Belo Horizonte, Brazil; Department of Internal Medicine, School ofMedicine, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efigênia, CEP30.130-100 Belo Horizonte, Brazil.
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El-Osta A, Sasco ER, Barbanti E, Webber I, Alaa A, Karki M, Asmar MLE, Idriss H, Almadi M, Massoud F, Alboksmaty A, Majeed A. Tools for measuring individual self-care capability: a scoping review. BMC Public Health 2023; 23:1312. [PMID: 37422637 PMCID: PMC10329804 DOI: 10.1186/s12889-023-16194-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND Our ability to self-care can play a crucial role in the prevention, management and rehabilitation of diverse conditions, including chronic non-communicable diseases. Various tools have been developed to support the measurement of self-care capabilities of healthy individuals, those experiencing everyday self-limiting conditions, or one or more multiple long-term conditions. We sought to characterise the various non-mono-disease specific self-care measurement tools for adults as such a review was lacking. OBJECTIVE The aim of the review was to identify and characterise the various non-mono-disease specific self-care measurement tools for adults. Secondary objectives were to characterise these tools in terms of their content, structure and psychometric properties. DESIGN Scoping review with content assessment. METHODS The search was conducted in Embase, PubMed, PsycINFO and CINAHL databases using a variety of MeSH terms and keywords covering 1 January 1950 to 30 November 2022. Inclusion criteria included tools assessing health literacy, capability and/or performance of general health self-care practices and targeting adults. We excluded tools targeting self-care in the context of disease management only or indicated to a specific medical setting or theme. We used the Seven Pillars of Self-Care framework to inform the qualitative content assessment of each tool. RESULTS We screened 26,304 reports to identify 38 relevant tools which were described in 42 primary reference studies. Descriptive analysis highlighted a temporal shift in the overall emphasis from rehabilitation-focused to prevention-focused tools. The intended method of administration also transitioned from observe-and-interview style methods to the utilisation of self-reporting tools. Only five tools incorporated questions relevant to the seven pillars of self-care. CONCLUSIONS Various tools exist to measure individual self-care capability, but few consider assessing capability against all seven pillars of self-care. There is a need to develop a comprehensive, validated tool and easily accessible tool to measure individual self-care capability including the assessment of a wide range of self-care practices. Such a tool could be used to inform targeted health and social care interventions.
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Affiliation(s)
- Austen El-Osta
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Eva Riboli Sasco
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Evelina Barbanti
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Iman Webber
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Aos Alaa
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Manisha Karki
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Marie line El Asmar
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Haitham Idriss
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Mashael Almadi
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Farah Massoud
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Ahmed Alboksmaty
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
| | - Azeem Majeed
- Self-Care Academic Research Unit (SCARU), Department of Primary Care & Public Health, School of Public Health, Imperial College London, Charing Cross Hospital, 323 Reynolds BuildingSt Dunstan’s Road, London, W6 8RP UK
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Arya SS, Dias SB, Jelinek HF, Hadjileontiadis LJ, Pappa AM. The convergence of traditional and digital biomarkers through AI-assisted biosensing: A new era in translational diagnostics? Biosens Bioelectron 2023; 235:115387. [PMID: 37229842 DOI: 10.1016/j.bios.2023.115387] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 04/11/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
Advances in consumer electronics, alongside the fields of microfluidics and nanotechnology have brought to the fore low-cost wearable/portable smart devices. Although numerous smart devices that track digital biomarkers have been successfully translated from bench-to-bedside, only a few follow the same fate when it comes to track traditional biomarkers. Current practices still involve laboratory-based tests, followed by blood collection, conducted in a clinical setting as they require trained personnel and specialized equipment. In fact, real-time, passive/active and robust sensing of physiological and behavioural data from patients that can feed artificial intelligence (AI)-based models can significantly improve decision-making, diagnosis and treatment at the point-of-procedure, by circumventing conventional methods of sampling, and in person investigation by expert pathologists, who are scarce in developing countries. This review brings together conventional and digital biomarker sensing through portable and autonomous miniaturized devices. We first summarise the technological advances in each field vs the current clinical practices and we conclude by merging the two worlds of traditional and digital biomarkers through AI/ML technologies to improve patient diagnosis and treatment. The fundamental role, limitations and prospects of AI in realizing this potential and enhancing the existing technologies to facilitate the development and clinical translation of "point-of-care" (POC) diagnostics is finally showcased.
