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Sample records for care study poc1

  1. How can point-of-care HbA1c testing be integrated into UK primary care consultations? - A feasibility study.

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    Hirst, J A; Stevens, R J; Smith, I; James, T; Gudgin, B C; Farmer, A J

    2017-08-01

    Point-of-care (POC) HbA1c testing gives a rapid result, allowing testing and treatment decisions to take place in a single appointment. Trials of POC testing have not been shown to improve HbA1c, possibly because of how testing was implemented. This study aimed to identify key components of POC HbA1c testing and determine strategies to optimise implementation in UK primary care. This cohort feasibility study recruited thirty patients with type 2 diabetes and HbA1c>7.5% (58mmol/mol) into three primary care clinics. Patients' clinical care included two POC HbA1c tests over six months. Data were collected on appointment duration, clinical decisions, technical performance and patient behaviour. Fifty-three POC HbA1c consultations took place during the study; clinical decisions were made in 30 consultations. Five POC consultations with a family doctor lasted on average 11min and 48 consultations with nurses took on average 24min. Five POC study visits did not take place in one clinic. POC results were uploaded to hospital records from two clinics. In total, sixty-three POC tests were performed, and there were 11 cartridge failures. No changes in HbA1c or patient behaviour were observed. HbA1c measurement with POC devices can be effectively implemented in primary care. This work has identified when these technologies might work best, as well as potential challenges. The findings can be used to inform the design of a pragmatic trial to implement POC HbA1c testing. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  2. A highly conserved Poc1 protein characterized in embryos of the hydrozoan Clytia hemisphaerica: localization and functional studies.

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    Cécile Fourrage

    Full Text Available Poc1 (Protein of Centriole 1 proteins are highly conserved WD40 domain-containing centriole components, well characterized in the alga Chlamydomonas, the ciliated protazoan Tetrahymena, the insect Drosophila and in vertebrate cells including Xenopus and zebrafish embryos. Functions and localizations related to the centriole and ciliary axoneme have been demonstrated for Poc1 in a range of species. The vertebrate Poc1 protein has also been reported to show an additional association with mitochondria, including enrichment in the specialized "germ plasm" region of Xenopus oocytes. We have identified and characterized a highly conserved Poc1 protein in the cnidarian Clytia hemisphaerica. Clytia Poc1 mRNA was found to be strongly expressed in eggs and early embryos, showing a punctate perinuclear localization in young oocytes. Fluorescence-tagged Poc1 proteins expressed in developing embryos showed strong localization to centrioles, including basal bodies. Anti-human Poc1 antibodies decorated mitochondria in Clytia, as reported in human cells, but failed to recognise endogenous or fluorescent-tagged Clytia Poc1. Injection of specific morpholino oligonucleotides into Clytia eggs prior to fertilization to repress Poc1 mRNA translation interfered with cell division from the blastula stage, likely corresponding to when neosynthesis normally takes over from maternally supplied protein. Cell cycle lengthening and arrest were observed, phenotypes consistent with an impaired centriolar biogenesis or function. The specificity of the defects could be demonstrated by injection of synthetic Poc1 mRNA, which restored normal development. We conclude that in Clytia embryos, Poc1 has an essentially centriolar localization and function.

  3. POC CD4 Testing Improves Linkage to HIV Care and Timeliness of ART Initiation in a Public Health Approach: A Systematic Review and Meta-Analysis.

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    Lara Vojnov

    Full Text Available CD4 cell count is an important test in HIV programs for baseline risk assessment, monitoring of ART where viral load is not available, and, in many settings, antiretroviral therapy (ART initiation decisions. However, access to CD4 testing is limited, in part due to the centralized conventional laboratory network. Point of care (POC CD4 testing has the potential to address some of the challenges of centralized CD4 testing and delays in delivery of timely testing and ART initiation. We conducted a systematic review and meta-analysis to identify the extent to which POC improves linkages to HIV care and timeliness of ART initiation.We searched two databases and four conference sites between January 2005 and April 2015 for studies reporting test turnaround times, proportion of results returned, and retention associated with the use of point-of-care CD4. Random effects models were used to estimate pooled risk ratios, pooled proportions, and 95% confidence intervals.We identified 30 eligible studies, most of which were completed in Africa. Test turnaround times were reduced with the use of POC CD4. The time from HIV diagnosis to CD4 test was reduced from 10.5 days with conventional laboratory-based testing to 0.1 days with POC CD4 testing. Retention along several steps of the treatment initiation cascade was significantly higher with POC CD4 testing, notably from HIV testing to CD4 testing, receipt of results, and pre-CD4 test retention (all p<0.001. Furthermore, retention between CD4 testing and ART initiation increased with POC CD4 testing compared to conventional laboratory-based testing (p = 0.01. We also carried out a non-systematic review of the literature observing that POC CD4 increased the projected life expectancy, was cost-effective, and acceptable.POC CD4 technologies reduce the time and increase patient retention along the testing and treatment cascade compared to conventional laboratory-based testing. POC CD4 is, therefore, a useful tool

  4. Transcriptional repressor role of PocR on the 1,3-propanediol biosynthetic pathway by Lactobacillus panis PM1.

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    Kang, Tae Sun; Korber, Darren R; Tanaka, Takuji

    2014-06-01

    The regulatory role of a transcriptional regulator (PocR) in the 1,3-propanediol biosynthetic pathway of Lactobacillus panis PM1 contributes to the optimization of 1,3-propanediol production by this strain, which potentially will lead to 1,3-propanediol manufacturing efficiencies. Lactobacillus panis PM1 can utilize a 1,3-propanediol (1,3-PDO) biosynthetic pathway, consisting of diol dehydratase (PduCDE) and 1,3-PDO dehydrogenase, as a NADH recycling system, to survive under various environmental conditions. In this study, we identified a key transcriptional repressor (PocR) which was annotated as a transcriptional factor of AraC family as part of the 1,3-PDO biosynthetic pathway of L. panis PM1. The over-expression of the PocR gene resulted in the significant repression (81 %) of pduC (PduCDE large subunit) transcription, and subsequently, the decreased activity of PduCDE by 22 %. As a result of the regulation of PduCDE, production of both 3-hydroxypropionaldehyde and 1,3-PDO in the PocR over-expressing strain were significantly decreased by 40 % relative to the control strain. These results clearly demonstrate the transcriptional repressor role of PocR in the 1,3-PDO biosynthetic pathway.

  5. Novel POC1A mutation in primordial dwarfism reveals new insights for centriole biogenesis.

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    Koparir, Asuman; Karatas, Omer F; Yuceturk, Betul; Yuksel, Bayram; Bayrak, Ali O; Gerdan, Omer F; Sagiroglu, Mahmut S; Gezdirici, Alper; Kirimtay, Koray; Selcuk, Ece; Karabay, Arzu; Creighton, Chad J; Yuksel, Adnan; Ozen, Mustafa

    2015-10-01

    POC1A encodes a WD repeat protein localizing to centrioles and spindle poles and is associated with short stature, onychodysplasia, facial dysmorphism and hypotrichosis (SOFT) syndrome. These main features are related to the defect in cell proliferation of chondrocytes in growth plate. In the current study, we aimed at identifying the molecular basis of two patients with primordial dwarfism (PD) in a single family through utilization of whole-exome sequencing. A novel homozygous p.T120A missense mutation was detected in POC1A in both patients, a known causative gene of SOFT syndrome, and confirmed using Sanger sequencing. To test the pathogenicity of the detected mutation, primary fibroblast cultures obtained from the patients and a control individual were used. For evaluating the global gene expression profile of cells carrying p.T120A mutation in POC1A, we performed the gene expression array and compared their expression profiles to those of control fibroblast cells. The gene expression array analysis showed that 4800 transcript probes were significantly deregulated in cells with p.T120A mutation in comparison to the control. GO term association results showed that deregulated genes are mostly involved in the extracellular matrix and cytoskeleton. Furthermore, the p.T120A missense mutation in POC1A caused the formation of abnormal mitotic spindle structure, including supernumerary centrosomes, and changes in POC1A were accompanied by alterations in another centrosome-associated WD repeat protein p80-katanin. As a result, we identified a novel mutation in POC1A of patients with PD and showed that this mutation causes the formation of multiple numbers of centrioles and multipolar spindles with abnormal chromosome arrangement. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. The use of upconverting phosphors in point-of-care (POC) testing

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    Tanke, Hans J.; Zuiderwijk, Michel; Wiesmeijer, Karien C.; Breedveld, Robert N.; Abrams, William R.; de Dood, Claudia J.; Tjon Kon Fat, Elisa M.; Corstjens, Paul L. A. M.

    2014-03-01

    Point-of-care (POC) testing is increasingly applied as a cost effective alternative to many diagnostic tests. Key in POC testing is to create sufficient assay sensitivity with relatively low cost reagents and equipment. For this purpose we have employed a unique reporter, upconverting phosphor (UCP) particles, in combination with lateral flow (LF) assays. UCPs, submicron ceramic particles doped with rare earth ions (lanthanides), convert infrared to visible light and do not suffer from autofluorescence which limits conventional fluorescence based assays. Low cost handheld readers and microfluidics were evaluated in various applications. Designed assays are well suited for applications outside diagnostic laboratories, in resource poor settings, and can even be used by patients at home. Using two distinctly different UCP-LF assay formats, we focussed on assays for infectious diseases based on the detection of pathogen-specific antibodies and/or antigens including nucleic acids to demonstrate active infection with HIV. Only minor adaptation of the standard UCP-LF assay format is needed to render the format suitable for applications involving low affinity capture antibodies (e.g. in the detection of neurotoxin, botulism), capture of small molecules (e.g. detection of melatonin, a key hormone in chronopharmacology) or the use of dry UCP reagents (e.g. detection of protein based fruit-ripening markers, of economic interest in agriculture). Finally, we anticipate on developments in healthcare (personalized medicine) by discussing the potential of one of the UCP-LF assay formats to measure serum trough levels of immunodrugs (e.g. infliximab or adalimumab) in patients treated for inflammatory bowel disease and rheumatoid arthritis.

  7. POC1A truncation mutation causes a ciliopathy in humans characterized by primordial dwarfism.

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    Shaheen, Ranad; Faqeih, Eissa; Shamseldin, Hanan E; Noche, Ramil R; Sunker, Asma; Alshammari, Muneera J; Al-Sheddi, Tarfa; Adly, Nouran; Al-Dosari, Mohammed S; Megason, Sean G; Al-Husain, Muneera; Al-Mohanna, Futwan; Alkuraya, Fowzan S

    2012-08-10

    Primordial dwarfism (PD) is a phenotype characterized by profound growth retardation that is prenatal in onset. Significant strides have been made in the last few years toward improved understanding of the molecular underpinning of the limited growth that characterizes the embryonic and postnatal development of PD individuals. These include impaired mitotic mechanics, abnormal IGF2 expression, perturbed DNA-damage response, defective spliceosomal machinery, and abnormal replication licensing. In three families affected by a distinct form of PD, we identified a founder truncating mutation in POC1A. This gene is one of two vertebrate paralogs of POC1, which encodes one of the most abundant proteins in the Chlamydomonas centriole proteome. Cells derived from the index individual have abnormal mitotic mechanics with multipolar spindles, in addition to clearly impaired ciliogenesis. siRNA knockdown of POC1A in fibroblast cells recapitulates this ciliogenesis defect. Our findings highlight a human ciliopathy syndrome caused by deficiency of a major centriolar protein. Copyright © 2012 The American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

  8. Integrating patient reported outcomes with clinical cancer registry data: a feasibility study of the electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) system.

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    Ashley, Laura; Jones, Helen; Thomas, James; Newsham, Alex; Downing, Amy; Morris, Eva; Brown, Julia; Velikova, Galina; Forman, David; Wright, Penny

    2013-10-25

    Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both Pplanning and for targeting service provision.

  9. Simultaneous point-of-care detection of anemia and sickle cell disease in Tanzania: the RAPID study.

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    Smart, Luke R; Ambrose, Emmanuela E; Raphael, Kevin C; Hokororo, Adolfine; Kamugisha, Erasmus; Tyburski, Erika A; Lam, Wilbur A; Ware, Russell E; McGann, Patrick T

    2018-02-01

    Both anemia and sickle cell disease (SCD) are highly prevalent across sub-Saharan Africa, and limited resources exist to diagnose these conditions quickly and accurately. The development of simple, inexpensive, and accurate point-of-care (POC) assays represents an important advance for global hematology, one that could facilitate timely and life-saving medical interventions. In this prospective study, Robust Assays for Point-of-care Identification of Disease (RAPID), we simultaneously evaluated a POC immunoassay (Sickle SCAN™) to diagnose SCD and a first-generation POC color-based assay to detect anemia. Performed at Bugando Medical Center in Mwanza, Tanzania, RAPID tested 752 participants (age 1 day to 20 years) in four busy clinical locations. With minimally trained medical staff, the SCD POC assay diagnosed SCD with 98.1% sensitivity and 91.1% specificity. The hemoglobin POC assay had 83.2% sensitivity and 74.5% specificity for detection of severe anemia (Hb ≤ 7 g/dL). Interobserver agreement was excellent for both POC assays (r = 0.95-0.96). Results for the hemoglobin POC assay have informed the second-generation assay design to be more suitable for low-resource settings. RAPID provides practical feasibility data regarding two novel POC assays for the diagnosis of anemia and SCD in real-world field evaluations and documents the utility and potential impact of these POC assays for sub-Saharan Africa.

  10. hPOC5 is a centrin-binding protein required for assembly of full-length centrioles.

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    Azimzadeh, Juliette; Hergert, Polla; Delouvée, Annie; Euteneuer, Ursula; Formstecher, Etienne; Khodjakov, Alexey; Bornens, Michel

    2009-04-06

    Centrin has been shown to be involved in centrosome biogenesis in a variety of eukaryotes. In this study, we characterize hPOC5, a conserved centrin-binding protein that contains Sfi1p-like repeats. hPOC5 is localized, like centrin, in the distal portion of human centrioles. hPOC5 recruitment to procentrioles occurs during G2/M, a process that continues up to the full maturation of the centriole during the next cell cycle and is correlated with hyperphosphorylation of the protein. In the absence of hPOC5, RPE1 cells arrest in G1 phase, whereas HeLa cells show an extended S phase followed by cell death. We show that hPOC5 is not required for the initiation of procentriole assembly but is essential for building the distal half of centrioles. Interestingly, the hPOC5 family reveals an evolutionary divergence between vertebrates and organisms like Drosophila melanogaster or Caenorhabditis elegans, in which the loss of hPOC5 may correlate with the conspicuous differences in centriolar structure.

  11. Requirements for Successful Adoption of a Glucose Measurement System Into a Hospital POC Program.

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    Füzéry, Anna K; Cembrowski, George S

    2016-07-01

    Widespread and successful implementation of any glucose measurement system in a hospital point-of-care (POC) program requires a number of features in addition to accurate and reliable analytical performance. Such features include, but are not limited to, a system's glucose-hematocrit dependence, durability, information technology capabilities, and battery capacity and battery life. While the study of Ottiger et al in this issue supports the analytical accuracy and reliability of Bayer's CONTOUR XT® blood glucose monitoring system, the suitability of other features of this system for a hospital POC program remains to be established. © 2016 Diabetes Technology Society.

  12. Point of care strategy for rapid diagnosis of novel A/H1N1 influenza virus.

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    Antoine Nougairede

    Full Text Available Within months of the emergence of the novel A/H1N1 pandemic influenza virus (nA/H1N1v, systematic screening for the surveillance of the pandemic was abandoned in France and in some other countries. At the end of June 2009, we implemented, for the public hospitals of Marseille, a Point Of Care (POC strategy for rapid diagnosis of the novel A/H1N1 influenza virus, in order to maintain local surveillance and to evaluate locally the kinetics of the pandemic.Two POC laboratories, located in strategic places, were organized to receive and test samples 24 h/24. POC strategy consisted of receiving and processing naso-pharyngeal specimens in preparation for the rapid influenza diagnostic test (RIDT and real-time RT-PCR assay (rtRT-PCR. This strategy had the theoretical capacity of processing up to 36 samples per 24 h. When the flow of samples was too high, the rtRT-PCR test was abandoned in the POC laboratories and transferred to the core virology laboratory. Confirmatory diagnosis was performed in the core virology laboratory twice a day using two distinct rtRT-PCR techniques that detect either influenza A virus or nA/N1N1v. Over a period of three months, 1974 samples were received in the POC laboratories, of which 111 were positive for nA/H1N1v. Specificity and sensitivity of RIDT were 100%, and 57.7% respectively. Positive results obtained using RIDT were transmitted to clinical practitioners in less than 2 hours. POC processed rtRT-PCR results were available within 7 hours, and rtRT-PCR confirmation within 24 hours.The POC strategy is of benefit, in all cases (with or without rtRT-PCR assay, because it provides continuous reception/processing of samples and reduction of the time to provide consolidated results to the clinical practitioners. We believe that implementation of the POC strategy for the largest number of suspect cases may improve the quality of patient care and our knowledge of the epidemiology of the pandemic.

