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Zhang JY, Shang T, Koliwad SK, Klonoff DC. Continuous Ketone Monitoring: A New Paradigm for Physiologic Monitoring. J Diabetes Sci Technol 2021; 15:775-780. [PMID: 33834884 PMCID: PMC8258504 DOI: 10.1177/19322968211009860] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this issue of JDST, Alva and colleagues present for the first time, development of a continuous ketone monitor (CKM) tested both in vitro and in humans. Their sensor measured betahydroxybutyrate (BHB) in interstitial fluid (ISF). The sensor was based on wired enzyme electrochemistry technology using BHB dehydrogenase. The sensor required only a single retrospective calibration without a need for further adjustments over 14 days. The device produced a linear response over the 0-8 mM range with good accuracy. This novel CKM could provide a new dimension of useful automatically collected information for managing diabetes. Passively collected ISF ketone information would be useful for predicting and managing ketoacidosis in patients with type 1 diabetes, as well as other states of abnormal ketonemia. Although additional studies of this CKM will be required to assess performance in intended patient populations and prospective factory calibration will be required to support real time measurements, this novel monitor has the potential to greatly improve outcomes for people with diabetes. In the future, a CKM might be integrated with a continuous glucose monitor in the same sensor platform.
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Affiliation(s)
| | - Trisha Shang
- Diabetes Technology Society, Burlingame, CA, USA
| | - Suneil K. Koliwad
- Division of Endocrinology and Metabolism, University of California San Francisco, San Francisco, CA, USA
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Huang AW, Wei M, Caputo S, Wilson ML, Antoun J, Hsu WC. An Intermittent Fasting Mimicking Nutrition Bar Extends Physiologic Ketosis in Time Restricted Eating: A Randomized, Controlled, Parallel-Arm Study. Nutrients 2021; 13:1523. [PMID: 33946428 PMCID: PMC8147148 DOI: 10.3390/nu13051523] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/28/2021] [Indexed: 12/26/2022] Open
Abstract
There has been increasing interest in time-restricted eating to attain intermittent fasting's metabolic benefits. However, a more extended daily fast poses many challenges. This study was designed to evaluate the effects of a 200-calorie fasting-mimicking diet (FMD) energy bar formulated to prolong ketogenesis and mitigate fasting-associated side effects. A randomized, controlled study was conducted comparing the impact of consuming an FMD bar vs. continued water fast, after a 15-h overnight fast. Subjects in the FMD group showed a 3-h postprandial beta-hydroxybutyrate (BHB) level and 4-h postprandial BHB area under the curve (AUC0-4) that were non-inferior to those who continued with the water fast (p = 0.891 and p = 0.377, respectively). The postprandial glucose AUC0-4 in the FMD group was non-inferior to that in the water fast group (p = 0.899). A breakfast group served as a control, which confirmed that the instrument used in home glucose and ketone monitoring functioned as expected. The results indicate that FMD bar consumption does not interfere with the physiological ketogenesis associated with overnight fasting and could be used to facilitate the practice of time-restricted eating or intermittent fasting.
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Affiliation(s)
- Angie W. Huang
- L-Nutra, Inc., Plano, TX 75024, USA; (A.W.H.); (M.W.); (S.C.); (J.A.)
| | - Min Wei
- L-Nutra, Inc., Plano, TX 75024, USA; (A.W.H.); (M.W.); (S.C.); (J.A.)
| | - Sara Caputo
- L-Nutra, Inc., Plano, TX 75024, USA; (A.W.H.); (M.W.); (S.C.); (J.A.)
| | - Melissa L. Wilson
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90089, USA;
| | - Joseph Antoun
- L-Nutra, Inc., Plano, TX 75024, USA; (A.W.H.); (M.W.); (S.C.); (J.A.)
| | - William C. Hsu
- L-Nutra, Inc., Plano, TX 75024, USA; (A.W.H.); (M.W.); (S.C.); (J.A.)
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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Danne T, Garg S, Peters AL, Buse JB, Mathieu C, Pettus JH, Alexander CM, Battelino T, Ampudia-Blasco FJ, Bode BW, Cariou B, Close KL, Dandona P, Dutta S, Ferrannini E, Fourlanos S, Grunberger G, Heller SR, Henry RR, Kurian MJ, Kushner JA, Oron T, Parkin CG, Pieber TR, Rodbard HW, Schatz D, Skyler JS, Tamborlane WV, Yokote K, Phillip M. International Consensus on Risk Management of Diabetic Ketoacidosis in Patients With Type 1 Diabetes Treated With Sodium-Glucose Cotransporter (SGLT) Inhibitors. Diabetes Care 2019; 42:1147-1154. [PMID: 30728224 PMCID: PMC6973545 DOI: 10.2337/dc18-2316] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sodium-glucose cotransporter (SGLT) inhibitors are new oral antidiabetes medications shown to effectively reduce glycated hemoglobin (A1C) and glycemic variability, blood pressure, and body weight without intrinsic properties to cause hypoglycemia in people with type 1 diabetes. However, recent studies, particularly in individuals with type 1 diabetes, have demonstrated increases in the absolute risk of diabetic ketoacidosis (DKA). Some cases presented with near-normal blood glucose levels or mild hyperglycemia, complicating the recognition/diagnosis of DKA and potentially delaying treatment. Several SGLT inhibitors are currently under review by the U.S. Food and Drug Administration and European regulatory agencies as adjuncts to insulin therapy in people with type 1 diabetes. Strategies must be developed and disseminated to the medical community to mitigate the associated DKA risk. This Consensus Report reviews current data regarding SGLT inhibitor use and provides recommendations to enhance the safety of SGLT inhibitors in people with type 1 diabetes.