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Affiliation(s)
- Sagar S Arya
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates
| | - Sofia B Dias
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Interdisciplinary Center for Human Performance, Faculdade de Motricidade Humana, Universidade de Lisboa, Portugal.
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates
| | - Leontios J Hadjileontiadis
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates; Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, GR, 54124, Thessaloniki, Greece
| | - Anna-Maria Pappa
- Department of Biomedical Engineering, Khalifa University of Science and Technology, P.O. Box 127788, Abu Dhabi, United Arab Emirates; Healthcare Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, P O Box 127788, Abu Dhabi, United Arab Emirates; Department of Chemical Engineering and Biotechnology, Cambridge University, Cambridge, UK.
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Tenorio-Mucha J, Busta-Flores P, Lazo-Porras M, Vetter B, Safary E, Moran AE, Gupta R, Bernabé-Ortiz A. Facilitators and barriers of the implementation of point-of-care devices for cardiometabolic diseases: a scoping review. BMC Health Serv Res 2023; 23:412. [PMID: 37118750 PMCID: PMC10144879 DOI: 10.1186/s12913-023-09419-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/19/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Point-of-care testing (POCT) devices may facilitate the delivery of rapid and timely results, providing a clinically important advantage in patient management. The challenges and constraints in the implementation process, considering different levels of actors have not been much explored. This scoping review aimed to assess literature pertaining to implementation facilitators and barriers of POCT devices for the diagnosis or monitoring of cardiometabolic diseases. METHODS A scoping review of the literature was conducted. The inclusion criteria were studies on the inception, planning, or implementation of interventions with POCT devices for the diagnosis or monitoring of cardiometabolic diseases defined as dyslipidemia, cardiovascular diseases, type 2 diabetes, and chronic kidney disease. We searched MEDLINE, Embase, and Global Health databases using the OVID searching engine until May 2022. The Consolidated Framework of Implementation Research (CFIR) was used to classify implementation barriers and facilitators in five constructs. Also, patient, healthcare professional (HCP), and organization level was used. RESULTS Twenty studies met the eligibility criteria for data extraction. All studies except two were conducted in high-income countries. Some findings are: 1) Intervention: the most widely recognized facilitator was the quick turnaround time with which results are obtained. 2) Outer setting: at the organizational level, the lack of clear regulatory and accreditation mechanisms has hindered the adoption and sustainability of the use of POCT. 3) Inner setting: for HCP, performing POCT during the consultation was both a facilitator and a barrier in terms of time, personnel, and service delivery. 4) Individuals: the implementation of POCT may generate stress and discomfort in some HCP in terms of training and new responsibilities. 5) Process: for patients, it is highly appreciated that obtaining the sample was simple and more comfortable if venipuncture was not used. CONCLUSION This scoping review has described the facilitators and barriers of implementing a POCT device for cardiometabolic conditions using the CFIR. The information can be used to design better strategies to implement these devices and benefit more populations that have low access to cardiometabolic tests.
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Affiliation(s)
- Janeth Tenorio-Mucha
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru
| | - Patricia Busta-Flores
- CONEVID - Unidad de Conocimiento y Evidencia, Facultad de Medicina "Alberto Hurtado", Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru
| | | | | | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- Department of Medicine of Medicine, University of California, San Francisco, USA
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 445 - Miraflores, Lima, Peru.
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Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services. Healthcare (Basel) 2022; 10:healthcare10112251. [PMID: 36360593 PMCID: PMC9691080 DOI: 10.3390/healthcare10112251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces. All PMCIs had medical/nursing officers, but data entry operators (44%) and laboratory technicians (33%) were mostly not available. Existing staff were assigned additional responsibilities in PSSP, decreasing their motivation and efficiency. While 11/18 (61%) essential drugs were available in all PMCIs, buffer stocks were not maintained in >50% due to poor supply chain management and storage infrastructure. Only 6/14 (43%) essential laboratory investigations were available in >50% of PMCIs, non-availability was due to shortages of reagents/consumables and lack of sample collection−transportation system. The HMIS was installed in PMCIs but its usage was sub-optimal due to perceived lack of utility, few trained operators and poor internet connectivity. The PSSP needs to address these bottlenecks as a priority to ensure sustainability and successful scale-up.