  13. Mechanical, Permeability, and Degradation Properties of 3D Designed Poly(1,8 Octanediol-co-Citrate)(POC) Scaffolds for Soft Tissue Engineering

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    Jeong, Claire G.; Hollister, Scott J.

    2015-01-01

    Poly(1,8-octanediol-co-citric acid) (POC) is a synthetic biodegradable elastomer that can be processed into 3D scaffolds for tissue engineering. We investigated the effect of designed porosity on the mechanical properties, permeability and degradation profiles of the POC scaffolds. For mechanical properties, scaffold compressive data was fit to a 1D nonlinear elastic model and solid tensile data was fit to a Neohookean incompressible nonlinear elastic model. Chondrocytes were seeded on scaffolds to assess the biocompatibility of POC. Increased porosity was associated with increased degradation rate, increased permeability, and decreased mechanical stiffness which also became less nonlinear. Scaffold characterization in this paper will provide design guidance for POC scaffolds to meet the mechanical and biological parameters needed for engineering soft tissues such as cartilage. PMID:20091910

  14. Oxadiazole-carbazole polymer (POC)-Ir(ppy)3 tunable emitting composites

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    Bruno, Annalisa; Borriello, Carmela; Di Luccio, Tiziana; Sessa, Lucia; Concilio, Simona; Haque, Saif A.; Minarini, Carla

    2017-04-01

    POC polymer is an oxadiazole-carbazole copolymer we have previously synthetized and established as light emitting material in Organic Light Emitting Devices (OLEDs), although POC quantum yield emission efficiency and color purity still need to be enhanced. On the other hand, tris[2-phenylpyridinato-C2,N]iridium(III) (Ir(ppy)3) complexes, namely Ir(ppy)3 are among the brightest luminophores employed in green light emitting devices. Our aim, in this work, is to take advantage of Ir(ppy)3 bright emission by combining the Ir complex with blue emitting POC to obtain tunable light emitting composites over a wide range of the visible spectrum. Here we have investigated the optical proprieties POC based nanocomposites with different concentrations of Ir(ppy)3, ranging from 1 to 10 wt%. Both spectral and time resolved fluorescence measurements show an efficient energy transfer from the polymer to the dopants, resulting in white-emitting composites. The most intense and stable emission has been found when POC was doped with about 5 wt% concentration of Ir(ppy)3.

  15. Point-of-Care Ultrasound: A Trend in Health Care.

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    Buerger, Anita M; Clark, Kevin R

    2017-11-01

    To discuss the current and growing use of point-of-care (POC) ultrasound in the management and care of patients. Several electronic research databases were searched to find articles that emphasized the use of POC ultrasound by health care providers who manage and treat critically ill or injured patients. Thirty-five relevant peer-reviewed journal articles were selected for this literature review. Common themes identified in the literature included the use of POC ultrasound in emergency medicine, military medicine, and remote care; comparison of POC ultrasound to other medical imaging modalities; investigation of the education and training required for nonimaging health care professionals who perform POC ultrasound in their practices; and discussion of the financial implications and limitations of POC ultrasound. POC ultrasound provides clinicians with real-time information to better manage and treat critically ill or injured patients in emergency medicine, military medicine, and remote care. In addition to providing immediate bedside diagnostic information, use of POC ultrasound has increased because of concerns regarding radiation protection. Finally, the expansion of POC ultrasound to other specialty areas requires nonimaging health care professionals to perform bedside ultrasound examinations and interpret the resulting images. Because POC ultrasound is user-dependent, adequate training is essential for all who perform and interpret the examinations. Research involving POC ultrasound will continue as innovations and confidence in ultrasound applications advance. Future research should continue to examine the broad use of POC ultrasound in patient care and management. ©2017 American Society of Radiologic Technologists.

  16. Two novel POC1A mutations in the primordial dwarfism, SOFT syndrome: Clinical homogeneity but also unreported malformations.

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    Barraza-García, Jimena; Iván Rivera-Pedroza, Carlos; Salamanca, Luis; Belinchón, Alberta; López-González, Vanesa; Sentchordi-Montané, Lucía; del Pozo, Ángela; Santos-Simarro, Fernando; Campos-Barros, Ángel; Lapunzina, Pablo; Guillén-Navarro, Encarna; González-Casado, Isabel; García-Miñaur, Sixto; Heath, Karen E

    2016-01-01

    Primordial dwarfism encompasses rare conditions characterized by severe intrauterine growth retardation and growth deficiency throughout life. Recently, three POC1A mutations have been reported in six families with the primordial dwarfism, SOFT syndrome (Short stature, Onychodysplasia, Facial dysmorphism, and hypoTrichosis). Using a custom-designed Next-generation sequencing skeletal dysplasia panel, we have identified two novel homozygous POC1A mutations in two individuals with primordial dwarfism. The severe growth retardation and the facial profiles are strikingly similar between our patients and those described previously. However, one of our patients was diagnosed with severe foramen magnum stenosis and subglottic tracheal stenosis, malformations not previously associated with this syndrome. Our findings confirm that POC1A mutations cause SOFT syndrome and that mutations in this gene should be considered in patients with severe pre- and postnatal short stature, symmetric shortening of long bones, triangular facies, sparse hair and short, thickened distal phalanges. © 2015 Wiley Periodicals, Inc.

  17. Impact of point-of-care ultrasound on quality of care in clinical practice

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    Adhikari S

    2014-09-01

    Full Text Available Srikar Adhikari,1 Richard Amini,1 Lori A Stolz,1 Michael Blaivas2 1Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ, 2Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA Abstract: The use of point-of-care (POC ultrasonography has rapidly expanded in recent years, in both academic and community settings. It is one of the few diagnostic modalities that can be performed rapidly at the bedside by a physician and has significant impact on patient outcomes. It is portable, readily accessible, and cost-effective, and has no risk of ionizing radiation. There is an abundance of evidence that supports the use of POC ultrasound by physicians in different subspecialties. Multiple studies have documented the diagnostic accuracy of POC ultrasound and its ability to decrease the time to definitive treatment. As ultrasound technology has advanced, POC ultrasound applications have also evolved from being used solely in patients with blunt abdominal trauma to applications for nearly every clinical scenario imaginable. From performing procedures more safely to diagnosing pathology more quickly, POC ultrasound is radically changing clinical practice, patient outcomes, and the overall quality of patient care a clinician can provide. Recently, there has been a paradigm shift involving a symptom-based approach to POC ultrasound. This unique symptom-based ultrasound approach has led to improved quality of care in a variety of clinical settings. Keywords: point-of-care ultrasound, ultrasonography, bedside ultrasound, emergency physician, emergency department, quality, symptom-based

  18. NCAR 2009+2010 and VII POC Weather Data

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    Department of Transportation — The first major set of trials conducted at the Michigan Test Bed was the Proof of Concept (POC) trials during 2008. The POC trials featured fifty-two RSEs within 45...

  19. Laboratory and field evaluation of the Partec CyFlow miniPOC for absolute and relative CD4 T-cell enumeration.

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    Djibril Wade

    Full Text Available A new CD4 point-of-care instrument, the CyFlow miniPOC, which provides absolute and percentage CD4 T-cells, used for screening and monitoring of HIV-infected patients in resource-limited settings, was introduced recently. We assessed the performance of this novel instrument in a reference laboratory and in a field setting in Senegal.A total of 321 blood samples were obtained from 297 adults and 24 children, all HIV-patients attending university hospitals in Dakar, or health centers in Ziguinchor. Samples were analyzed in parallel on CyFlow miniPOC, FACSCount CD4 and FACSCalibur to assess CyFlow miniPOC precision and accuracy.At the reference lab, CyFlow miniPOC, compared to FACSCalibur, showed an absolute mean bias of -12.6 cells/mm3 and a corresponding relative mean bias of -2.3% for absolute CD4 counts. For CD4 percentages, the absolute mean bias was -0.1%. Compared to FACSCount CD4, the absolute and relative mean biases were -31.2 cells/mm3 and -4.7%, respectively, for CD4 counts, whereas the absolute mean bias for CD4 percentages was 1.3%. The CyFlow miniPOC was able to classify HIV-patients eligible for ART with a sensitivity of ≥ 95% at the different ART-initiation thresholds (200, 350 and 500 CD4 cells/mm3. In the field lab, the room temperature ranged from 30 to 35°C during the working hours. At those temperatures, the CyFlow miniPOC, compared to FACSCount CD4, had an absolute and relative mean bias of 7.6 cells/mm3 and 2.8%, respectively, for absolute CD4 counts, and an absolute mean bias of 0.4% for CD4 percentages. The CyFlow miniPOC showed sensitivity equal or greater than 94%.The CyFlow miniPOC showed high agreement with FACSCalibur and FACSCount CD4. The CyFlow miniPOC provides both reliable absolute CD4 counts and CD4 percentages even under the field conditions, and is suitable for monitoring HIV-infected patients in resource-limited settings.

  20. Impact of HbA1c Testing at Point of Care on Diabetes Management

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    Schnell, Oliver; Crocker, J. Benjamin; Weng, Jianping

    2016-01-01

    Diabetes is a highly prevalent disease also implicated in the development of several other serious complications like cardiovascular or renal disease. HbA1c testing is a vital step for effective diabetes management, however, given the low compliance to testing frequency and, commonly, a subsequent delay in the corresponding treatment modification, HbA1c at the point of care (POC) offers an opportunity for improvement of diabetes care. In this review, based on data from 1999 to 2016, we summarize the evidence supporting a further implementation of HbA1c testing at POC, discuss its limitations and propose recommendations for further development. PMID:27898388

  1. Multispectral remote-sensing algorithms for particulate organic carbon (POC): The Gulf of Mexico

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    Son, Young Baek; Gardner, Wilford D.; Mishonov, Alexey V.; Richardson, Mary Jo

    2009-01-01

    To greatly increase the spatial and temporal resolution for studying carbon dynamics in the marine environment, we have developed remote-sensing algorithms for particulate organic carbon (POC) by matching in situ POC measurements in the Gulf of Mexico with matching SeaWiFS remote-sensing reflectance. Data on total particulate matter (PM) as well as POC collected during nine cruises in spring, summer and early winter from 1997-2000 as part of the Northeastern Gulf of Mexico (NEGOM) study were ...

  2. Diurnal and seasonal DOC and POC variability in the land-locked sea

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    Beata Szymczycha

    2017-07-01

    Full Text Available Organic matter is a minor yet important component of the marine environment. The aim of this study was to investigate the diurnal and seasonal changes in dissolved and particulate organic carbon (DOC and POC, respectively. Thus, DOC and POC as well as chlorophyll a (Chl a, δ13C, NO3−, NO2−, NH4+, PO43−, salinity, pH, and temperature were regularly measured in samples collected for 24 h (2-h resolution in the Gdańsk Deep (54°44.730′N, 19°08.531′E at three water depths (1, 10, and 40 m during sampling campaigns in 2011 (May, 2014 (May, and 2015 (January, March, May, July, September, November. Seasonal variations in DOC and POC followed the seasonality of Chl a (proportional trend and nutrients (reverse trend concentrations. Diurnal oscillations were detected in six out of the eight measurement series. The strongest diurnal variability in both POC and DOC occurred in May 2011 and March 2015, when phytoplankton activity was highest (high Chl a. The surprisingly low δ13C values (range: −28‰ to −24‰ measured over the course of the study revealed the gaps in our knowledge of the isotopic characteristics of terrestrial- vs. marine-derived particulate organic matter.

  3. Requirements for Successful Adoption of a Glucose Measurement System Into a Hospital POC Program

    OpenAIRE

    F?z?ry, Anna K.; Cembrowski, George S.

    2016-01-01

    Widespread and successful implementation of any glucose measurement system in a hospital point-of-care (POC) program requires a number of features in addition to accurate and reliable analytical performance. Such features include, but are not limited to, a system?s glucose-hematocrit dependence, durability, information technology capabilities, and battery capacity and battery life. While the study of Ottiger et al in this issue supports the analytical accuracy and reliability of Bayer?s CONTO...

  4. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

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    Kim, Chloe S; Vanture, Sarah; Cho, Margaret; Klapperich, Catherine M; Wang, Catharine; Huang, Franklin W

    2016-01-01

    Well-developed point-of-care (POC) cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57%) stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97%) stated they were either "very interested" (68%) or "somewhat interested" (29%) in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and patients.

  5. Multidisciplinary Point-of-Care Testing in South African Primary Health Care Clinics Accelerates HIV ART Initiation but Does Not Alter Retention in Care.

    Science.gov (United States)

    Stevens, Wendy S; Gous, Natasha M; MacLeod, William B; Long, Lawrence C; Variava, Ebrahim; Martinson, Neil A; Sanne, Ian; Osih, Regina; Scott, Lesley E

    2017-09-01

    Lack of accessible laboratory infrastructure limits HIV antiretroviral therapy (ART) initiation, monitoring, and retention in many resource-limited settings. Point-of-care testing (POCT) is advocated as a mechanism to overcome these limitations. We executed a pragmatic, prospective, randomized, controlled trial comparing the impact of POCT vs. standard of care (SOC) on treatment initiation and retention in care. Selected POC technologies were embedded at 3 primary health clinics in South Africa. Confirmed HIV-positive participants were randomized to either SOC or POC: SOC participants were venesected and specimens referred to the laboratory with patient follow-up as per algorithm (∼3 visits); POC participants had phlebotomy and POCT immediately on-site using Pima CD4 to assess ART eligibility followed by hematology, chemistry, and tuberculosis screening with the goal of receiving same-day adherence counseling and treatment initiation. Participant outcomes measured at recruitment 6 and 12 months after initiation. Four hundred thirty-two of 717 treatment eligible participants enrolled between May 2012 and September 2013: 198 (56.7%) SOC; 234 (63.6%) POC. Mean age was 37.4 years; 60.5% were female. Significantly more participants were initiated using POC [adjusted prevalence ratio (aPR) 0.83; 95% confidence interval (CI): 0.74 to 0.93; P ART was similar for both arms at 6 months (47 vs. 50%) (aPR 0.96; 95% CI: 0.79 to 1.16) and 12 months (32 vs. 32%) (aPR 1.05; 95% CI: 0.80 to 1.38), with similar mortality rates. Loss to follow-up at 12 months was higher for POC (36% vs. 51%) (aPR 0.82; 95% CI: 0.65 to 1.04). Adoption of POCT accelerated ART initiation but once on treatment, there was unexpectedly higher loss to follow-up on POC and no improvement in outcomes at 12 months over SOC.

  6. Awareness, Interest, and Preferences of Primary Care Providers in Using Point-of-Care Cancer Screening Technology.

    Directory of Open Access Journals (Sweden)

    Chloe S Kim

    Full Text Available Well-developed point-of-care (POC cancer screening tools have the potential to provide better cancer care to patients in both developed and developing countries. However, new medical technology will not be adopted by medical providers unless it addresses a population's existing needs and end-users' preferences. The goals of our study were to assess primary care providers' level of awareness, interest, and preferences in using POC cancer screening technology in their practice and to provide guidelines to biomedical engineers for future POC technology development. A total of 350 primary care providers completed a one-time self-administered online survey, which took approximately 10 minutes to complete. A $50 Amazon gift card was given as an honorarium for the first 100 respondents to encourage participation. The description of POC cancer screening technology was provided in the beginning of the survey to ensure all participants had a basic understanding of what constitutes POC technology. More than half of the participants (57% stated that they heard of the term "POC technology" for the first time when they took the survey. However, almost all of the participants (97% stated they were either "very interested" (68% or "somewhat interested" (29% in using POC cancer screening technology in their practice. Demographic characteristics such as the length of being in the practice of medicine, the percentage of patients on Medicaid, and the average number of patients per day were not shown to be associated with the level of interest in using POC. These data show that there is a great interest in POC cancer screening technology utilization among this population of primary care providers and vast room for future investigations to further understand the interest and preferences in using POC cancer technology in practice. Ensuring that the benefits of new technology outweigh the costs will maximize the likelihood it will be used by medical providers and

  7. Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: an evaluation of a pilot program in South Africa.