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Affiliation(s)
- Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Satish Garg
- University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium
| | - Jeremy H Pettus
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, San Diego, CA
| | | | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia
| | | | | | - Bertrand Cariou
- Clinique d'endocrinologie, L'institut du thorax, CHU Nantes, CIC 1413 INSERM, Nantes, France
| | | | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, University at Buffalo, The State University of New York, Buffalo, NY
| | | | - Ele Ferrannini
- National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | | | - Simon R Heller
- Academic Unit of Diabetes, Endocrinology & Metabolism, University of Sheffield, Sheffield, U.K
| | - Robert R Henry
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, San Diego, CA
| | | | | | - Tal Oron
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Thomas R Pieber
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Desmond Schatz
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL
| | - Jay S Skyler
- Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL
| | | | - Koutaro Yokote
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Moshe Phillip
- Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Casillas S, Pomerantz A, Surani S, Varon J. Role of vitamin C in diabetic ketoacidosis: Is it ready for prime time? World J Diabetes 2018; 9:206-208. [PMID: 30588281 PMCID: PMC6304299 DOI: 10.4239/wjd.v9.i12.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/20/2018] [Accepted: 11/03/2018] [Indexed: 02/05/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is life-threatening acute metabolic complication of diabetes mellitus (DM) that is characterized by acidosis, ketosis, and hyperglycemia, currently affecting mostly patients under 30 years of age with diabetes mellitus type 1. In both, DM and DKA, a pro-inflammatory state exists. This clinical entity occurs as a result of hyperglycemia-induced disturbances, resulting in an increased oxidative metabolism. For the latter reason, the use of vitamin C seems promising in DKA due to its antioxidant role in reducing the superoxide radicals that are consequence of the oxidative stress. This can decrease the pro-inflammatory state and avoids complications. Vitamin C, or also known as ascorbic acid, has been widely used in several illnesses, such as common cold, tissue healing, fertility, atherosclerosis, cancer prevention, immunity restoration, neuro-degenerative disease and also has been suggested to decrease the risk of DM, and this reason is giving place to believe that vitamin C can have an important role in treating diabetic complications such as DKA. In order to counteract these oxidative disturbances in DKA patients, we analyzed the current data regarding vitamin C and evaluate its role in any type treatment of this complication in the near future.
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Affiliation(s)
| | - Alan Pomerantz
- Dorrington Medical Associates, PA, Houston, TX 77030, United States
| | - Salim Surani
- Division of Pulmonary, Critical Care and Sleep Medicine, Texas A and M University, Health Science Center, Corpus Christi, TX 78414, United States
| | - Joseph Varon
- Acute and Continuing Care, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
- Department of Medicine, the University of Texas, Medical Branch at Galveston, Houston, TX 77030, United States
- Critical Care Services, United Memorial Medical Center/United General Hospital, Houston, TX 77030, United States
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Megahed AA, Hiew MWH, Townsend JR, Constable PD. Characterization of the analytic performance of an electrochemical point-of-care meter for measuring β-hydroxybutyrate concentration in blood and plasma from periparturient dairy cattle. Vet Clin Pathol 2017; 46:314-325. [DOI: 10.1111/vcp.12493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ameer A. Megahed
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Purdue University; West Lafayette IN USA
- Department of Animal Medicine (Internal Medicine); Faculty of Veterinary Medicine; Benha University; Benha Egypt
| | - Mark W. H. Hiew
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Purdue University; West Lafayette IN USA
- Department of Veterinary Clinical Studies; Faculty of Veterinary Medicine; Universiti Putra Malaysia; Selangor Malaysia
| | - Jonathan R. Townsend
- Department of Veterinary Clinical Sciences; College of Veterinary Medicine; Purdue University; West Lafayette IN USA
| | - Peter D. Constable
- Department of Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois at Urbana-Champaign; Urbana IL USA
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Abstract
Type 1 diabetes is a disease in which autoimmune destruction of pancreatic β-cells leads to insulin deficiency. Controlling blood glucose with an acceptable range is a major goal of therapy. Measurements of hemoglobin A1c and blood glucose levels are used for both the diagnosis and the long-term management of the disease. This chapter briefly describes the pathophysiology, diagnosis, and management of type 1 diabetes.