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Lingervelder D, Koffijberg H, Emery JD, Fennessy P, Price CP, van Marwijk H, Eide TB, Sandberg S, Cals JW, Derksen JT, Kusters R, IJzerman MJ. How to Realize the Benefits of Point-of-Care Testing at the General Practice: A Comparison of Four High-Income Countries. Int J Health Policy Manag 2022; 11:2248-2260. [PMID: 34814677 PMCID: PMC9808289 DOI: 10.34172/ijhpm.2021.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/12/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations. METHODS The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country. RESULTS The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support. CONCLUSION Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Jon D. Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Fennessy
- Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, Australia
| | - Christopher P. Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Torunn B. Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Sverre Sandberg
- The Norwegian Organisation for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Jochen W.L. Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | | | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Maarten J. IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Cancer Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
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Baker AN, Hawker-Bond GW, Georgiou PG, Dedola S, Field RA, Gibson MI. Glycosylated gold nanoparticles in point of care diagnostics: from aggregation to lateral flow. Chem Soc Rev 2022; 51:7238-7259. [PMID: 35894819 PMCID: PMC9377422 DOI: 10.1039/d2cs00267a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current point-of-care lateral flow immunoassays, such as the home pregnancy test, rely on proteins as detection units (e.g. antibodies) to sense for analytes. Glycans play a fundamental role in biological signalling and recognition events such as pathogen adhesion and hence they are promising future alternatives to antibody-based biosensing and diagnostics. Here we introduce the potential of glycans coupled to gold nanoparticles as recognition agents for lateral flow diagnostics. We first introduce the concept of lateral flow, including a case study of lateral flow use in the field compared to other diagnostic tools. We then introduce glycosylated materials, the affinity gains achieved by the cluster glycoside effect and the current use of these in aggregation based assays. Finally, the potential role of glycans in lateral flow are explained, and examples of their successful use given. Antibody-based lateral flow (immune) assays are well established, but here the emerging concept and potential of using glycans as the detection agents is reviewed.![]()
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Affiliation(s)
- Alexander N Baker
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK.
| | - George W Hawker-Bond
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital Oxford, Oxford, OX3 9DU, UK
| | - Panagiotis G Georgiou
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK.
| | | | - Robert A Field
- Iceni Glycoscience Ltd, Norwich, NR4 7GJ, UK.,Department of Chemistry and Manchester Institute of Biotechnology, University of Manchester, Manchester M1 7DN, UK
| | - Matthew I Gibson
- Department of Chemistry, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK. .,Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, CV4 7AL, Coventry, UK
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10
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Gupta A, Ramachandran K, Paul D, Gupta E. Evaluation of three different rapid card tests for the detection of hepatitis B surface antigen. Trop Doct 2022; 52:307-310. [PMID: 35072566 DOI: 10.1177/00494755211069712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rapid diagnostic card tests are crucial steps on the road to hepatitis B elimination and should be incorporated into diagnostic algorithms. However, all commercial rapid diagnostic card tests are not equal and require evaluation before clinical use. Thus, we aimed to compare the performance characteristics of three different rapid diagnostic card tests with chemiluminescence-based assay (CLIA) for the detection of hepatitis B surface antigen.We concluded rapid diagnostic card tests can be used to identify patients with high signal/cut-off ratio on CLIA, but patients with signal/cut-off ratio <200 may be missed. Rapid diagnostic card tests may help pave the way for decentralised testing, but should be used only after evaluation in the community.