    Science.gov (United States)

    Larson, Bruce A; Schnippel, Kathryn; Ndibongo, Buyiswa; Xulu, Thembisile; Brennan, Alana; Long, Lawrence; Fox, Matthew P; Rosen, Sydney

    2012-10-01

    A mobile HIV counseling and testing (HCT) program around Johannesburg piloted the integration of point-of-care (POC) CD4 testing, using the Pima analyzer, to improve linkages to HIV care. We report results from this pilot program for patients testing positive (n = 508) from May to October 2010. We analyzed 3 primary outcomes: assignment to testing group (offered POC CD4 or not), successful follow-up (by telephone), and completed the referral visit for HIV care within 8 weeks after HIV testing if successfully followed up. Proportions for each outcome were calculated, and relative risks were estimated using a modified Poisson approach. Three hundred eleven patients were offered the POC CD4 test, and 197 patients were not offered the test. No differences in patient characteristics were observed between the 2 groups. Approximately 62.7% of patients were successfully followed up 8 weeks after HIV testing, with no differences observed between testing groups. Among those followed up, 54.4% reported completing their referral visit. Patients offered the POC CD4 test were more likely to complete the referral visit for further HIV care (relative risk 1.25, 95% confidence interval: 1.00 to 1.57). In this mobile HCT setting, patients offered POC CD4 testing as part of the HCT services were more likely to visit a referral clinic after testing, suggesting that rapid CD4 testing technology may improve linkage to HIV care. Future research can evaluate options for adjusting HCT services if POC CD4 testing was included permanently and the cost-effectiveness of the POC CD4 testing compared with other approaches for improving linkage of care.

  8. Cross-sectional comparison of point-of-care with laboratory HbA1c in detecting diabetes in real-world remote Aboriginal settings

    Science.gov (United States)

    Marley, Julia V; Oh, May S; Hadgraft, Nyssa; Singleton, Sally; Isaacs, Kim; Atkinson, David

    2015-01-01

    Objectives To determine if point-of-care (POC) glycated haemoglobin (HbA1c) is sufficiently accurate in real-world remote settings to predict or exclude the diagnosis of diabetes based on laboratory HbA1c measurements. Design Cross-sectional study comparing POC capillary HbA1c results with corresponding venous HbA1c levels measured in a reference laboratory. Participants Aboriginal patients ≥15 years old who were due for diabetes screening at the participating clinics were invited to participate. Two hundred and fifty-five Aboriginal participants were enrolled and 241 were included in the analysis. Setting 6 primary healthcare sites in the remote Kimberley region of Western Australia from September 2011 to November 2013. Main outcome measures Concordance and mean differences between POC capillary blood HbA1c measurement and laboratory measurement of venous blood HbA1c level; POC capillary blood HbA1c equivalence value for screening for diabetes or a high risk of developing diabetes; sensitivity, specificity and positive-predictive value for diagnosing and screening for diabetes; barriers to conducting POC testing. Results Concordance between POC and laboratory results was good (ρ=0.88, pHbA1c measurements ≥6.5%, 48 mmol/mol had a specificity of 98.2% and sensitivity of 73.7% for laboratory measurements ≥6.5%. The POC equivalence value for screening for diabetes or a high risk of developing diabetes was ≥5.7%, 39 mmol/mol (sensitivity, 91%; specificity, 76.7% for laboratory measurements ≥6.0%, 42 mmol/mol). Staff trained by other clinic staff ‘on the job’ performed as well as people with formal accredited training. Staff reported difficulty in maintaining formal accreditation. Conclusions POC HbA1c testing is sufficiently accurate to be a useful component in screening for, and diagnosing, diabetes in remote communities. Limited local training is adequate to produce results comparable to laboratory results and accreditation processes need to

  9. Implication of POC/234Th ratios in oceanic particulate matter. An approach to particle aggregation

    International Nuclear Information System (INIS)

    Hirose, Katumi

    2003-01-01

    234 Th has been widely applied as a tracer of particulate organic carbon (POC) fluxes in the upper ocean. Fundamental to this approach is the determination of 234 Th fluxes from water column measurements of the 234 Th- 238 U disequilibria, and the conversion of 234 Th flux to POC export, using the measured POC/ 234 Th ratio on particles. As such, POC/ 234 Th ratios are one of the most critical factors in quantifying the carbon export flux in ocean interior when using this approach. However, the POC/ 234 Th ratios show significant temporal and spatial variations, but cannot be predicted at this time. therefore, it is important to elucidate factors controlling the variations of the POC/ 234 Th ratios. To achieve this purpose, we should understand the chemical interactions between POC and 234 Th. In the open ocean, POC/ 234 Th ratios have been determined together with other oceanographic parameters. We examined here the relationship between POC/ 234 Th and primary production. The POC/ 234 Th ratios were linearly related to logarithmic values of primary production. Taken into account the complexation between surface ligand on particulate organic matter (POM) and 234 Th, a complexation model suggests that the size of particles adsorbing 234 Th is related to primary production; in the equatorial Pacific, the size of particles adsorbing 234 Th apparently decreases with increasing primary production, whereas opposite phenomenon occurs in the North Atlantic. Since the POC/ 234 Th ratios were determined in filtered particulate matter, this finding suggests that aggregation of small particles would be dominant in the equatorial Pacific, which can be explained by a chemical aggregation model. (author)

  10. Upper ocean carbon flux determined by the 234Th approach and sediment traps using size-fractionated POC and 234Th data from the Golf of Mexico

    International Nuclear Information System (INIS)

    Hung, Chin-Chang; Roberts, Kimberly A.; Santschi, Peter H.; Guo, Laodong

    2004-01-01

    Size-fractionated particulate 234 Th and particulate organic carbon (POC) fluxes were measured in the Gulf of Mexico during 2000 and 2001 in order to obtain a better estimation of upper ocean organic carbon export out of the euphotic zone within cold core and warm core rings, and to assess the relative merit of sediment trap and POC/ 234 Th methods. In 2000, the flux of POC measured by sediment traps at 120 m ranged from 60 to 148 mg C m -2 d -1 , while 234 Th-derived POC fluxes in large particles (>53 μm) varied from 18 to 61 mg C m -2 d -1 using the ratio of POC/ 234 Th at 120 m, and from 51 to 163 mg C m -2 d -1 using an average ratio of POC/ 234 Th for the upper 120 m water column. In 2001, the fluxes of POC measured by traps deployed at 120 m water depth ranged from 39 to 48 mg C m -2 d -1 , while the 234 Th-derived POC fluxes in large particles (>53 μm) varied from 7 to 37 mg C m -2 d -1 using a ratio of POC/ 234 Th at 120 m, and from 37 to 45 mg C m -2 d -1 using an average ratio of POC/ 234 Th within the 0-120 m interval. The results show that POC fluxes estimated by the 234 Th method using the average ratio of POC/ 234 Th within the euphotic zone are similar to those measured by sediment traps. Furthermore, the results demonstrate that the variability in POC export fluxes estimated by the 234 Th/ 238 U disequilibrium approach is strongly related to the ratio of POC/ 234 Th that is taken, and for which we have independent evidence that it may be controlled by the chemical composition of the suspended particles. The results also reveal that using POC/ 234 Th ratios in small particles may result in an estimate of the POC export flux that is considerably higher than when using POC/ 234 Th ratios in large particles (>53 μm). The POC flux calculated from ratios in large particles is, however, more comparable to the POC flux determined directly by sediment traps, but both of these estimates are much lower than that determined by using the POC/ 234 Th ratios in

  11. WE-G-207-02: Full Sequential Projection Onto Convex Sets (FS-POCS) for X-Ray CT Reconstruction

    International Nuclear Information System (INIS)

    Liu, L; Han, Y; Jin, M

    2015-01-01

    Purpose: To develop an iterative reconstruction method for X-ray CT, in which the reconstruction can quickly converge to the desired solution with much reduced projection views. Methods: The reconstruction is formulated as a convex feasibility problem, i.e. the solution is an intersection of three convex sets: 1) data fidelity (DF) set – the L2 norm of the difference of observed projections and those from the reconstructed image is no greater than an error bound; 2) non-negativity of image voxels (NN) set; and 3) piecewise constant (PC) set - the total variation (TV) of the reconstructed image is no greater than an upper bound. The solution can be found by applying projection onto convex sets (POCS) sequentially for these three convex sets. Specifically, the algebraic reconstruction technique and setting negative voxels as zero are used for projection onto the DF and NN sets, respectively, while the projection onto the PC set is achieved by solving a standard Rudin, Osher, and Fatemi (ROF) model. The proposed method is named as full sequential POCS (FS-POCS), which is tested using the Shepp-Logan phantom and the Catphan600 phantom and compared with two similar algorithms, TV-POCS and CP-TV. Results: Using the Shepp-Logan phantom, the root mean square error (RMSE) of reconstructed images changing along with the number of iterations is used as the convergence measurement. In general, FS- POCS converges faster than TV-POCS and CP-TV, especially with fewer projection views. FS-POCS can also achieve accurate reconstruction of cone-beam CT of the Catphan600 phantom using only 54 views, comparable to that of FDK using 364 views. Conclusion: We developed an efficient iterative reconstruction for sparse-view CT using full sequential POCS. The simulation and physical phantom data demonstrated the computational efficiency and effectiveness of FS-POCS

  12. Laboratory Evaluation of the Alere q Point-of-Care System for Early Infant HIV Diagnosis.

    Science.gov (United States)

    Hsiao, Nei-yuan; Dunning, Lorna; Kroon, Max; Myer, Landon

    2016-01-01

    Early infant diagnosis (EID) and prompt linkage to care are critical to minimise the high morbidity and mortality associated with infant HIV infection. Attrition in the "EID cascade" is common; however, point-of-care (POC) EID assays with same-day result could facilitate prompt linkage of HIV-infected infant to treatment. Despite a number of POC EID assays in development, few have been independently evaluated and data on new technologies are urgently needed to inform policy. We compared Alere q 1/2 Detect POC system laboratory test characteristics with the local standard of care (SOC), Roche CAP/CTM HIV-1 qualitative PCR in an independent laboratory-based evaluation in Cape Town, South Africa. Routinely EID samples collected between November 2013 and September 2014 were each tested by both SOC and POC systems. Repeat testing was done to troubleshoot any discrepancy between POC and SOC results. Overall, 1098 children with a median age of 47 days (IQR, 42-117) were included. Birth PCR (age laboratory. The high specificity and thus high positive predictive value would suggest a positive POC result may be adequate for immediate infant ART initiation. While POC testing for EID may have particular utility for birth testing at delivery facilities, the lower sensitivity and error rate requires further attention, as does field implementation of POC EID technologies in other clinical care settings.

  13. Improvement of POC-CCA Interpretation by Using Lyophilization of Urine from Patients with Schistosoma mansoni Low Worm Burden: Towards an Elimination of Doubts about the Concept of Trace.

    Directory of Open Access Journals (Sweden)

    Paulo Marcos Zech Coelho

    2016-06-01

    Full Text Available Accurate diagnostic techniques for schistosomiasis are essential for prevalence determination and identification of positive patients. A point-of-care test for detecting schistosome circulating cathodic antigen (POC-CCA has been evaluated for its accuracy in different endemic regions. This reagent strip/dipstick based assay has showed high sensitivity for individuals with high or moderate worm burden, but the interpretation of light infections is less clear, especially for trace readings.We introduced a urine lyophilization step to the POC-CCA assay to improve its sensitivity and clarify the interpretation of traces. We evaluated POC-CCA sensitivity and specificity within individuals with low parasite burdens in a Brazilian endemic area where a high number of traces were detected. Patients that were positive for other helminths were also evaluated for cross reactions. In all cases, a combined parasitological diagnosis using Kato-Katz (24 slides and Saline Gradient (1 g of feces were used as reference. At baseline, diagnosis by POC-CCA (1-2 cassettes showed 6% sensitivity, inaccurately predicting a low prevalence of Schistosoma mansoni infections (2 POC-CCA positives/32 egg positives. After urine lyophilization, the sensitivity was increased significantly (p < 0.05. Prevalence rates changed from 2% to 32% (27 POC-CCA positives/32 egg positives, equivalent to parasitological techniques. Most of the trace readings changed to positive after lyophilization while some negatives turned into traces. Cross reaction analysis confirmed the specificity of POC-CCA.Trace readings cannot be primarily defined as positive or negative cases. It is critical to verify case-by-case by concentrating urine 10 fold by lyophilization for the diagnosis. Following lyophilization, persistent trace readings should be read as negatives. No trained technician is needed and cost is restricted to the cost of a lyophilizer and the electricity to run it.

  14. Perceptions of point-of-care infectious disease testing among European medical personnel, point-of-care test kit manufacturers, and the general public

    Directory of Open Access Journals (Sweden)

    Kaman WE

    2013-06-01

    Full Text Available Wendy E Kaman,1 Eleni-Rosalina Andrinopoulou,2 John P Hays11Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands; 2Department of Biostatistics, Erasmus Medical Center, Rotterdam, The NetherlandsBackground: The proper development and implementation of point-of-care (POC diagnostics requires knowledge of the perceived requirements and barriers to their implementation. To determine the current requirements and perceived barriers to the introduction of POC diagnostics in the field of medical microbiology (MM-POC a prospective online survey (TEMPOtest-QC was established.Methods and results: The TEMPOtest-QC survey was online between February 2011 and July 2012 and targeted the medical community, POC test diagnostic manufacturers, general practitioners, and the general public. In total, 293 individuals responded to the survey, including 91 (31% medical microbiologists, 39 (13% nonmedical microbiologists, 25 (9% employees of POC test manufacturers, and 138 (47% members of the general public. Responses were received from 18 different European countries, with the largest percentage of these living in The Netherlands (52%. The majority (>50% of medical specialists regarded the development of MM-POC for blood culture and hospital acquired infections as “absolutely necessary”, but were much less favorable towards their use in the home environment. Significant differences in perceptions between medical specialists and the general public included the: (1 Effect on quality of patient care; (2 Ability to better monitor patients; (3 Home testing and the doctor-patient relationship; and (4 MM-POC interpretation. Only 34.7% of the general public is willing to pay more than €10 ($13 for a single MM-POC test, with 85.5% preferring to purchase their MM-POC test from a pharmacy.Conclusion: The requirements for the proper implementation of MM-POC were found to be generally similar between medical

  15. Source and flux of POC in two subtropical karstic tributaries with contrasting land use practice in the Yangtze River Basin

    International Nuclear Information System (INIS)

    Tao, F.-X.; Liu, C.-Q.; Li, S.-L.

    2009-01-01

    Elemental (C/N ratio) and C isotope composition (δ 13 C) of particulate organic C (POC) and organic C content (OC) of total suspended solids (TSS) were determined for two subtropical karstic tributaries of the Yangtze River, the Wujiang (the eighth largest tributary) and Yuanjiang (the third largest tributary). For the latter, two headwaters, the karstic Wuyanghe and non-karstic Qingshuijiang were studied. The Wujiang catchment is subject to intensive land use, has low forest coverage and high soil erosion rate. The δ 13 C of POC covered a range from -30.6 per mille to -24.9 per mille, from -27.6 per mille to -24.7 per mille , and from -26.2 per mille to -23.3 per mille at the low-water stage, while at the high-water stage varied in a span between -28.6 per mille and -24.4 per mille , between -27.7 per mille and -24.5 per mille, and between -27.6 per mille and -24.2 per mille for the Wujiang, Wuyanghe, and Qingshuijiang, respectively. The combined application of C isotopes, C/N ratio, OC, and TSS analyses indicated that catchment soil was the predominant source of POC for the Wujiang while for the Wuyanghe and Qingshuijiang, in-stream processes supplied the main part of POC in winter and summer. A significant increase in δ 13 C value (1.4 per mille ) of POC was found in the Wujiang during summer, and was attributed to the enhanced soil erosion of the dry arable uplands close to the riverbanks of the main channel. Based on a conservative estimate, POC fluxes were 3.123 x 10 10 , 0.084 x 10 10 , and 0.372 x 10 10 g a -1 while export rates of POC were 466, 129, and 218 mg m -2 a -1 for the Wujiang, Wuyanghe, and Qingshuijiang, respectively. The POC export rate for the karstic Wujiang, with intensive land use, was 2-3 higher than that of the karstic Wuyanghe or of the non-karstic Qingshuijiang where soil erosion was minor. Such high values imply rapid degradation of related karstic ecosystems impacted by intensive land use activities, and pose a potential threat to

  16. Abundance, stable isotopic composition, and export fluxes of DOC, POC, and DIC from the Lower Mississippi River during 2006–2008

    Science.gov (United States)

    Cai, Yihua; Guo, Laodong; Wang, Xuri; Aiken, George R.