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Affiliation(s)
- Lindy Kahanovitz
- Department of Biotechnology Engineering, Ben Gurion University of the Negev, Beersheva, Israel
- Diabetes Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick M. Sluss
- Pathology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Steven J. Russell
- Diabetes Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Sarah Brewster
- Diabetes Department; Poole Hospital NHS Foundation Trust; Poole UK
| | - Louise Curtis
- Diabetes Department; Poole Hospital NHS Foundation Trust; Poole UK
| | - Ruth Poole
- Diabetes Department; Poole Hospital NHS Foundation Trust; Poole UK
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9
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Chambers D, Booth A, Baxter SK, Johnson M, Dickinson KC, Goyder EC. Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Susan K Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katherine C Dickinson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth C Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Wang CC, Hennek JW, Ainla A, Kumar AA, Lan WJ, Im J, Smith B, Zhao M, Whitesides GM. A Paper-Based "Pop-up" Electrochemical Device for Analysis of Beta-Hydroxybutyrate. Anal Chem 2016; 88:6326-33. [PMID: 27243791 PMCID: PMC5633928 DOI: 10.1021/acs.analchem.6b00568] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This paper describes the design and fabrication of a "pop-up" electrochemical paper-based analytical device (pop-up-EPAD) to measure beta-hydroxybutyrate (BHB)-a biomarker for diabetic ketoacidosis-using a commercial combination BHB/glucometer. Pop-up-EPADs are inspired by pop-up greeting cards and children's books. They are made from a single sheet of paper folded into a three-dimensional (3D) device that changes shape, and fluidic and electrical connectivity, by simply folding and unfolding the structure. The reconfigurable 3D structure makes it possible to change the fluidic path and to control timing; it also provides mechanical support for the folded and unfolded structures that enables good registration and repeatability on folding. A pop-up-EPAD designed to detect BHB shows performance comparable to commercially available plastic test strips over the clinically relevant range of BHB in blood when used with a commercial glucometer that integrates the ability to measure glucose and BHB (combination BHB/glucometer). With simple modifications of the electrode and the design of the fluidic path, the pop-up-EPAD also detects BHB in buffer using a simple glucometer-a device that is more available than the combination BHB/glucometer. Strategies that use a "3D pop-up"-that is, large-scale changes in 3D structure and fluidic paths-by folding/unfolding add functionality to EPADs (e.g., controlled timing, fluidic handling and path programming, control over complex sequences of steps, and alterations in electrical connectivity) and should enable the development of new classes of paper-based diagnostic devices.
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Affiliation(s)
- Chien-Chung Wang
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Jonathan W. Hennek
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Alar Ainla
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Ashok A. Kumar
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Wen-Jie Lan
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Judy Im
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Barbara Smith
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - Mengxia Zhao
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
| | - George M. Whitesides
- Department of Chemistry & Chemical Biology, Harvard University, 12 Oxford Street, Cambridge, MA 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, 60 Oxford Street, Cambridge, MA 02138, USA
- Kavli Institute for Bionano Science & Technology, Harvard University, 29 Oxford Street, Cambridge, MA 02138, USA
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Jones CHD, Howick J, Roberts NW, Price CP, Heneghan C, Plüddemann A, Thompson M. Primary care clinicians' attitudes towards point-of-care blood testing: a systematic review of qualitative studies. BMC FAMILY PRACTICE 2013; 14:117. [PMID: 23945264 PMCID: PMC3751354 DOI: 10.1186/1471-2296-14-117] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/29/2013] [Indexed: 11/16/2022]
Abstract
Background Point-of-care blood tests are becoming increasingly available and could replace current venipuncture and laboratory testing for many commonly used tests. However, at present very few have been implemented in most primary care settings. Understanding the attitudes of primary care clinicians towards these tests may help to identify the barriers and facilitators to their wider adoption. We aimed to systematically review qualitative studies of primary care clinicians’ attitudes to point-of-care blood tests. Methods We systematically searched Medline, Embase, ISI Web of Knowledge, PsycINFO and CINAHL for qualitative studies of primary care clinicians’ attitudes towards point-of-care blood tests in high income countries. We conducted a thematic synthesis of included studies. Results Our search identified seven studies, including around two hundred participants from Europe and Australia. The synthesis generated three main themes: the impact of point-of-care testing on decision-making, diagnosis and treatment; impact on clinical practice more broadly; and impact on patient-clinician relationships and perceived patient experience. Primary care clinicians believed point-of-care testing improved diagnostic certainty, targeting of treatment, self-management of chronic conditions, and clinician-patient communication and relationships. There were concerns about test accuracy, over-reliance on tests, undermining of clinical skills, cost, and limited usefulness. Conclusions We identified several perceived benefits and barriers regarding point-of-care tests in primary care. These imply that if point-of-care tests are to become more widely adopted, primary care clinicians require evidence of their accuracy, rigorous testing of the impact of introduction on patient pathways and clinical practice, and consideration of test funding.
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