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Affiliation(s)
- Akshita Gupta
- Department of Clinical Virology, 80402Institute of Liver and Biliary Sciences, New Delhi, India
| | - Krithiga Ramachandran
- Department of Clinical Virology, 80402Institute of Liver and Biliary Sciences, New Delhi, India
| | - Diptanu Paul
- Department of Clinical Virology, 80402Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, 80402Institute of Liver and Biliary Sciences, New Delhi, India
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Relevant Biomarkers in Medical Practices: An Analysis of the Needs Addressed by an International Survey. J Pers Med 2022; 12:jpm12010106. [PMID: 35055421 PMCID: PMC8778050 DOI: 10.3390/jpm12010106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 02/04/2023] Open
Abstract
(1) Backround: Technological advances should foster gains in physicians’ efficiency. For example, a reduction of the medical decision time can be enabled by faster biological tests. The main objective of this study was to collect responses from an international panel of physicians on their needs for biomarkers and also to convey the improvement in the outcome to be made possible by the potential development of fast diagnostic tests for these biomarkers. (2) Methods: we distributed a questionnaire on the Internet to physicians. (3) Results: 508 physicians participated in this survey. The mean age was 38 years. General practice and emergency medicine were heavily represented, with 95% CIs of 44% (39.78, 48.41) and 32% (27.84, 35.94)), respectively. The two most represented countries were France (95% CI: 74% (70.20, 77.83)) and the USA (95% CI: 11% (8.65, 14.18)). Ninety-eight percentages of the physicians thought that obtaining cited biomarkers more quickly would be beneficial to their practice and to patient’s care. The main biomarkers of interest identified by our panel were troponin (95% CI: 51% (46.24, 54.94)), C-reactive protein (95% CI: 42% (38.03, 46.62)), D-dimer (95% CI: 29% (24.80, 32.68)), and brain natriuretic peptide (95% CI: 13% (10.25, 16.13)). (4) Conclusions: Our study highlights the real technological need for fast biomarker results, which could be provided by biosensors. The relevance of some answers such as troponin is questionable.
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12
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Regan B, O'Kennedy R, Collins D. Advances in point-of-care testing for cardiovascular diseases. Adv Clin Chem 2021; 104:1-70. [PMID: 34462053 DOI: 10.1016/bs.acc.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Point-of-care testing (POCT) is a specific format of diagnostic testing that is conducted without accompanying infrastructure or sophisticated instrumentation. Traditionally, such rapid sample-to-answer assays provide inferior analytical performances to their laboratory counterparts when measuring cardiac biomarkers. Hence, their potentially broad applicability is somewhat bound by their inability to detect clinically relevant concentrations of cardiac troponin (cTn) in the early stages of myocardial injury. However, the continuous refinement of biorecognition elements, the optimization of detection techniques, and the fabrication of tailored fluid handling systems to manage the sensing process has stimulated the production of commercial assays that can support accelerated diagnostic pathways. This review will present the latest commercial POC assays and examine their impact on clinical decision-making. The individual elements that constitute POC assays will be explored, with an emphasis on aspects that contribute to economically feasible and highly sensitive assays. Furthermore, the prospect of POCT imparting a greater influence on early interventions for medium to high-risk individuals and the potential to re-shape the paradigm of cardiovascular risk assessments will be discussed.
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Affiliation(s)
- Brian Regan
- School of Biotechnology, Dublin City University, Dublin, Ireland.
| | - Richard O'Kennedy
- School of Biotechnology, Dublin City University, Dublin, Ireland; Research Complex, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - David Collins
- School of Biotechnology, Dublin City University, Dublin, Ireland
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Lingervelder D, Koffijberg H, Kusters R, IJzerman MJ. Health Economic Evidence of Point-of-Care Testing: A Systematic Review. PHARMACOECONOMICS - OPEN 2021; 5:157-173. [PMID: 33405188 PMCID: PMC8160040 DOI: 10.1007/s41669-020-00248-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Point-of-care testing (POCT) has become an essential diagnostic technology for optimal patient care. Its implementation, however, still falls behind. This paper reviews the available evidence on the health economic impact of introducing POCT to assess if poor POCT uptake may be related to lacking evidence. STUDY DESIGN The Scopus and PubMed databases were searched to identify publications describing a health economic evaluation of a point-of-care (POC) test. Data were extracted from the included publications, including general and methodological characteristics as well as the study results summarized in either cost, effects or an incremental cost-effectiveness ratio. Results were sorted into six groups according to the POC test's purpose (diagnosis, screening or monitoring) and care setting (primary care or secondary care). The reporting quality of the publications was determined using the CHEERS checklist. RESULTS The initial search resulted in 396 publications, of which 44 met the inclusion criteria. Most of the evaluations were performed in a primary care setting (n = 31; 70.5%) compared with a secondary care setting (n = 13; 29.5%). About two thirds of the evaluations were on POC tests implemented with a diagnostic purpose (n = 28; 63.6%). More than 75% of evaluations concluded that POCT is recommended for implementation, although in some cases only under specific circumstances and conditions. Compliance with the CHEERS checklist items ranged from 20.8% to 100%, with an average reporting quality of 72.0%. CONCLUSION There were very few evaluations in this review that advised against the implementation of POCT. However, the uptake of POCT in many countries remains low. Even though the evaluations included in this review did not always include the full long-term benefits of POCT, it is clear that health economic evidence across a few dimensions of value already indicate the benefits of POCT. This suggests that the lack of evidence on POCT is not the primary barrier to its implementation and that the low uptake of these tests in clinical practice is due to (a combination of) other barriers. In this context, aspects around organization of care, support of clinicians and quality management may be crucial in the widespread implementation of POCT.