    2015-01-01

    Sources, abundance, isotopic compositions, and export fluxes of dissolved inorganic carbon (DIC), dissolved and colloidal organic carbon (DOC and COC), and particulate organic carbon (POC), and their response to hydrologic regimes were examined through monthly sampling from the Lower Mississippi River during 2006–2008. DIC was the most abundant carbon species, followed by POC and DOC. Concentration and δ13C of DIC decreased with increasing river discharge, while those of DOC remained fairly stable. COC comprised 61 ± 3% of the bulk DOC with similar δ13C abundances but higher percentages of hydrophobic organic acids than DOC, suggesting its aromatic and diagenetically younger status. POC showed peak concentrations during medium flooding events and at the rising limb of large flooding events. While δ13C-POC increased, δ15N of particulate nitrogen decreased with increasing discharge. Overall, the differences in δ13C between DOC or DIC and POC show an inverse correlation with river discharge. The higher input of soil organic matter and respired CO2 during wet seasons was likely the main driver for the convergence of δ13C between DIC and DOC or POC, whereas enhanced in situ primary production and respiration during dry seasons might be responsible for their isotopic divergence. Carbon export fluxes from the Mississippi River were estimated to be 13.6 Tg C yr−1 for DIC, 1.88 Tg C yr−1 for DOC, and 2.30 Tg C yr−1 for POC during 2006–2008. The discharge-normalized DIC yield decreased during wet seasons, while those of POC and DOC increased and remained constant, respectively, implying variable responses in carbon export to the increasing discharge.

  17. Clinical accuracy of point-of-care urine culture in general practice

    DEFF Research Database (Denmark)

    Holm, Anne; Cordoba, Gloria; Sørensen, Tina Møller

    2017-01-01

    OBJECTIVE: To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. DESIGN: Prospective diagnostic...... uncomplicated, symptomatic UTI. MAIN OUTCOME MEASURES: (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply...... general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci...

  18. Impact and Cost-Effectiveness of Point-Of-Care CD4 Testing on the HIV Epidemic in South Africa.

    Directory of Open Access Journals (Sweden)

    Alastair Heffernan

    Full Text Available Rapid diagnostic tools have been shown to improve linkage of patients to care. In the context of infectious diseases, assessing the impact and cost-effectiveness of such tools at the population level, accounting for both direct and indirect effects, is key to informing adoption of these tools. Point-of-care (POC CD4 testing has been shown to be highly effective in increasing the proportion of HIV positive patients who initiate ART. We assess the impact and cost-effectiveness of introducing POC CD4 testing at the population level in South Africa in a range of care contexts, using a dynamic compartmental model of HIV transmission, calibrated to the South African HIV epidemic. We performed a meta-analysis to quantify the differences between POC and laboratory CD4 testing on the proportion linking to care following CD4 testing. Cumulative infections averted and incremental cost-effectiveness ratios (ICERs were estimated over one and three years. We estimated that POC CD4 testing introduced in the current South African care context can prevent 1.7% (95% CI: 0.4% - 4.3% of new HIV infections over 1 year. In that context, POC CD4 testing was cost-effective 99.8% of the time after 1 year with a median estimated ICER of US$4,468/DALY averted. In healthcare contexts with expanded HIV testing and improved retention in care, POC CD4 testing only became cost-effective after 3 years. The results were similar when, in addition, ART was offered irrespective of CD4 count, and CD4 testing was used for clinical assessment. Our findings suggest that even if ART is expanded to all HIV positive individuals and HIV testing efforts are increased in the near future, POC CD4 testing is a cost-effective tool, even within a short time horizon. Our study also illustrates the importance of evaluating the potential impact of such diagnostic technologies at the population level, so that indirect benefits and costs can be incorporated into estimations of cost-effectiveness.

  19. Protocol for a randomised controlled implementation trial of point-of-care viral load testing and task shifting: the Simplifying HIV TREAtment and Monitoring (STREAM) study

    OpenAIRE

    Dorward, Jienchi; Garrett, Nigel; Quame-Amaglo, Justice; Samsunder, Natasha; Ngobese, Hope; Ngomane, Noluthando; Moodley, Pravikrishnen; Mlisana, Koleka; Schaafsma, Torin; Donnell, Deborah; Barnabas, Ruanne; Naidoo, Kogieleum; Abdool Karim, Salim; Celum, Connie; Drain, Paul K

    2017-01-01

    Introduction Achieving the Joint United Nations Programme on HIV and AIDS 90-90-90 targets requires models of HIV care that expand antiretroviral therapy (ART) coverage without overburdening health systems. Point-of-care (POC) viral load (VL) testing has the potential to efficiently monitor ART treatment, while enrolled nurses may be able to provide safe and cost-effective chronic care for stable patients with HIV. This study aims to demonstrate whether POC VL testing combined with task shift...

  20. Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.

    Science.gov (United States)

    Cohen-Bacrie, Stéphan; Ninove, Laetitia; Nougairède, Antoine; Charrel, Rémi; Richet, Hervé; Minodier, Philippe; Badiaga, Sékéné; Noël, Guilhem; La Scola, Bernard; de Lamballerie, Xavier; Drancourt, Michel; Raoult, Didier

    2011-01-01

    Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.

  1. Revolutionizing clinical microbiology laboratory organization in hospitals with in situ point-of-care.

    Directory of Open Access Journals (Sweden)

    Stéphan Cohen-Bacrie

    Full Text Available BACKGROUND: Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC tests have been developed for this purpose. METHODS AND FINDINGS: One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844 and pregnant women negative for Streptococcus agalactiae carriage (n = 763. The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009. Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. CONCLUSIONS: The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care.

  2. Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Lisa Natoli

    Full Text Available Point-of-care (POC testing for chlamydia (CT and gonorrhoea (NG offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings.In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise.Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection.The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

  3. Point-of-Care Testing for Chlamydia and Gonorrhoea: Implications for Clinical Practice

    Science.gov (United States)

    Natoli, Lisa; Maher, Lisa; Shephard, Mark; Hengel, Belinda; Tangey, Annie; Badman, Steven G.; Ward, James; Guy, Rebecca J.

    2014-01-01

    Objectives Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. Methods In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Results Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection. Conclusions The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines. PMID:24956111

  4. Compounding diagnostic delays: a qualitative study of point-of-care testing in South Africa.

    Science.gov (United States)

    Engel, Nora; Davids, Malika; Blankvoort, Nadine; Pai, Nitika Pant; Dheda, Keertan; Pai, Madhukar

    2015-04-01

    Successful point-of-care (POC) testing (completion of test-and-treat cycle in one patient encounter) has immense potential to reduce diagnostic and treatment delays, and improve patient and public health outcomes. We explored what tests are done and how in public/private, rural/urban hospitals and clinics in South Africa and whether they can ensure successful POC testing. This qualitative research study examined POC testing across major diseases in Cape Town, Durban and Eastern Cape. We conducted 101 semi-structured interviews and seven focus group discussions with doctors, nurses, community health workers, patients, laboratory technicians, policymakers, hospital managers and diagnostic manufacturers. In South Africa, diagnostics are characterised by a centralised system. Most tests conducted on the spot can be made to work successfully as POC tests. The majority of public/private clinics and smaller hospitals send samples via couriers to centralised laboratories and retrieve results the same way, via internet, fax or phone. The main challenge to POC testing lies in transporting samples and results, while delays risk patient loss from diagnostic/treatment pathways. Strategies to deal with associated delays create new problems, such as artificially prolonged turnaround times, strains on human resources and quality of testing, compounding additional diagnostic and treatment delays. For POC testing to succeed, particular characteristics of diagnostic ecosystems and adaptations of professional practices to overcome associated challenges must be taken into account. © 2014 John Wiley & Sons Ltd.

  5. Evaluating Diagnostic Point-of-Care Tests in Resource-Limited Settings

    Science.gov (United States)

    Drain, Paul K; Hyle, Emily P; Noubary, Farzad; Freedberg, Kenneth A; Wilson, Douglas; Bishai, William; Rodriguez, William; Bassett, Ingrid V

    2014-01-01

    Diagnostic point-of-care (POC) testing is intended to minimize the time to obtain a test result, thereby allowing clinicians and patients to make an expeditious clinical decision. As POC tests expand into resource-limited settings (RLS), the benefits must outweigh the costs. To optimize POC testing in RLS, diagnostic POC tests need rigorous evaluations focused on relevant clinical outcomes and operational costs, which differ from evaluations of conventional diagnostic tests. Here, we reviewed published studies on POC testing in RLS, and found no clearly defined metric for the clinical utility of POC testing. Therefore, we propose a framework for evaluating POC tests, and suggest and define the term “test efficacy” to describe a diagnostic test’s capacity to support a clinical decision within its operational context. We also proposed revised criteria for an ideal diagnostic POC test in resource-limited settings. Through systematic evaluations, comparisons between centralized diagnostic testing and novel POC technologies can be more formalized, and health officials can better determine which POC technologies represent valuable additions to their clinical programs. PMID:24332389

  6. Evidence-based point-of-care tests and device designs for disaster preparedness.

    Science.gov (United States)

    Brock, T Keith; Mecozzi, Daniel M; Sumner, Stephanie; Kost, Gerald J

    2010-01-01

    To define pathogen tests and device specifications needed for emerging point-of-care (POC) technologies used in disasters. Surveys included multiple-choice and ranking questions. Multiple-choice questions were analyzed with the chi2 test for goodness-of-fit and the binomial distribution test. Rankings were scored and compared using analysis of variance and Tukey's multiple comparison test. Disaster care experts on the editorial boards of the American Journal of Disaster Medicine and the Disaster Medicine and Public Health Preparedness, and the readers of the POC Journal. Vibrio cholera and Staphylococcus aureus were top-ranked pathogens for testing in disaster settings. Respondents felt that disaster response teams should be equipped with pandemic infectious disease tests for novel 2009 H1N1 and avian H5N1 influenza (disaster care, p disaster settings, respondents preferred self-contained test cassettes (disaster care, p disaster care, p disaster care scenarios, in which Vibrio cholera, methicillin-sensitive and methicillin-resistant Staphylococcus aureus, and Escherichia coli ranked the highest. POC testing should incorporate setting-specific design criteria such as safe disposable cassettes and direct blood sampling at the site of care.

  7. Barriers to compliance with evidence-based care in trauma.

    Science.gov (United States)

    Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Kudyakov, Rustam; Ballard, David; Gentilello, Larry M; Shafi, Shahid

    2012-03-01

    We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care. Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus. These encompassed all aspects of trauma care, including initial evaluation, resuscitation, operative care, critical care, rehabilitation, and injury prevention. Multivariate logistic regression was used to identify patients likely to receive recommended care. Study patients were eligible for a total of 2,603 T-POC, of which only 1,515 (58%) were provided to the patient. Compliance was highest for T-POC involving resuscitation (83%) and was lowest for neurosurgical interventions (17%). Increasing severity of head injuries was associated with lower compliance, while intensive care unit stay was associated with higher compliance. There was no relationship between compliance and patient demographics, socioeconomic status, overall injury severity, or daily volume of trauma admissions. Little over half of recommended care was delivered to trauma patients with moderate to severe injuries. Patients with increasing severity of traumatic brain injuries were least likely to receive optimal care. However, differences among patient subgroups are small in relation to the overall gap between observed and recommended care. II.

  8. Point-of-care diagnostics: market trends and growth drivers.

    Science.gov (United States)

    Rajan, Aruna; Glorikian, Harry

    2009-01-01

    There is a significant demand for in vitro diagnostic (IVD) testing to move closer to the patient point-of-care diagnostics [POC]), whether in the hospital, physician's office, rapid clinic or the home, effectively cutting time to results and helping patients make better informed decisions about their health. To analyze the point-of-care market and its trends and growth drivers. In 2007, POC made up 30% of the IVD market and is expected to grow at 9% a year. Although the overall POC market is expected to grow steadily, infectious POC is now the most attractive segment. Availability of rapid random access molecular diagnostic system for critical care infectious diseases such as MRSA and sepsis in the near future is likely to be a significant driver of infectious POC post 2012. Owing to the extraordinary increase in the cost of care, healthcare delivery is moving to increasingly decentralized settings such as rapid clinics and the home, driven by point-of-care diagnostics that provide accurate and directional results. We are evolving from the analog testing world to the digital testing world, where diagnosis is exact and therapy can be administered and be predictably effective.

  9. Laboratory-based performance evaluation of PIMA CD4+ T-lymphocyte count point-of-care by lay-counselors in Kenya.

    Science.gov (United States)

    Zeh, Clement; Rose, Charles E; Inzaule, Seth; Desai, Mitesh A; Otieno, Fredrick; Humwa, Felix; Akoth, Benta; Omolo, Paul; Chen, Robert T; Kebede, Yenew; Samandari, Taraz

    2017-09-01

    CD4+ T-lymphocyte count testing at the point-of-care (POC) may improve linkage to care of persons diagnosed with HIV-1 infection, but the accuracy of POC devices when operated by lay-counselors in the era of task-shifting is unknown. We examined the accuracy of Alere's Pima™ POC device on both capillary and venous blood when performed by lay-counselors and laboratory technicians. In Phase I, we compared the perfomance of POC against FACSCalibur™ for 280 venous specimens by laboratory technicians. In Phase II we compared POC performance by lay-counselors versus laboratory technicians using 147 paired capillary and venous specimens, and compared these to FACSCalibur™. Statistical analyses included Bland-Altman analyses, concordance correlation coefficient, sensitivity, and specificity at treatment eligibility thresholds of 200, 350, and 500cells/μl. Phase I: POC sensitivity and specificity were 93.0% and 84.1% at 500cells/μl, respectively. Phase II: Good agreement was observed for venous POC results from both lay-counselors (concordance correlation coefficient (CCC)=0.873, bias -86.4cells/μl) and laboratory technicians (CCC=0.920, bias -65.7cells/μl). Capillary POC had good correlation: lay-counselors (CCC=0.902, bias -71.2cells/μl), laboratory technicians (CCC=0.918, bias -63.0cells/μl). Misclassification at the 500 cells/μl threshold for venous blood was 13.6% and 10.2% for lay-counselors and laboratory technicians and 12.2% for capillary blood in both groups. POC tended to under-classify the CD4 values with increasingly negative bias at higher CD4 values. Pima™ results were comparable to FACSCalibur™ for both venous and capillary specimens when operated by lay-counselors. POC CD4 testing has the potential to improve linkage to HIV care without burdening laboratory technicians in resource-limited settings. Published by Elsevier B.V.

  10. Reliable and Valid Assessment of Point-of-care Ultrasonography

    DEFF Research Database (Denmark)

    Todsen, Tobias; Tolsgaard, Martin Grønnebæk; Olsen, Beth Härstedt

    2015-01-01

    physicians' OSAUS scores with diagnostic accuracy. RESULTS: The generalizability coefficient was high (0.81) and a D-study demonstrated that 1 assessor and 5 cases would result in similar reliability. The construct validity of the OSAUS scale was supported by a significant difference in the mean scores......OBJECTIVE: To explore the reliability and validity of the Objective Structured Assessment of Ultrasound Skills (OSAUS) scale for point-of-care ultrasonography (POC US) performance. BACKGROUND: POC US is increasingly used by clinicians and is an essential part of the management of acute surgical...... conditions. However, the quality of performance is highly operator-dependent. Therefore, reliable and valid assessment of trainees' ultrasonography competence is needed to ensure patient safety. METHODS: Twenty-four physicians, representing novices, intermediates, and experts in POC US, scanned 4 different...

  11. Protocol for a randomised controlled implementation trial of point-of-care viral load testing and task shifting: the Simplifying HIV TREAtment and Monitoring (STREAM) study.

    Science.gov (United States)

    Dorward, Jienchi; Garrett, Nigel; Quame-Amaglo, Justice; Samsunder, Natasha; Ngobese, Hope; Ngomane, Noluthando; Moodley, Pravikrishnen; Mlisana, Koleka; Schaafsma, Torin; Donnell, Deborah; Barnabas, Ruanne; Naidoo, Kogieleum; Abdool Karim, Salim; Celum, Connie; Drain, Paul K

    2017-09-27

    Achieving the Joint United Nations Programme on HIV and AIDS 90-90-90 targets requires models of HIV care that expand antiretroviral therapy (ART) coverage without overburdening health systems. Point-of-care (POC) viral load (VL) testing has the potential to efficiently monitor ART treatment, while enrolled nurses may be able to provide safe and cost-effective chronic care for stable patients with HIV. This study aims to demonstrate whether POC VL testing combined with task shifting to enrolled nurses is non-inferior and cost-effective compared with laboratory-based VL monitoring and standard HIV care. The STREAM (Simplifying HIV TREAtment and Monitoring) study is an open-label, non-inferiority, randomised controlled implementation trial. HIV-positive adults, clinically stable at 6 months after ART initiation, will be recruited in a large urban clinic in South Africa. Approximately 396 participants will be randomised 1:1 to receive POC HIV VL monitoring and potential task shifting to enrolled nurses, versus laboratory VL monitoring and standard South African HIV care. Initial clinic follow-up will be 2-monthly in both arms, with VL testing at enrolment, 6 months and 12 months. At 6 months (1 year after ART initiation), stable participants in both arms will qualify for a differentiated care model involving decentralised ART pickup at community-based pharmacies. The primary outcome is retention in care and virological suppression at 12 months from enrolment. Secondary outcomes include time to appropriate entry into the decentralised ART delivery programme, costs per virologically suppressed patient and cost-effectiveness of the intervention compared with standard care. Findings will inform the scale up of VL testing and differentiated care in HIV-endemic resource-limited settings. Ethical approval has been granted by the University of KwaZulu-Natal Biomedical Research Ethics Committee (BFC296/16) and University of Washington Institutional Review Board (STUDY

  12. Feasibility and Field Performance of a Simultaneous Syphilis and HIV Point-of-Care Test Based Screening Strategy in at Risk Populations in Edmonton, Canada

    Directory of Open Access Journals (Sweden)

    Joshua Bergman

    2013-01-01

    Full Text Available Few studies have evaluated the feasibility of delivering syphilis point-of-care (POC testing in outreach (nonclinical settings in resource rich countries. The objectives of the study were to evaluate the feasibility and diagnostic performance of performing both HIV and syphilis POC testing in outreach settings and to document new cases identified in the study population. 1,265 outreach testing visits were offered syphilis and HIV POC testing and 81.5% (n=1,031 consented to testing. In our population, the SD Bioline 3.0 Syphilis Test had a sensitivity of 85.3% [CI (68.9–95.0], specificity of 100.0% [CI (99.6–100.0], positive predictive value (PPV of 100.0% [CI (88.1–100.0], and negative predictive value (NPV of 99.5% [CI (98.9–99.8]. Test characteristics for the INSTI HIV-1/HIV-2 Antibody Test had a 100.0% sensitivity [CI (39.8–100.00], 99.8 specificity [CI (99.3–100], 66.7% PPV [CI (22.3–95.7], and 100.0% NPV [CI (99.6–100.0]. Four new cases of syphilis and four new HIV cases were diagnosed. In summary, at risk population seeking STI testing found POC tests to be acceptable, the POC tests performed well in outreach settings, and new cases of syphilis and HIV were identified and linked to treatment and care.

  13. Moving from "optimal resources" to "optimal care" at trauma centers.

    Science.gov (United States)

    Shafi, Shahid; Rayan, Nadine; Barnes, Sunni; Fleming, Neil; Gentilello, Larry M; Ballard, David

    2012-04-01

    The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients. We hypothesized that improved compliance with trauma-specific clinical processes of care (POC) is associated with reduced in-hospital mortality. Records of a random sample of 1,000 patients admitted to a Level I trauma center who met Trauma Quality Improvement Program criteria (age ≥ 16 years and Abbreviated Injury Scale score 3) were retrospectively reviewed for compliance with 25 trauma-specific POC (T-POC) that were evidence-based or expert consensus panel recommendations. Multivariate regression was used to determine the relationship between T-POC compliance and in-hospital mortality, adjusted for age, gender, injury type, and severity. Median age was 41 years, 65% were men, 88% sustained a blunt injury, and mortality was 12%. Of these, 77% were eligible for at least one T-POC and 58% were eligible for two or more. There was wide variation in T-POC compliance. Every 10% increase in compliance was associated with a 14% reduction in risk-adjusted in-hospital mortality. Unlike adoption of core measures, compliance with T-POC is associated with reduced mortality in trauma patients. Trauma centers with excess in-hospital mortality may improve patient outcomes by consistently applying T-POC. These processes should be explored for potential use as Core Trauma Center Performance Measures.

  14. Functional identification in Lactobacillus reuteri of a PocR-like transcription factor regulating glycerol utilization and vitamin B12 synthesis

    Directory of Open Access Journals (Sweden)

    Saulnier Delphine MA

    2011-07-01

    Full Text Available Abstract Background Lactobacillus reuteri harbors the genes responsible for glycerol utilization and vitamin B12 synthesis within a genetic island phylogenetically related to gamma-Proteobacteria. Within this island, resides a gene (lreu_1750 that based on its genomic context has been suggested to encode the regulatory protein PocR and presumably control the expression of the neighboring loci. However, this functional assignment is not fully supported by sequence homology, and hitherto, completely lacks experimental confirmation. Results In this contribution, we have overexpressed and inactivated the gene encoding the putative PocR in L. reuteri. The comparison of these strains provided metabolic and transcriptional evidence that this regulatory protein controls the expression of the operons encoding glycerol utilization and vitamin B12 synthesis. Conclusions We provide clear experimental evidence for assigning Lreu_1750 as PocR in Lactobacillus reuteri. Our genome-wide transcriptional analysis further identifies the loci contained in the PocR regulon. The findings reported here could be used to improve the production-yield of vitamin B12, 1,3-propanediol and reuterin, all industrially relevant compounds.

  15. Cholesterol Point-of-Care Testing for Community Pharmacies: A Review of the Current Literature.

    Science.gov (United States)

    Haggerty, Lauren; Tran, Deanna

    2017-08-01

    To summarize the literature on cholesterol point-of-care tests (POCTs). This article would serve as a resource to assist community pharmacists in developing cholesterol point-of-care (POC) pharmacy services. A literature search was performed in MEDLINE Ovid, PubMed, EMBASE, and Cochrane database using the following medical subject headings (MeSH) terms: point-of-care test, cholesterol, blood chemical analysis, rapid testing, collaborative practice, community pharmacy, and ambulatory care. Additional resources including device manufacturer web sites were summarized to supplement the current literature. All human research articles, review articles, meta-analyses, and abstracts published in English through September 1, 2014, were considered. A total of 36 articles were applicable for review. Information was divided into the following categories to be summarized: devices, pharmacists' impact, and operational cost for the pharmacy. The current literature suggests that POCTs in community pharmacies assist with patient outcomes by providing screenings and referring patients with dyslipidemia for further evaluation. The majority of studies on cholesterol POC devices focused on accuracy, revealing the need for further studies to develop best practices and practice models with successful reimbursement. Accuracy, device specifications, required supplies, and patient preference should be considered when selecting a POC device for purchase.

  16. Point-of-Care Hemoglobin/Hematocrit Testing: Comparison of Methodology and Technology.

    Science.gov (United States)

    Maslow, Andrew; Bert, Arthur; Singh, Arun; Sweeney, Joseph

    2016-04-01

    Point-of-care (POC) testing allows rapid assessment of hemoglobin (Hgb) and hematocrit (Hct) values. This study compared 3 POC testing devices--the Radical-7 pulse oximeter (Radical-7, Neuchȃtel, Switzerland), the i-STAT (Abbott Point of Care, Princeton, NJ), and the GEM 4000 (Instrumentation Laboratory, Bedford, MA)--to the hospital reference device, the UniCel DxH 800 (Beckman Coulter, Brea, CA) in cardiac surgery patients. Prospective study. Tertiary care cardiovascular center. Twenty-four consecutive elective adult cardiac surgery patients. Hgb and Hct values were measured using 3 POC devices (the Radical-7, i-STAT, and GEM 4000) and a reference laboratory device (UniCel DxH 800). Data were collected simultaneously before surgery, after heparin administration, after heparin reversal with protamine, and after sternal closure. Data were analyzed using bias analyses. POC testing data were compared with that of the reference laboratory device. Hgb levels ranged from 6.8 to 15.1 g/dL, and Hct levels ranged from 20.1% to 43.8%. The overall mean bias was lowest with the i-STAT (Hct, 0.22%; Hgb 0.05 g/dL) compared with the GEM 4000 (Hct, 2.15%; Hgb, 0.63 g/dL) and the Radical-7 (Hgb 1.16 g/dL). The range of data for the i-STAT and Radical-7 was larger than that with the GEM 4000, and the pattern or slopes changed significantly with the i-STAT and Radical-7, whereas that of the GEM 4000 remained relatively stable. The GEM 4000 demonstrated a consistent overestimation of laboratory data, which tended to improve after bypass and at lower Hct/Hgb levels. The i-STAT bias changed from overestimation to underestimation, the latter in the post-cardiopulmonary bypass period and at lower Hct/Hgb levels. By contrast, the Radical-7 biases increased during the surgical procedure and in the lower ranges of Hgb. Important clinical differences and limitations were found among the 3 POC testing devices that should caution clinicians from relying on these data as sole determinants of

  17. The clinical and economic impact of point-of-care CD4 testing in mozambique and other resource-limited settings: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Emily P Hyle

    2014-09-01

    Full Text Available Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique.We use a validated model of HIV testing, linkage, and treatment (CEPAC-International to examine two strategies of immunological staging in Mozambique: (1 laboratory-based CD4 testing (LAB-CD4 and (2 point-of-care CD4 testing (POC-CD4. Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs. Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%, probability of correctly detecting antiretroviral therapy (ART eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90% or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%, and test cost (LAB-CD4, US$10; POC-CD4, US$24. In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570 to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%-61.0%, increasing to 65.0% (95% CI, 64.9%-65.1% with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6-9.6 y and US$2,440 (95% CI, US$2,440-US$2,450 and increase with POC-CD4 to 10.3 y (95% CI, 10.3-10.3 y and US$2,800 (95% CI, US$2,790-US$2,800; the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS (95% CI, US$480-US$520/YLS. POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published

  18. Allergy Diagnosis in Children and Adults: Performance of a New Point-of-Care Device, ImmunoCAP Rapid.

    Science.gov (United States)

    Hedlin, Gunilla; Moreno, Carmen; Petersson, Carl Johan; Lilja, Gunnar; Toledano, Félix Lorente; García, Antonio Nieto; Nordvall, Lennart; Palmqvist, Mona; Rak, Sabina; Ahlstedt, Staffan; Borres, Magnus P

    2009-07-01

    : Allergy is a serious problem affecting approximately 1 of 4 individuals. The symptoms with and without allergy etiology are often difficult to distinguish from each other without using an IgE antibody test. The aim of this study was to investigate the performance of a new point-of-care (POC) test for IgE antibodies to relevant allergens in Europe. : IgE antibodies from children and adults with allergies recruited from allergy clinics in Sweden and Spain were analyzed for 10 allergens, suitable for the age groups, using the new POC test and ImmunoCAP laboratory test. The IgE antibody level best discriminating between positive and negative results (the cutoff point) for the different allergens of the POC test and the efficacy of the POC and the ImmunoCAP laboratory tests for diagnosing allergy compared with that of clinical diagnosis were investigated. : The estimated cutoffs for the different allergens in the POC test ranged from 0.70 to 2.56 kUA/L. Taking into account all positive allergen results in a given patient, the POC test could identify 95% of the patients with allergies. Seventy-eight percent of the allergen-specific physicians' diagnoses were identified and 97% of the negative ones. Most allergens exhibited good performance, identifying about 80% of clinically relevant cases. However, dog, mugwort, and wall pellitory would benefit from improvement. : The POC test will be a valuable adjunct in the identification or exclusion of patients with allergies and their most likely offending allergens, both in specialist and general care settings.

  19. Influence of point-of-care C-reactive protein testing on antibiotic prescription habits in primary care in the Netherlands.

    Science.gov (United States)

    Schuijt, Tim J; Boss, David S; Musson, Ruben E A; Demir, Ayse Y

    2018-03-27

    Bacterial resistance to antibiotics represents a serious global challenge that is associated with high morbidity and mortality. One of the most important causes of this threat is antibiotic overuse. The Dutch College of General Practitioners (DCGP) recommends the use of point-of-care (POC) testing for C-reactive protein (CRP) in two guidelines ('Acute Cough' and 'Diverticulitis') to achieve a more sensible prescription pattern of antibiotics. To evaluate the use of POC-CRP testing in light of the DCGP guidelines and the effect of CRP measurements on antibiotic prescription policy in primary care. In a prospective observational study, which included 1756 patients, general practitioners (GPs) were asked to complete a questionnaire after every POC-CRP testing, stating the indication for performing the test, the CRP result and their decision whether or not to prescribe antibiotics. Indications were verified against the DCGP guidelines and categorized. Antibiotic prescription was evaluated in relation to CRP concentrations. Indications to perform POC-CRP test and the prescription pattern of antibiotics based on CRP value varied considerably between GPs. Differences in antibiotic prescription rate were most obvious in patients who presented with CRP values between 20 and 100 mg/l, and could in part be explained by the indication for performing POC-CRP test and patient age. Most GPs followed the DCGP guidelines and used low CRP values to underpin their decision to refrain from antibiotic prescription. Peer-based reflection on differences in POC-CRP usage and antibiotic prescription rate amongst GPs may further nourish a more critical approach to prescription of antibiotics.

  20. Sources and fate of organic (DOC, POC, CDOM) and inorganic (DIC) carbon in a mangrove dominated estuary (French Guiana)

    Science.gov (United States)

    Ray, R.; Michaud, E.; Vantrepotte, V.; Aller, R. C.; Morvan, S.; Thouzeau, G.

    2016-12-01

    We studied the mangrove dominated Sinnamary estuarine system in French Guiana during the dry and wet seasons in 2015 to examine the sources, transport and fate of surface water DOC, POC and DIC along the salinity gradient and the effect of tidal fluctuations on carbon dynamics. Elemental ratios, stable isotopes and optical properties (absorption) were applied as proxies to delineate the sources and molecular structure of the organic carbon. Results showed that during the wet season there were significant net inputs of POC and DOC along the salinity gradient from mangroves and enhanced surface runoff. Time series performed during the dry season at a station in channel water adjacent to mangroves revealed mangrove-derived export and exchanges of DOC and POC during the ebb and marine algae import during the flood. DOC was the dominant form of carbon in both seasons with DOC:POC ratios typically between 13 and 40. Both δ13DOC and CDOM descriptors (e.g., S275-295 and a*412) confirmed mangrove litter leaching to be the primary contributor of high molecular weight dissolved organic matter in the wet season which was replaced by marine phytoplanktonic OC during transport offshore in the dry season. CDOM aromaticity is lower in the dry season as mangrove inputs decrease. POC showed similar trends as DOC, with maximum contributions of terrestrial litter in the river and mixing zone, and in situ production dominant in the marine zone. The entire estuary is heterotrophic, exhibiting high pCO2 (837-5575µatm) and oxygen undersaturation (59-86%) in both seasons, and substantial CO2 emission fluxes (278-3671mmol m-2 d-1). Intense local remineralization and laterally transported CO2 originating from mangrove benthic respiration could account for the water column pCO2 enrichment during low tide and night time. Keywords: Organic carbon, stable isotopes, CDOM, pCO2, mangrove, French Guiana

  1. The International Society for the Study of Women's Sexual Health Process of Care for Management of Hypoactive Sexual Desire Disorder in Women.