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Affiliation(s)
- Deon Lingervelder
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
| | - Ron Kusters
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands
- Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research Department, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, 7500 AE, The Netherlands.
- Cancer Health Services Research Unit, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
- Victorian Comprehensive Cancer Centre, Melbourne, Australia.
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Butler J, de Cassan S, Turner P, Lennox B, Hayward G, Glogowska M. Mental healthcare clinician engagement with point of care testing; a qualitative study. BMC Psychiatry 2021; 21:73. [PMID: 33541304 PMCID: PMC7863427 DOI: 10.1186/s12888-021-03067-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 01/25/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Point of Care Testing (POCT) is being increasingly used to augment the delivery of physical health care in a variety of settings, but their use in mental health has been limited. Research into understanding the barriers faced for successful implementation of POCT in these settings is lacking. We aimed to identify factors affecting engagement and implementation of POCT within mental health teams by exploring the attitudes to POCT, and the perceived impact POCT has on the practice of mental healthcare clinicians. METHODS Alongside a study evaluating the impact of a point of care device in Community Mental Health Teams (CMHTs), qualitative interviews were carried out with CMHT clinicians using POCT as part of annual physical checks for patients with severe and enduring mental illness. Data were collected using semi-structured interviews and analysed using thematic analysis. RESULTS Fifteen clinicians were interviewed across a range of professional backgrounds. Clinicians identified usability of the technology, positive impact on their patient's experience and improved self-efficacy as drivers for successful implementation of POCT into their clinical practice. Issues with device functioning and the potential for a negative effect on the therapeutic relationship with their patients were identified as barriers. Level of physical heath training was not found to be a barrier by mental health professionals to using POCT. CONCLUSIONS Understanding barriers and drivers for engagement is important to allow co-production of POCT and guidelines to facilitate introduction of POCT into routine clinical practice.
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Affiliation(s)
- Joseph Butler
- Foundation Year 3 Physical Health Care, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Simone de Cassan
- Core trainee Psychiatry, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Phil Turner
- NIHR Community Healthcare MIC, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Belinda Lennox
- Oxford Health NHS Foundation Trust, UK and Professor of Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Lipid profile assessed in the family pediatrician's office: the COLIBRI'- SIMPeF study. Eur J Pediatr 2021; 180:147-156. [PMID: 32613309 DOI: 10.1007/s00431-020-03726-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/27/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022]
Abstract
There is limited information on the prevalence of dyslipidemia in the Italian pediatric population. Aim of the study was to evaluate total cholesterol, high-density lipoprotein (HDL)-cholesterol and triglyceride levels, and associated factors in a large sample of Italian children, applying a micro-sampling procedure in the family pediatrician's office. In a population of 1910 children (50.2% males, age 7-11 years), 27.6% was overweight or obese and 28.3% had at least one parent with referred hypercholesterolemia. Total cholesterol and triglyceride levels were elevated in 4.5% and 23.5% of the subjects, respectively, while HDL cholesterol was below 40 mg/dl in 3.3%. Male gender (OR 1.58, 95% CI 1.01-2.49) and positive family history (OR 2.13, 95% CI 1.36-3.32) were independent predictors of hypercholesterolemia, while BMI z-score was associated with low HDL cholesterol (OR 1.46, 95% CI 1.13-1.88) and high levels of triglycerides (OR 1.39, 95% CI 1.26-1.55).Conclusion: The prevalence of dyslipidemia in our sample is worthy of attention. The study suggests the opportunity and feasibility to check for the presence of dyslipidemia at the family pediatrician's office. Familiarity is associated with high cholesterol levels, regardless of the children's weight class, while weight excess identifies subjects with the typical lipid profile of metabolic syndrome. What is Known: • Few data are available on the lipid profile in Italian children. • Early treatment of hypercholesterolemia is effective in reducing cardiovascular events later in life; there is no agreement on how to screen for dyslipidemia in childhood, however. What is New: • In a large sample of Italian children, familiarity doubles the risk of hypercholesterolemia, while increased BMI is associated with low HDL cholesterol levels and hypertriglyceridemia. • The pediatrician may perform an assessment of plasma lipids in his office as a first step to diagnose familial hypercholesterolemia.