    Science.gov (United States)

    Clayton, Anita H; Goldstein, Irwin; Kim, Noel N; Althof, Stanley E; Faubion, Stephanie S; Faught, Brooke M; Parish, Sharon J; Simon, James A; Vignozzi, Linda; Christiansen, Kristin; Davis, Susan R; Freedman, Murray A; Kingsberg, Sheryl A; Kirana, Paraskevi-Sofia; Larkin, Lisa; McCabe, Marita; Sadovsky, Richard

    2018-04-01

    The International Society for the Study of Women's Sexual Health process of care (POC) for management of hypoactive sexual desire disorder (HSDD) algorithm was developed to provide evidence-based guidelines for diagnosis and treatment of HSDD in women by health care professionals. Affecting 10% of adult females, HSDD is associated with negative emotional and psychological states and medical conditions including depression. The algorithm was developed using a modified Delphi method to reach consensus among the 17 international panelists representing multiple disciplines. The POC starts with the health care professional asking about sexual concerns, focusing on issues related to low sexual desire/interest. Diagnosis includes distinguishing between generalized acquired HSDD and other forms of low sexual interest. Biopsychosocial assessment of potentially modifiable factors facilitates initiation of treatment with education, modification of potentially modifiable factors, and, if needed, additional therapeutic intervention: sex therapy, central nervous system agents, and hormonal therapy, guided in part by menopausal status. Sex therapy includes behavior therapy, cognitive behavior therapy, and mindfulness. The only central nervous system agent currently approved by the US Food and Drug Administration (FDA) for HSDD is flibanserin in premenopausal women; use of flibanserin in postmenopausal women with HSDD is supported by data but is not FDA approved. Hormonal therapy includes off-label use of testosterone in postmenopausal women with HSDD, which is supported by data but not FDA approved. The POC incorporates monitoring the progress of therapy. In conclusion, the International Society for the Study of Women's Sexual Health POC for the management of women with HSDD provides a rational, evidence-based guideline for health care professionals to manage patients with appropriate assessments and individualized treatments. Copyright © 2017 Mayo Foundation for Medical

  2. Is there a suitable point-of-care glucose meter for tight glycemic control? Evaluation of one home-use and four hospital-use meters in an intensive care unit.

    Science.gov (United States)

    Gijzen, Karlijn; Moolenaar, David L J; Weusten, Jos J A M; Pluim, Hendrik J; Demir, Ayse Y

    2012-11-01

    Implementation of tight glycemic control (TGC) and avoidance of hypoglycemia in intensive care unit (ICU) patients require frequent analysis of blood glucose. This can be achieved by accurate point-of-care (POC) hospital-use glucose meters. In this study one home-use and four different hospital-use POC glucose meters were evaluated in critically ill ICU patients. All patients (n = 80) requiring TGC were included in this study. For each patient three to six glucose measurements (n = 390) were performed. Blood glucose was determined by four hospital-use POC glucose meters, Roche Accu-Check Inform II System, HemoCue Glu201DM, Nova StatStrip, Abbott Precision Xceed Pro, and one home-use POC glucose meter, Menarini GlucoCard Memory PC. The criteria described in ISO 15197, Dutch TNO quality guideline and in NACB/ADA-2011 were applied in the comparisons. According to the ISO 15197, the percentages of the measured values that fulfilled the criterion were 99.5% by Roche, 95.1% by HemoCue, 91.0% by Nova, 96.6% by Abbott, and 63.3% by Menarini. According to the TNO quality guideline these percentages were 96.1% , 91.0% , 81.8% , 94.2% , and 47.7% , respectively. Application of the NACB/ADA guideline resulted in percentages of 95.6%, 89.2%, 77.9%, 93.4%, and 45.4%, respectively. When ISO 15197 was applied, Roche, HemoCue and Abbott fulfilled the criterion in this patient population, whereas Nova and Menarini did not. However, when TNO quality guideline and NACB/ADA 2011 guideline were applied only Roche fulfilled the criteria.

  3. Clinical Evaluation of 2 Point-of-Care Lateral Flow Tests for the Diagnosis of Syphilis.

    Science.gov (United States)

    Nakku-Joloba, Edith; Kiragga, Agnes; Mbazira, Joshua Kimeze; Kambugu, Fred; Jett-Goheen, Mary; Ratanshi, Rosalind Parkes; Gaydos, Charlotte; Manabe, Yukari C

    2016-10-01

    A diagnostic performance study comparing the only Food and Drug Administration-approved, point-of-care (POC) treponemal test (Syphilis Health Check) and the World Health Organization pre-qualified SD Bioline POC treponemal test against a treponemal hemagglutination test (TPHA) and a sequential algorithm of nontreponemal rapid plasma reagin and TPHA found both POC tests had >85% sensitivity compared with the TPHA and >85% sensitivity and >95% specificity compared with the rapid plasma reagin and TPHA standards.

  4. Field evaluation of a rapid point-of-care assay for targeting antibiotic treatment for trachoma control: a comparative study.

    Science.gov (United States)

    Michel, Claude-Edouard C; Solomon, Anthony W; Magbanua, Jose P V; Massae, Patrick A; Huang, Ling; Mosha, Jonaice; West, Sheila K; Nadala, Elpidio C B; Bailey, Robin; Wisniewski, Craig; Mabey, David C W; Lee, Helen H

    2006-05-13

    Trachoma results from repeated episodes of conjunctival infection with Chlamydia trachomatis and is the leading infectious cause of blindness. To eliminate trachoma, control programmes use the SAFE strategy (Surgery, Antibiotics, Face cleanliness, and Environmental improvement). The A component is designed to treat C trachomatis infection, and is initiated on the basis of the prevalence of the clinical sign trachomatous inflammation-follicular (TF). Unfortunately, TF correlates poorly with C trachomatis infection. We sought to assess a newly developed point-of-care (POC) assay compared with presence of TF for guiding the use of antibiotics for trachoma control. We compared performance outcomes of the POC assay and presence of TF using commercial PCR as a comparator in 664 children aged 1-9 years in remote, trachoma-endemic villages in Tanzania. Signs of trachoma were graded according to the WHO simplified trachoma grading system. Of 664 participants, 128 (19%) were positive for ocular C trachomatis infection by PCR. Presence of TF had a sensitivity of 64.1% (95% CI 55.8-72.4), specificity of 80.2% (76.8-83.6), and positive predictive value of 43.6% (36.5-50.7). By contrast, the POC assay had a sensitivity of 83.6% (77.2-90.0), specificity of 99.4% (98.8-100.0), and positive predictive value of 97.3% (94.2-100.3). Interagreements and intra-agreements between four novice operators were 0.988 (0.973-1.000) and 0.950 (0.894-1.000), respectively. The POC assay is substantially more accurate than TF prevalence in identifying the presence or absence of infection. Additional studies should assess the use of the assay in the planning and monitoring of trachoma control activities.

  5. Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods.

    Science.gov (United States)

    Pastakia, Sonak D; Njuguna, Benson; Onyango, Beryl Ajwang'; Washington, Sierra; Christoffersen-Deb, Astrid; Kosgei, Wycliffe K; Saravanan, Ponnusamy

    2017-07-14

    Early diagnosis of gestational diabetes mellitus (GDM) is crucial to prevent short term delivery risks and long term effects such as cardiovascular and metabolic diseases in the mother and infant. Diagnosing GDM in Sub-Saharan Africa (SSA) however, remains sub-optimal due to associated logistical and cost barriers for resource-constrained populations. A cost-effective strategy to screen for GDM in such settings are therefore urgently required. We conducted this study to determine the prevalence of gestational diabetes mellitus (GDM) and assess utility of various GDM point of care (POC) screening strategies in a resource-constrained setting. Eligible women aged ≥18 years, and between 24 and 32 weeks of a singleton pregnancy, prospectively underwent testing over two days. On day 1, a POC 1-h 50 g glucose challenge test (GCT) and a POC glycated hemoglobin (HbA1c) was assessed. On day 2, fasting blood glucose, 1-h and 2-h 75 g oral glucose tolerance test (OGTT) were determined using both venous and POC tests, along with a venous HbA1c. The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria was used to diagnose GDM. GDM prevalence was reported with 95% confidence interval (CI). Specificity, sensitivity, positive predictive value, and negative predictive value of the various POC testing strategies were determined using IADPSG testing as the standard reference. Six hundred-sixteen eligible women completed testing procedures. GDM was diagnosed in 18 women, a prevalence of 2.9% (95% CI, 1.57% - 4.23%). Compared to IADPSG testing, POC IADPSG had a sensitivity and specificity of 55.6% and 90.6% respectively while that of POC 1-h 50 g GCT (using a diagnostic cut-off of ≥7.2 mmol/L [129.6 mg/dL]) was 55.6% and 63.9%. All other POC tests assessed showed poor sensitivity. POC screening strategies though feasible, showed poor sensitivity for GDM detection in our resource-constrained population of low GDM prevalence. Studies to identify

  6. A1c Gear: Laboratory quality HbA1c measurement at the point of care.

    Science.gov (United States)

    Ejilemele, Adetoun; Unabia, Jamie; Ju, Hyunsu; Petersen, John R

    2015-05-20

    HbA1c is an important part of assessing the diabetic control and since the use of point-of-care devices for monitoring HbA1c is increasing, it is important to determine how these devices compare to the central laboratory. One hundred and twenty patient samples were analyzed on the Bio-Rad Variant™II and one POC analyzer (Sakae A1c Gear). Three patient sample pools containing ~5%, ~7%, and ~10% HbA1c levels were run over 20 days. Three reagent lots and three instruments were evaluated for the A1c Gear. The 120 patient samples showed strong correlation (R(2)>0.989) when compared to the Variant™II with means=8.06% and 7.81%, for Variant IIand A1c Gear, respectively. Changing reagent lots or instruments had no impact for the A1c Gear. The ~5%, ~7%, and ~10% pools within-run and between-run imprecision was between 0.87-1.33% and 1.03-1.32%, and 1.41-2.35% and 1.24-1.89% with total imprecision of 1.67-2.35% and 1.61-2.31% for the A1c Gear and Variant II, respectively. The A1c Gear showed a small negative bias (0.25% HbA1c) across HbA1c measurement ranges of Gear meets the criteria of total CV Gear can give results as precise as the laboratory at the POC. Copyright © 2015. Published by Elsevier B.V.

  7. Perceptions of point-of-care infectious disease testing among European medical personnel, point-of-care test kit manufacturers, and the general public

    NARCIS (Netherlands)

    W.E. Kaman (Wendy); E-R. Andrinopoulou (Eleni-Rosalina); J.P. Hays (John)

    2013-01-01

    textabstractBackground: The proper development and implementation of point-of-care (POC) diagnostics requires knowledge of the perceived requirements and barriers to their implementation. To determine the current requirements and perceived barriers to the introduction of POC diagnostics in the field

  8. Impacts of erosion and restoration on POC flux and pollutant mobilisation in the peatlands of the Peak District National Park, UK

    Science.gov (United States)

    Shuttleworth, E. L.; Evans, M. G.; Rothwell, J. J.; Hutchinson, S. M.

    2012-04-01

    Peatlands represent major carbon stores. However, much of the UK's blanket peat is significantly degraded and actively eroding which significantly impacts carbon storage through the physical export of particulate organic carbon (POC). The stability of peatlands is therefore important for the preservation this carbon store and the restoration of the eroded peat of the Peak District, southern Pennines, UK has been a major conservation concern for several decades. The near-surface layer of these blanket peats is severely contaminated with high concentrations of atmospherically deposited lead - a legacy of Britain's Industrial Revolution. Recently there has been growing interest in the mobilisation of this heavy metal which has been shown to be associated with POC. However, little is known about the source and quality of sediment still entering the fluvial system in revegetated catchments. Understanding the physical process dynamics relating to revegetation and sediment flux is required in order to assess the efficacy of peatland restoration operations in reducing POC and lead release. Three sites have been studied in the Bleaklow area of the Peak District; each representing different surface conditions: (i) actively eroding, (ii) recently revegetated and, (iii) intact. The contaminated nature of the near surface peat distinguishes POC mobilised from the peat surface from that eroded from gully walls. This has allowed a fingerprinting approach to be adopted as a means of characterising and identifying the sources of sediment entering the fluvial system. A survey of surface lead concentrations at each site was conducted and other catchment sources were identified and their relative contribution to the suspended load assessed. POC fluxes are greatly reduced following restoration to levels comparable to intact sites. Lead flux is also significantly reduced but surface condition makes little difference to the quality of the sediment, i.e. the concentration of lead

  9. Accuracy of Handheld Point-of-Care Fingertip Lactate Measurement in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Gaieski, David G

    2013-02-01

    Full Text Available Introduction: Early recognition of elevated lactate levels in sepsis may hasten the detection of those patients eligible for aggressive resuscitation. Point-of-care (POC testing is now increasingly available for use in the emergency department (ED. We examined the accuracy and time-saving effect of a handheld POC device for the measurement of fingertip and whole blood lactate as compared with reference laboratory testing in critically ill ED patients.Methods: A convenience sample of adult ED patients receiving serum lactate testing was prospectively enrolled at an urban, tertiary care US hospital. Consenting patients underwent fingertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC device and standard laboratory analyzer (‘‘reference method’’. Lactate measurements were compared by intraclass correlation (ICC and Bland and Altman plots. Differences in time to test result were compared by paired t test.Results: Twenty-four patients, 19 (79% with sepsis and 21 (88% with lactate levels below 4 mmol/L, were included from April 2005 to May 2005. Fingertip POC and whole blood POC lactate measurements each correlated tightly with the reference method (ICC ¼ 0.90 and ICC ¼ 0.92, respectively. Mean time between obtaining fingertip lactate samples and whole blood reference lactate samples was 8 6 13 minutes. Mean time between obtaining POC and reference laboratory lactate results was 65 minutes (95% confidence interval, 30–103.Conclusion: Fingertip POC lactate measurement is an accurate method to determine lactate levels in infected ED patients with normal or modestly elevated lactate values and significantly decreases time to test results. These findings should be verified in a larger, more critically ill, ED population. [West J Emerg Med. 2013;14(1:58-62.

  10. Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia.

    Science.gov (United States)

    Kaindjee-Tjituka, Francina; Sawadogo, Souleymane; Mutandi, Graham; Maher, Andrew D; Salomo, Natanael; Mbapaha, Claudia; Neo, Marytha; Beukes, Anita; Gweshe, Justice; Muadinohamba, Alexinah; Lowrance, David W

    2017-01-01

    Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid ( p = 0.1); 95.6% and 98.1% of results were received by the patient ( p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day ( p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results ( p lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.

  11. Point-of-Care Versus Central Laboratory Measurements of Hemoglobin, Hematocrit, Glucose, Bicarbonate and Electrolytes: A Prospective Observational Study in Critically Ill Patients.

    Directory of Open Access Journals (Sweden)

    Jérôme Allardet-Servent

    Full Text Available Rapid detection of abnormal biological values using point-of-care (POC testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose.314 paired samples were collected prospectively from 51 critically ill patients. All samples were drawn simultaneously in the morning from an arterial line. BD Vacutainer tubes were analyzed in the central laboratory using Beckman Coulter analyzers (AU 5800 and DxH 800. BD Preset 3 ml heparinized-syringes were analyzed immediately in the ICU using the POC Siemens RAPIDPoint 500 blood gas system. We used CLIA proficiency testing criteria to define acceptable analytical performance and interchangeability.Biases, limits of agreement (±1.96 SD and coefficients of correlation were respectively: 1.3 (-2.2 to 4.8 mmol/L, r = 0.936 for sodium; 0.2 (-0.2 to 0.6 mmol/L, r = 0.944 for potassium; -0.9 (-3.7 to 2 mmol/L, r = 0.967 for chloride; 0.8 (-1.9 to 3.4 mmol/L, r = 0.968 for bicarbonate; -11 (-30 to 9 mg/dL, r = 0.972 for glucose; -0.8 (-1.4 to -0.2 g/dL, r = 0.985 for hemoglobin; and -1.1 (-2.9 to 0.7%, r = 0.981 for hematocrit. All differences were below CLIA cut-off values, except for hemoglobin.Compared to central Laboratory analyzers, the POC Siemens RAPIDPoint 500 blood gas system satisfied the CLIA criteria of interchangeability for all tested parameters, except for hemoglobin. These results are warranted for our own procedures and devices. Bearing these restrictions, we recommend clinicians to initiate an appropriate therapy based on POC testing without awaiting a control measurement.

  12. Point-of-Care Versus Central Laboratory Measurements of Hemoglobin, Hematocrit, Glucose, Bicarbonate and Electrolytes: A Prospective Observational Study in Critically Ill Patients.

    Science.gov (United States)

    Allardet-Servent, Jérôme; Lebsir, Melissa; Dubroca, Christian; Fabrigoule, Martine; Jordana, Sylvie; Signouret, Thomas; Castanier, Matthias; Thomas, Guillemette; Soundaravelou, Rettinavelou; Lepidi, Anne; Delapierre, Laurence; Penaranda, Guillaume; Halfon, Philippe; Seghboyan, Jean-Marie

    2017-01-01

    Rapid detection of abnormal biological values using point-of-care (POC) testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose. 314 paired samples were collected prospectively from 51 critically ill patients. All samples were drawn simultaneously in the morning from an arterial line. BD Vacutainer tubes were analyzed in the central laboratory using Beckman Coulter analyzers (AU 5800 and DxH 800). BD Preset 3 ml heparinized-syringes were analyzed immediately in the ICU using the POC Siemens RAPIDPoint 500 blood gas system. We used CLIA proficiency testing criteria to define acceptable analytical performance and interchangeability. Biases, limits of agreement (±1.96 SD) and coefficients of correlation were respectively: 1.3 (-2.2 to 4.8 mmol/L, r = 0.936) for sodium; 0.2 (-0.2 to 0.6 mmol/L, r = 0.944) for potassium; -0.9 (-3.7 to 2 mmol/L, r = 0.967) for chloride; 0.8 (-1.9 to 3.4 mmol/L, r = 0.968) for bicarbonate; -11 (-30 to 9 mg/dL, r = 0.972) for glucose; -0.8 (-1.4 to -0.2 g/dL, r = 0.985) for hemoglobin; and -1.1 (-2.9 to 0.7%, r = 0.981) for hematocrit. All differences were below CLIA cut-off values, except for hemoglobin. Compared to central Laboratory analyzers, the POC Siemens RAPIDPoint 500 blood gas system satisfied the CLIA criteria of interchangeability for all tested parameters, except for hemoglobin. These results are warranted for our own procedures and devices. Bearing these restrictions, we recommend clinicians to initiate an appropriate therapy based on POC testing without awaiting a control measurement.

  13. A Systematic Review of Point of Care Testing for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis

    Directory of Open Access Journals (Sweden)

    Sasha Herbst de Cortina

    2016-01-01

    Full Text Available Objectives. Systematic review of point of care (POC diagnostic tests for sexually transmitted infections: Chlamydia trachomatis (CT, Neisseria gonorrhoeae (NG, and Trichomonas vaginalis (TV. Methods. Literature search on PubMed for articles from January 2010 to August 2015, including original research in English on POC diagnostics for sexually transmitted CT, NG, and/or TV. Results. We identified 33 publications with original research on POC diagnostics for CT, NG, and/or TV. Thirteen articles evaluated test performance, yielding at least one test for each infection with sensitivity and specificity ≥90%. Each infection also had currently available tests with sensitivities <60%. Three articles analyzed cost effectiveness, and five publications discussed acceptability and feasibility. POC testing was acceptable to both providers and patients and was also demonstrated to be cost effective. Fourteen proof of concept articles introduced new tests. Conclusions. Highly sensitive and specific POC tests are available for CT, NG, and TV, but improvement is possible. Future research should focus on acceptability, feasibility, and cost of POC testing. While pregnant women specifically have not been studied, the results available in nonpregnant populations are encouraging for the ability to test and treat women in antenatal care to prevent adverse pregnancy and neonatal outcomes.

  14. A pilot evaluation of whole blood finger-prick sampling for point-of-care HIV viral load measurement: the UNICORN study.

    Science.gov (United States)

    Fidler, Sarah; Lewis, Heather; Meyerowitz, Jodi; Kuldanek, Kristin; Thornhill, John; Muir, David; Bonnissent, Alice; Timson, Georgina; Frater, John

    2017-10-20

    There is a global need for HIV viral load point-of-care (PoC) assays to monitor patients receiving antiretroviral therapy. UNICORN was the first study of an off-label protocol using whole blood finger-prick samples tested with and without a simple three minute spin using a clinic-room microcentrifuge. Two PoC assays were evaluated in 40 HIV-positive participants, 20 with detectable and 20 with undetectable plasma viral load (pVL) (<20 copies/ml). Using 100 µl finger-prick blood samples, the Cepheid Xpert HIV-1 Viral Load and HIV-1 Qual cartridges were compared with laboratory pVL assessment (TaqMan, Roche). For participants with undetectable viraemia by TaqMan, there was poor concordance without centrifugation with the TaqMan platform with only 40% 'undetectable' using Xpert VL and 25% 'not detected' using the Qual assay. After a 3 minute spin, 100% of samples were undetectable using either assay, showing full concordance with the TaqMan assay. Defining a lower limit of detection of 1000 copies/ml when including a spin, there was 100% concordance with the TaqMan platform with strong correlation (rho 0.95 and 0.94; p < 0.0001 for both assays). When including a simple microcentrifugation step, finger-prick PoC testing was a quick and accurate approach for assessing HIV viraemia, with excellent concordance with validated laboratory approaches.

  15. Approaching a diagnostic point-of-care test for pediatric tuberculosis through evaluation of immune biomarkers across the clinical disease spectrum

    DEFF Research Database (Denmark)

    Jenum, Synne; Dhanasekaran, S; Lodha, Rakesh

    2016-01-01

    The World Health Organization (WHO) calls for an accurate, rapid, and simple point-of-care (POC) test for the diagnosis of pediatric tuberculosis (TB) in order to make progress "Towards Zero Deaths". Whereas the sensitivity of a POC test based on detection of Mycobacterium tuberculosis (MTB...... (CD14, FCGR1A, FPR1, MMP9, RAB24, SEC14L1, and TIMP2) or "downstream" towards a decreased likelihood of TB disease (BLR1, CD3E, CD8A, IL7R, and TGFBR2), suggesting a correlation with MTB-related pathology and high relevance to a future POC test for pediatric TB. A biomarker signature consisting of BPI...

  16. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders.

    Science.gov (United States)

    Mashamba-Thompson, Tivani P; Jama, Ngcwalisa A; Sartorius, Benn; Drain, Paul K; Thompson, Rowan M

    2017-01-08

    Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  17. Implementation of Point-of-Care Diagnostics in Rural Primary Healthcare Clinics in South Africa: Perspectives of Key Stakeholders

    Directory of Open Access Journals (Sweden)

    Tivani P. Mashamba-Thompson

    2017-01-01

    Full Text Available Introduction: Key stakeholders’ involvement is crucial to the sustainability of quality point-of-care (POC diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC clinics in South Africa. Method: We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it criteria for POC diagnostic services in resource-limited settings. Results: 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients’ needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Conclusions: Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.

  18. Nano-Calorimetry based point of care biosensor for metabolic disease management.

    Science.gov (United States)

    Kazura, Evan; Lubbers, Brad R; Dawson, Elliott; Phillips, John A; Baudenbacher, Franz

    2017-09-01

    Point of care (POC) diagnostics represents one of the fastest growing health care technology segments. Developments in microfabrication have led to the development of highly-sensitive nanocalorimeters ideal for directly measuring heat generated in POC biosensors. Here we present a novel nano-calorimeter-based biosensor design with differential sensing to eliminate common mode noise and capillary microfluidic channels for sample delivery to the thermoelectric sensor. The calorimeter has a resolution of 1.4 ± 0.2 nJ/(Hz) 1/2 utilizing a 27 junction bismuth/titanium thermopile, with a total Seebeck coefficient of 2160 μV/K. Sample is wicked to the calorimeter through a capillary channel making it suitable for monitoring blood obtained through a finger prick (performance in a model assay using catalase, achieving a threshold for hydrogen peroxide quantification of 50 μM. The potential for our device as a POC blood test for metabolic diseases is shown through the quantification of phenylalanine (Phe) in serum, an unmet necessary service in the management of Phenylketonuria (PKU). Pegylated phenylalanine ammonia-lyase (PEG-PAL) was utilized to react with Phe, but reliable detection was limited to <5 mM due to low enzymatic activity. The POC biosensor concept can be multiplexed and adapted to a large number of metabolic diseases utilizing different immobilized enzymes.

  19. Institutional point-of-care glucometer identifies population trends in blood glucose associated with war.

    Science.gov (United States)

    Boaz, Mona; Matas, Zipora; Chaimy, Tova; Landau, Zohar; Bar Dayan, Yosefa; Berlovitz, Yitzhak; Wainstein, Julio

    2013-11-01

    Acute physiological stress has been shown to impair glucose homeostasis. War is a period of acute psychological stress, and its effect on glucose control is unknown. In this study random point-of-care (POC) glucose levels were measured using an automated, institutional glucometer in hospitalized adult patients prior to versus during the Israeli Pillar of Defense campaign (November 7-10, 2012). Random POC glucose values measured with the institutional blood glucose monitoring system were obtained 1 week prior to the Pillar of Defense campaign (November 7-10, 2012) and compared with values to those obtained during the first 4 days of the war (November 14-17, 2012). In total, 3,573 POC glucose measures were included: 1,865 during the pre-war period and 1,708 during the campaign. POC glucose measures were significantly higher during the war compared with the week preceding the war: 9.7±4.7 versus 9.3±4.2 mmol/L (P=0.02). In a general linear model, period (pre-war vs. during war) persisted as a significant predictor of POC glucose even after controlling for age, sex, and department type (internal medicine vs. surgical). Acute stress, such as a wartime situation, is associated with a significant increase in random blood glucose values in a population of hospitalized adults. Long-term follow-up of the individuals hospitalized during these two periods can reveal differences in morbidity and mortality trends.

  20. Successful Integration of Hepatitis C Virus Point-of-Care Tests into the Denver Metro Health Clinic

    Directory of Open Access Journals (Sweden)

    A. Jewett

    2013-01-01

    Full Text Available Background. The Centers for Disease Control and Prevention (CDC recommends testing and linkage to care for persons most likely infected with hepatitis C virus (HCV, including persons with human immunodeficiency virus. We explored facilitators and barriers to integrating HCV point-of-care (POC testing into standard operations at an urban STD clinic. Methods. The OraQuick HCV rapid antibody test was integrated at the Denver Metro Health Clinic (DMHC. All clients with at least one risk factor were offered the POC test. Research staff conducted interviews with clients (three HCV positive and nine HCV negative. Focus groups were conducted with triage staff, providers, and linkage-to-care counselors. Results. Clients were pleased with the ease of use and rapid return of results from the HCV POC test. Integrating the test into this setting required more time but was not overly burdensome. While counseling messages were clear to staff, clients retained little knowledge of hepatitis C infection or factors related to risk. Barriers to integrating the HCV POC test into clinic operations were loss to follow-up and access to care. Conclusion. DMHC successfully integrated HCV POC testing and piloted a HCV linkage-to-care program. Providing testing opportunities at STD clinics could increase identification of persons with HCV infection.

  1. Advances in point-of-care technologies for molecular diagnostics.

    Science.gov (United States)

    Zarei, Mohammad

    2017-12-15

    Advances in miniaturization, nanotechnology, and microfluidics, along with developments in cloud-connected point-of-care (POC) diagnostics technologies are pushing the frontiers of POC devices toward low-cost, user-friendly, and enhanced sensitivity molecular-level diagnostics. The combination of various bio-sensing platforms within smartphone-integrated electronic readers provides accurate on-site and on-time diagnostics based on various types of chemical and biological targets. Further, 3D printing technology shows a huge potential toward fabrication and improving the performance of POC devices. Integration of skin-like flexible sensors with wireless communication technology creates a unique opportunity for continuous, real-time monitoring of patients for both preventative healthcare and during disease outbreaks. Here, we review recent developments and advances in POC technologies and describe how these advances enhance the performance of POC platforms. Also, this review describes challenges, directions, and future trends on application of emerging technologies in POC diagnostics. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. The Value of Clinical Needs Assessments for Point-of-Care Diagnostics.

    Science.gov (United States)

    Weigl, Bernhard H; Gaydos, Charlotte A; Kost, Gerald; Beyette, Fred R; Sabourin, Stephanie; Rompalo, Anne; de Los Santos, Tala; McMullan, Jason T; Haller, John

    2012-06-01

    Most entrepreneurial ventures fail long before the core technology can be brought to the marketplace because of disconnects in performance and usability measures such as accuracy, cost, complexity, assay stability, and time requirements between technology developers' specifications and needs of the end-users. By going through a clinical needs assessment (CNA) process, developers will gain vital information and a clear focus that will help minimize the risks associated with the development of new technologies available for use within the health care system. This article summarizes best practices of the principal investigators of the National Institute of Biomedical Imaging and Bioengineering point-of-care (POC) centers within the National Institute of Biomedical Imaging and Bioengineering POC Technologies Research Network. Clinical needs assessments are particularly important for product development areas that do not sufficiently benefit from traditional market research, such as grant-funded research and development, new product lines using cutting-edge technologies developed in start-up companies, and products developed through product development partnerships for low-resource settings. The objectives of this article were to (1) highlight the importance of CNAs for development of POC devices, (2) discuss methods applied by POC Technologies Research Network for assessing clinical needs, and (3) provide a road map for future CNAs.

  3. The Value of Clinical Needs Assessments for Point-of-Care Diagnostics

    Science.gov (United States)

    Weigl, Bernhard H.; Gaydos, Charlotte A.; Kost, Gerald; Beyette, Fred R.; Sabourin, Stephanie; Rompalo, Anne; de los Santos, Tala; McMullan, Jason T.; Haller, John

    2013-01-01

    Most entrepreneurial ventures fail long before the core technology can be brought to the marketplace because of disconnects in performance and usability measures such as accuracy, cost, complexity, assay stability, and time requirements between technology developers’ specifications and needs of the end-users. By going through a clinical needs assessment (CNA) process, developers will gain vital information and a clear focus that will help minimize the risks associated with the development of new technologies available for use within the health care system. This article summarizes best practices of the principal investigators of the National Institute of Biomedical Imaging and Bioengineering point-of-care (POC) centers within the National Institute of Biomedical Imaging and Bioengineering POC Technologies Research Network. Clinical needs assessments are particularly important for product development areas that do not sufficiently benefit from traditional market research, such as grant-funded research and development, new product lines using cutting-edge technologies developed in start-up companies, and products developed through product development partnerships for low-resource settings. The objectives of this article were to (1) highlight the importance of CNAs for development of POC devices, (2) discuss methods applied by POC Technologies Research Network for assessing clinical needs, and (3) provide a road map for future CNAs. PMID:23935405

  4. Evaluation and optimization of the Circulating Cathodic Antigen (POC-CCA) cassette test for detecting Schistosoma mansoni infection by using image analysis in school children in Mwanza Region, Tanzania

    DEFF Research Database (Denmark)

    Partal, Miriam Casacuberta; Kinunghi, Safari; Vennervald, Birgitte J

    2016-01-01

    of Lake Victoria in Mwanza Region, Tanzania, and to optimize the reading of the POC-CCA test lines by using a computer software image analysis. Initially, a pilot study in 106 school children indicated that time of urine collection did not have an impact on CCA results as 84.9% (90) had identical scores...... POC-CCAs were compared to six Kato-Katz smears (75.0% vs. 42.6%; p reading of the POC-CCA, a Software...... tool (Image Studio Lite®) was used to read and quantify the colour (expressed as pixels) of the test line on all positive tests, showing a positive correlation between number of pixels and the visually scored intensities and between number of pixels and egg counts. In conclusion, the POC-CCA assay...

  5. Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US

    Directory of Open Access Journals (Sweden)

    Anne Zinski

    2013-01-01

    Full Text Available The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.

  6. Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management.

    Science.gov (United States)

    Kuupiel, Desmond; Bawontuo, Vitalis; Mashamba-Thompson, Tivani P

    2017-11-29

    Access to point-of-care (POC) diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs) and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

  7. Improving the Accessibility and Efficiency of Point-of-Care Diagnostics Services in Low- and Middle-Income Countries: Lean and Agile Supply Chain Management

    Directory of Open Access Journals (Sweden)

    Desmond Kuupiel

    2017-11-01

    Full Text Available Access to point-of-care (POC diagnostics services is essential for ensuring rapid disease diagnosis, management, control, and surveillance. POC testing services can improve access to healthcare especially where healthcare infrastructure is weak and access to quality and timely medical care is a challenge. Improving the accessibility and efficiency of POC diagnostics services, particularly in resource-limited settings, may be a promising route to improving healthcare outcomes. In this review, the accessibility of POC testing is defined as the distance/proximity to the nearest healthcare facility for POC diagnostics service. This review provides an overview of the impact of POC diagnostics on healthcare outcomes in low- and middle-income countries (LMICs and factors contributing to the accessibility of POC testing services in LMICs, focusing on characteristics of the supply chain management and quality systems management, characteristics of the geographical location, health infrastructure, and an enabling policy framework for POC diagnostics services. Barriers and challenges related to the accessibility of POC diagnostics in LMICs were also discussed. Bearing in mind the reported barriers and challenges as well as the disease epidemiology in LMICs, we propose a lean and agile supply chain management framework for improving the accessibility and efficiency of POC diagnostics services in these settings.