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Barroso M, Baena-Díez JM, Muñoz-Aguayo D, Díaz JL, Schröder H, Grau M. Reference ranges of glycated hemoglobin (HbA1c) in capillary blood in the Spanish population. Prim Care Diabetes 2020; 14:768-771. [PMID: 31836306 DOI: 10.1016/j.pcd.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 11/16/2022]
Abstract
Cross-sectional analysis describing HbA1c reference values by sex and age in a randomly selected Mediterranean general population sample. Using two methods, Point-of-Care systems and centralized laboratory, results show that HbA1c values increase with age. Almost half of the sample aged 65 years or older had median values >5.7% (prediabetes cut-off point).
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Affiliation(s)
- María Barroso
- Cardiovascular Epidemiology and Genetics, IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain; Gornal Primary Care Centre, IDIAP Jordi Gol, Catalan Institute of Health (ICS), L'Hospitalet de Llobregat, Spain; PhD Programme in Methodology of Biomedical Research and Public Health, Department of Pediatrics, Obstetrics and Gynecology and Preventive Medicine, Autonomous University of Barcelona, Spain
| | - Jose Miguel Baena-Díez
- La Marina Primary Care Centre, IDIAP Jordi Gol, Catalan Institute of Health (ICS), Barcelona, Spain
| | - Daniel Muñoz-Aguayo
- Cardiovascular Risk and Nutrition, IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Obesity and Nutrition (CIBERobn), Barcelona, Spain
| | - Jorge Luis Díaz
- Cardiovascular Epidemiology and Genetics, IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain; Teaching Unit of Preventive Medicine and Public Health Mar Health Park, Pompeu-Fabra University, Barcelona Public Health Agency, Spain
| | - Helmut Schröder
- Cardiovascular Risk and Nutrition, IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Spain
| | - María Grau
- Cardiovascular Epidemiology and Genetics, IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Spain; Department of Medicine, University of Barcelona, Spain.
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Williams M, Thomson L, Butcher E, Morriss R, Khunti K, Packham C. NHS Health Check Programme: a qualitative study of prison experience. J Public Health (Oxf) 2020; 44:174-183. [PMID: 33215193 DOI: 10.1093/pubmed/fdaa189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/28/2020] [Accepted: 09/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND NHS Health Checks began in England in 2009 and were subsequently introduced into English prisons. Uptake has been patchy and there is limited understanding about factors that may limit or enhance uptake in prison settings. Uptake of this programme is a key policy in reducing the risk of cardiovascular disease and death in these settings. METHOD Semi-structured focus groups were conducted with groups of prisoners (attendees and non-attendees to the health check), prison healthcare staff, custodial staff and ex-prisoners (n = 50). Participants were asked about their awareness and experiences of the NHS Health Check Programme in prison. RESULTS All groups highlighted barriers for not attending a health check appointment, such as poor accessibility to the healthcare department, stigma and fear. The majority of participants expressed a lack of awareness and discussed common misconceptions regarding the health check programme. Methods of increasing the uptake of health checks through group-based approaches and accessibility to healthcare were suggested. CONCLUSIONS This study reports on prisoner, staff and ex-prisoner perspectives on the implementation of NHS Health Checks within a restrictive prison environment. These findings have potentially substantial implications for successful delivery of care within offender healthcare services.
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Affiliation(s)
- Marie Williams
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
| | - Louise Thomson
- Centre for Organizational Health and Development, University of Nottingham, Nottingham NG8 1BB, UK
| | | | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham NG7 2TU, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Chris Packham
- Nottinghamshire Healthcare NHS Trust, Nottingham NG6 3AA, UK
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Butler J, de Cassan S, Glogowska M, Fanshawe TR, Turner P, Walton D, Lasserson D, Bale R, Lennox B, Hayward G. Effect of point of care blood testing on physical health check completion in mental health services: mixed-methods evaluation. BJPsych Open 2020; 6:e127. [PMID: 33107428 PMCID: PMC7745242 DOI: 10.1192/bjo.2020.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Physical health outcomes in severe mental illness are worse than in the general population. Routine physical health check completion in this group is poor. AIMS To quantitatively and qualitatively evaluate the impact of point of care (POC) blood testing on physical health check completion in community mental health services. METHOD In a prospective cohort design, we equipped an early intervention service (EIS) and a community mental health team (CMHT) with a POC blood testing device for 6 months. We compared rates of blood test and full physical health check completion in the intervention teams with a matched EIS and CMHT, historically and during the intervention. We explored attitudes to POC testing using thematic analysis of semi-structured interviews with patients and clinicians. RESULTS Although the CMHT scarcely used the POC device and saw no change in outcomes, direct comparison of testing rates in the intervention period showed increased physical health check completion in the EIS with the device (rate ratio RR = 5.18; 95% CI 2.54-12.44; P < 0.001) compared with usual care. The rate was consistent with the EIS's increasing rate of testing over time (RR = 0.45; 95% 0.09-2.08; P = 0.32). Similar trends were seen in blood test completion. POC testing was acceptable to patients but clinicians reported usability, provision and impact on the therapeutic relationship as barriers to uptake. CONCLUSIONS POC testing was beneficial and acceptable to patients and may increase physical health check uptake. Further research, accounting for clinician barriers, is needed to evaluate its clinical and cost-effectiveness.
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Affiliation(s)
| | | | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Phil Turner
- National Institute for Health Research Community Healthcare Healthcare MedTech and In Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Debbie Walton
- Adult and Older Adult Mental Health, Oxford Health NHS Foundation Trust, UK
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham; and Department of Acute Medicine, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, UK
| | - Robert Bale
- Adult Mental Health Services, Oxford Health NHS Foundation Trust, UK
| | - Belinda Lennox
- Oxford Health NHS Foundation Trust; Department of Psychiatry, University of Oxford, UK
| | - Gail Hayward
- National Institute for Health Research Community Healthcare MedTech and In Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Point-of-care used in the treatment of older patients with cancer. The perception and experience of nurses. Appl Nurs Res 2020; 53:151268. [PMID: 32451011 DOI: 10.1016/j.apnr.2020.151268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nursing tasks are changing as the proportion of people over the age of 65 years is increasing and is expected to double over the next four decades. New innovative solutions such as Point of Care Treatment (POCT) are being tested in oncological settings in order to optimise treatment, and this changes the nurse management in oncology. There is a need to explore oncology nurses' perception and experience when implementing the innovations in order to understand the implications for nursing and the treatment of older patients with cancer. METHODS Qualitative research with face to face interviews with nurses working in oncology. Sample size (Mean = 8). Data were recorded verbatim, transcribed, and thematic analysis used. RESULTS Three themes were identified: a, A great advantage in nursing, b, Change of practice in nursing care, c, Challenges in shifting roles. A majority of the participants had the perception that POCT treatment was an advantage not only for the nursing profession but for the older patients in cancer treatment as well. Monitoring the older patients with cancer at home would prevent them from accessing the hospital and get exposed to viral infections as well as saving them the journey to the hospital. Involvement from relatives, clear communication and management of the device and data transferred is essential. CONCLUSIONS The use of POCT in oncology will shift the nurses' tasks on the ward as well as improve treatment for older patients with cancer.
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20
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Serafin A, Malinowski M, Prażmowska-Wilanowska A. Blood volume and pain perception during finger prick capillary blood sampling: are all safety lancets equal? Postgrad Med 2020; 132:288-295. [PMID: 32027205 DOI: 10.1080/00325481.2020.1717160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aimed to assess various types of safety lancets in terms of blood volume and pain perception during capillary blood sampling, a routine finger-puncture procedure for obtaining a small amount of human blood for running various screening and diagnostic tests. METHODS Data were collected from 100 adult healthy volunteers following finger-puncture procedure. Four different types of safety lancets were tested (Acti-Lance, Prolance, Medlance Plus, and MediSafe Solo). Each type has its own versions, giving 16 different safety lancets in total. RESULTS A significant difference in the mean capillary blood volume was found between blade and needle equipped safety lancets. MediSafe Solo type lancet had no blade version, and hence its use was associated with the lowest mean collected capillary blood volume (42.4 μL). Acti-Lance and Medlance Plus type lancets had one blade version and the mean collected capillary blood volume was 82.2 and 99.0 μL, respectively. Prolance type lancet had two blade versions, and its use was associated with the highest mean capillary blood volume (118.3 μL). The level of pain intensity was evaluated as low by the majority of patients for all lancets. Medlance Plus was the least painful and Acti-Lance was the most painful type of safety lancet. On a 0-to-10 scale of pain, 75% of punctures were assessed by the participants at a level not exceeding 3 points. CONCLUSIONS This study suggests that although all investigated safety lancets achieve adequate performance regarding the necessary capillary blood volume to run a diagnostic of test, lancets equipped with blades differ significantly from those equipped with needles in terms of the mean obtained capillary blood volume. Further, although all devices produced relatively low levels of pain, the amount of pain caused by blade versions of safety lancets has been found to be higher than that of needle versions. CLINICALTRIALS.GOV ID NCT04001348. (https://clinicaltrials.gov/ct2/show/NCT04001348?term=NCT04001348&draw=2&rank=1).
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Affiliation(s)
- A Serafin
- Regulatory Affairs Department, HTL-Strefa S.A , Ozorków, Poland
| | - M Malinowski
- Regulatory Affairs Department, HTL-Strefa S.A , Ozorków, Poland
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22
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Taking connected mobile-health diagnostics of infectious diseases to the field. Nature 2019; 566:467-474. [PMID: 30814711 DOI: 10.1038/s41586-019-0956-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/08/2018] [Indexed: 11/08/2022]
Abstract
Mobile health, or 'mHealth', is the application of mobile devices, their components and related technologies to healthcare. It is already improving patients' access to treatment and advice. Now, in combination with internet-connected diagnostic devices, it offers novel ways to diagnose, track and control infectious diseases and to improve the efficiency of the health system. Here we examine the promise of these technologies and discuss the challenges in realizing their potential to increase patients' access to testing, aid in their treatment and improve the capability of public health authorities to monitor outbreaks, implement response strategies and assess the impact of interventions across the world.
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Fanshawe TR, Ordóñez-Mena JM, Turner PJ, Bruel AVD, Shine B, Hayward GN. Frequencies and patterns of laboratory test requests from general practice: a service evaluation to inform point-of-care testing. J Clin Pathol 2018; 71:1065-1071. [PMID: 30228215 DOI: 10.1136/jclinpath-2018-205242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022]
Abstract
AIMS The demand for test requests from general practice to laboratory services remains high. Tests performed at the point of care could reduce turnaround time and speed up clinical decision making. Replicating laboratory testing in the community would require panels of tests to be performed simultaneously, which is now approaching technological feasibility. We assessed frequencies and combinations of test requests from community settings to inform the potential future development of multiplex point-of-care panels. METHODS We assessed all laboratory test requests made from general practice in Oxfordshire, UK, from January 2014 to March 2017. We summarised test request frequency overall and in combination, using heatmaps and hierarchical cluster analysis. Results are also presented by age/sex subgroups. We further assessed patterns of tests requested within 7 and 14 days after an initial test request. RESULTS 11 763 473 test requests were made for 413 073 individuals (28% age >65). Of more than 500 test types, 62 were requested at least 5000 times, most commonly renal function tests (approximately 296 000/year), full blood count (278 000/year) and liver function tests (237 000/year). Cluster analysis additionally identified a clear grouping of tests commonly used to investigate anaemia. Follow-up test frequency was much lower than the frequency of multiple tests ordered at initial presentation. CONCLUSIONS The current high volume of single and combination test requests highlights an opportunity for reliable multiplex point-of-care panels to cover a core set of frequently requested tests. The impact on test use of introducing such panels to general practice requires additional research.
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Affiliation(s)
- Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - Philip J Turner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK.,Academic Centre of General Practice, University of Leuven, Leuven, Belgium
| | - Brian Shine
- Clinical Biochemistry, John Radcliffe Hospital, Oxford , UK
| | - Gail N Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford , UK
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