  8. Evaluating Laboratory Performance on Point-of-Care Glucose Testing with Six Sigma Metric for 151 Institutions in China.

    Science.gov (United States)

    Fei, Yang; Wang, Wei; He, Falin; Zhong, Kun; Wang, Zhiguo

    2015-10-01

    The aim of this study was to use Six Sigma(SM) (Motorola Trademark Holdings, Libertyville, IL) techniques to analyze the quality of point-of-care (POC) glucose testing measurements quantitatively and to provide suggestions for improvement. In total, 151 laboratories in China were included in this investigation in 2014. Bias and coefficient of variation were collected from an external quality assessment and an internal quality control program, respectively, for POC glucose testing organized by the National Center for Clinical Laboratories. The σ values and the Quality Goal Index were used to evaluate the performance of POC glucose meters. There were 27, 30, 57, and 37 participants in the groups using Optium Xceed™ (Abbott Diabetes Care, Alameda, CA), Accu-Chek(®) Performa (Roche, Basel, Switzerland), One Touch Ultra(®) (Abbott), and "other" meters, respectively. The median of the absolute value of percentage difference varied among different lots and different groups. Among all the groups, the Abbott One Touch Ultra group had the smallest median of absolute value of percentage difference except for lot 201411, whereas the "other" group had the largest median in all five lots. More than 85% of participate laboratories satisfied the total allowable error (TEa) requirement in International Organization for Standardization standard 15197:2013, and 85.43% (129/151) of laboratories obtained intralaboratory coefficient of variations less than 1/3TEa. However, Six Sigma techniques suggested that 41.72% (63/151) to 65.56% (99/151) of the laboratories needed to improve their POC glucose testing performance, in either precision, trueness, or both. Laboratories should pay more attention on the practice of POC glucose testing and take actions to improve their performance. Only in this way can POC glucose testing really function well in clinical practice.

  9. The Ebola Spatial Care Path™: Accelerating point-of-care diagnosis, decision making, and community resilience in outbreaks.

    Science.gov (United States)

    Kost, Gerald J; Ferguson, William J; Hoe, Jackie; Truong, Anh-Thu; Banpavichit, Arirat; Kongpila, Surin

    2015-01-01

    To present a vision where point-of-care testing (POCT) accelerates an Ebola Spatial Care Path™ (SCP) and future molecular diagnostics enable facilitated-access self-testing (FAST POC); to design an alternate care facility (ACF) for the SCP; to innovate an Ebola diagnostic center (DC); and to propel rapid POCT to the frontline to create resilience that stops future outbreaks. PubMed, literature, and web searches. Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Medicine Without Frontiers, and World Health Organization (WHO) document analyses. Investigations in China, the Philippines, Thailand, and the United States. Review of SE Asia, US, and West Africa isolation-treatment centers. Innovation of a SCP, ACF, and DC suitable for American and other communities. The authors designed an ACF and DC to integrate SCP principles for urgent Ebola care. FDA emergency use authorizations for Ebola molecular diagnostics were discovered, but no portable, handheld, or self-contained molecular POC instruments are yet available, although feasible. The WHO initiated design criteria and an acceptance protocol for testing. Financial investment in POCT will downsize Ebola outbreaks. POCT is facilitating global health. Now, global health problems are elevating POCT to new levels of importance for accelerating diagnosis and evidence-based decision making during disease outbreaks. Authorities concur that rapid diagnosis has potential to stop disease spread. With embedded POCT, strategic SCPs planned by communities fulfill CDC recommendations. POC devices should consolidate multiplex test clusters supporting patients with Ebola in isolation. The ultimate future solution is FAST POC. New technologies offer minimally significant risks. Diagnostic centers in ACFs and transportable formats also will optimize Ebola SCPs.

  10. Point-of-care testing in the diagnosis of gastrointestinal cancers: current technology and future directions.

    Science.gov (United States)

    Huddy, Jeremy R; Ni, Melody Z; Markar, Sheraz R; Hanna, George B

    2015-04-14

    Point-of-care (POC) tests enable rapid results and are well established in medical practice. Recent advances in analytical techniques have led to a new generation of POC devices that will alter gastrointestinal diagnostic pathways. This review aims to identify current and new technologies for the POC diagnosis of gastrointestinal cancer. A structured search of the Embase and Medline databases was performed. Papers reporting diagnostic tests for gastrointestinal cancer available as a POC device or containing a description of feasibility for POC application were included. Studies recovered were heterogeneous and therefore results are presented as a narrative review. Six diagnostic methods were identified (fecal occult blood, fecal proteins, volatile organic compounds, pyruvate kinase isoenzyme type M2, tumour markers and DNA analysis). Fecal occult blood testing has a reported sensitivity of 66%-85% and specificity greater than 95%. The others are at a range of development and clinical application. POC devices have a proven role in the diagnosis of gastrointestinal cancer. Barriers to their implementation exist and the transition from experimental to clinical medicine is currently slow. New technologies demonstrate potential to provide accurate POC tests and an ability to diagnose gastrointestinal cancer at an early stage with improved clinical outcome and survival.

  11. PIMA Point of Care CD4+ Cell Count Machines in Remote MNCH Settings: Lessons Learned from Seven Districts in Zimbabwe

    Science.gov (United States)

    Mtapuri-Zinyowera, Sekesai; Chiyaka, Edward T.; Mushayi, Wellington; Musuka, Godfrey; Naluyinda-Kitabire, Florence; Mushavi, Angella; Chikwasha, Vasco

    2013-01-01

    An evaluation was commissioned to generate evidence on the impact of PIMA point-of-care CD4+ count machines in maternal and new-born child health settings in Zimbabwe; document best practices, lessons learned, challenges, and recommendations related to scale up of this new technology. A mixed methodology approach that included 31 in-depth interviews with stakeholders involved in procurement, distribution, and use of the POC machines was employed. Additionally, data was also abstracted from 207 patient records from 35 sites with the PIMA POC CD4+ count machines and 10 other comparative sites without the machine. A clearer training strategy was found to be necessary. The average time taken to initiate clients on antiretroviral treatment (ART) was substantially less, 15 days (IQR-1-149) for sites with a PIMA POC machine as compared to 32.7 days (IQR-1-192) at sites with no PIMA POC machine. There was general satisfaction because of the presence of the PIMA POC CD4+ count machine at sites that also initiated ART. PMID:24847177

  12. Effect of point-of-care susceptibility testing in general practice on appropriate prescription of antibiotics for patients with uncomplicated urinary tract infection

    DEFF Research Database (Denmark)

    Holm, Anne; Cordoba, Gloria; Møller Sørensen, Tina

    2017-01-01

    OBJECTIVES: To investigate the effect of adding point-of-care (POC) susceptibility testing to POC culture on appropriate use of antibiotics as well as clinical and microbiological cure for patients with suspected uncomplicated urinary tract infection (UTI) in general practice. DESIGN: Open......, individually randomised controlled trial. SETTING: General practice. PARTICIPANTS: Women with suspected uncomplicated UTI, including elderly patients above 65, patients with recurrent UTI and patients with diabetes. The sample size calculation predicted 600 patients were needed. INTERVENTIONS: Flexicult SSI......-Urinary Kit was used for POC culture and susceptibility testing and ID Flexicult was used for POC culture only. MAIN OUTCOME MEASURES: Primary outcome: appropriate antibiotic prescribing on the day after consultation defined as either (1) patient with UTI: to prescribe a first-line antibiotic to which...

  13. Statistical transformation and the interpretation of inpatient glucose control data from the intensive care unit.

    Science.gov (United States)

    Saulnier, George E; Castro, Janna C; Cook, Curtiss B

    2014-05-01

    Glucose control can be problematic in critically ill patients. We evaluated the impact of statistical transformation on interpretation of intensive care unit inpatient glucose control data. Point-of-care blood glucose (POC-BG) data derived from patients in the intensive care unit for 2011 was obtained. Box-Cox transformation of POC-BG measurements was performed, and distribution of data was determined before and after transformation. Different data subsets were used to establish statistical upper and lower control limits. Exponentially weighted moving average (EWMA) control charts constructed from April, October, and November data determined whether out-of-control events could be identified differently in transformed versus nontransformed data. A total of 8679 POC-BG values were analyzed. POC-BG distributions in nontransformed data were skewed but approached normality after transformation. EWMA control charts revealed differences in projected detection of out-of-control events. In April, an out-of-control process resulting in the lower control limit being exceeded was identified at sample 116 in nontransformed data but not in transformed data. October transformed data detected an out-of-control process exceeding the upper control limit at sample 27 that was not detected in nontransformed data. Nontransformed November results remained in control, but transformation identified an out-of-control event less than 10 samples into the observation period. Using statistical methods to assess population-based glucose control in the intensive care unit could alter conclusions about the effectiveness of care processes for managing hyperglycemia. Further study is required to determine whether transformed versus nontransformed data change clinical decisions about the interpretation of care or intervention results. © 2014 Diabetes Technology Society.

  14. Microfluidic point-of-care diagnostics for resource-poor environments

    Science.gov (United States)

    Laksanasopin, Tassaneewan; Chin, Curtis D.; Moore, Hannah; Wang, Jennifer; Cheung, Yuk Kee; Sia, Samuel K.

    2009-05-01

    Point-of-care (POC) diagnostics have tremendous potential to improve human health in remote and resource-poor settings. However, the design criteria for diagnostic tests appropriate in settings with limited infrastructure are unique and challenging. Here we present a custom optical reader which quantifies silver absorbance from heterogeneous immunoassays. The reader is simple and low-cost and suited for POC diagnostics.

  15. 14C as a tool for evaluating riverine POC sources and erosion of the Zhujiang (Pearl River) drainage basin, South China

    International Nuclear Information System (INIS)

    Wei Xiuguo; Yi Weixi; Shen Chengde; Yechieli, Yoseph; Li Ningli; Ding Ping; Wang Ning; Liu Kexin

    2010-01-01

    Radiocarbon can serve as a powerful tool for identifying sources of organic carbon and evaluating the erosion intensity in river drainage basins. In this paper we present 14 C-AMS measurements of particulate organic carbon (POC) collected from the three major tributaries of the Zhujiang (Pearl River) system: the Xijiang (Western River), Beijiang (Northern River) and Dongjiang (Eastern River) rivers. Furthermore, we discuss the distribution of POC 14 C apparent ages and the related watersheds erosion of these rivers. Results yield Δ 14 C values of -425 per mille to -65 per mille which indicate that the 14 C apparent ages of suspended POC in the entire area are in the range of 540-4445 years. The POC apparent ages from Xijiang are mostly between 2000 and 4000 years, while in Dongjiang they mostly range from 540 to 1010 years. These 14 C apparent ages indicate that the watershed erosion of the Xijiang is more severe than that of the Dongjiang. This is in agreement with other data showing deeper erosion in Xijiang due to human activities.

  16. Product qualification: a barrier to point-of-care microfluidic-based diagnostics?

    Science.gov (United States)

    Tantra, Ratna; van Heeren, Henne

    2013-06-21

    One of the most exciting applications of microfluidics-based diagnostics is its potential use in next generation point-of-care (POC) devices. Many prototypes are already in existence, but, as of yet, few have achieved commercialisation. In this article, we consider the issue surrounding product qualification as a potential barrier to market success. The study discusses, in the context of POC microfluidics-based diagnostics, what the generic issues are and potential solutions. Our findings underline the need for a community-based effort that is necessary to speed up the product qualification process.

  17. Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview.

    Science.gov (United States)

    Martínez Lomakin, Felipe; Tobar, Catalina

    2014-12-01

    Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.

  18. Criteria required for an acceptable point-of-care test for UTI detection: Obtaining consensus using the Delphi technique.

    Science.gov (United States)

    Weir, Nichola-Jane M; Pattison, Sally H; Kearney, Paddy; Stafford, Bob; Gormley, Gerard J; Crockard, Martin A; Gilpin, Deirdre F; Tunney, Michael M; Hughes, Carmel M

    2018-01-01

    Urinary Tract Infections (UTIs) are common bacterial infections, second only to respiratory tract infections and particularly prevalent within primary care. Conventional detection of UTIs is culture, however, return of results can take between 24 and 72 hours. The introduction of a point of care (POC) test would allow for more timely identification of UTIs, facilitating improved, targeted treatment. This study aimed to obtain consensus on the criteria required for a POC UTI test, to meet patient need within primary care. Criteria for consideration were compiled by the research team. These criteria were validated through a two-round Delphi process, utilising an expert panel of healthcare professionals from across Europe and United States of America. Using web-based questionnaires, panellists recorded their level of agreement with each criterion based on a 5-point Likert Scale, with space for comments. Using median response, interquartile range and comments provided, criteria were accepted/rejected/revised depending on pre-agreed cut-off scores. The first round questionnaire presented thirty-three criteria to the panel, of which 22 were accepted. Consensus was not achieved for the remaining 11 criteria. Following response review, one criterion was removed, while after revision, the remaining 10 criteria entered the second round. Of these, four were subsequently accepted, resulting in 26 criteria considered appropriate for a POC test to detect urinary infections. This study generated an approved set of criteria for a POC test to detect urinary infections. Criteria acceptance and comments provided by the healthcare professionals also supports the development of a multiplex point of care UTI test.

  19. Point-of-care testing for Toxoplasma gondii IgG/IgM using Toxoplasma ICT IgG-IgM test with sera from the United States and implications for developing countries.

    Science.gov (United States)

    Begeman, Ian J; Lykins, Joseph; Zhou, Ying; Lai, Bo Shiun; Levigne, Pauline; El Bissati, Kamal; Boyer, Kenneth; Withers, Shawn; Clouser, Fatima; Noble, A Gwendolyn; Rabiah, Peter; Swisher, Charles N; Heydemann, Peter T; Contopoulos-Ioannidis, Despina G; Montoya, Jose G; Maldonado, Yvonne; Ramirez, Raymund; Press, Cindy; Stillwaggon, Eileen; Peyron, François; McLeod, Rima

    2017-06-01

    Congenital toxoplasmosis is a serious but preventable and treatable disease. Gestational screening facilitates early detection and treatment of primary acquisition. Thus, fetal infection can be promptly diagnosed and treated and outcomes can be improved. We tested 180 sera with the Toxoplasma ICT IgG-IgM point-of-care (POC) test. Sera were from 116 chronically infected persons (48 serotype II; 14 serotype I-III; 25 serotype I-IIIa; 28 serotype Atypical, haplogroup 12; 1 not typed). These represent strains of parasites infecting mothers of congenitally infected children in the U.S. 51 seronegative samples and 13 samples from recently infected persons known to be IgG/IgM positive within the prior 2.7 months also were tested. Interpretation was confirmed by two blinded observers. A comparison of costs for POC vs. commercial laboratory testing methods was performed. We found that this new Toxoplasma ICT IgG-IgM POC test was highly sensitive (100%) and specific (100%) for distinguishing IgG/IgM-positive from negative sera. Use of such reliable POC tests can be cost-saving and benefit patients. Our work demonstrates that the Toxoplasma ICT IgG-IgM test can function reliably as a point-of-care test to diagnose Toxoplasma gondii infection in the U.S. This provides an opportunity to improve maternal-fetal care by using approaches, diagnostic tools, and medicines already available. This infection has serious, lifelong consequences for infected persons and their families. From the present study, it appears a simple, low-cost POC test is now available to help prevent morbidity/disability, decrease cost, and make gestational screening feasible. It also offers new options for improved prenatal care in low- and middle-income countries.

  20. White light-emitting nanocomposites based on an oxadiazole-carbazole copolymer (POC) and InP/ZnS quantum dots

    Science.gov (United States)

    Bruno, Annalisa; Borriello, Carmela; Di Luccio, Tiziana; Nenna, Giuseppe; Sessa, Lucia; Concilio, Simona; Haque, Saif A.; Minarini, Carla

    2013-11-01

    In this work, we studied energetic and optical proprieties of a polyester-containing oxadiazole and carbazole units that we will indicate as POC. This polymer is characterized by high photoluminescence activity in the blue region of the visible spectrum, making it suitable for the development of efficient white-emitting organic light emission devices. Moreover, POC polymer has been combined with two red emitters InP/ZnS quantum dots (QDs) to obtain nanocomposites with wide emission spectra. The two types of QDs have different absorption wavelengths: 570 nm [InP/ZnS(570)] and 627 nm [InP/ZnS(627)] and were inserted in the polymer at different concentrations. The optical properties of the nanocomposites have been investigated and compared to the ones of the pure polymer. Both spectral and time resolved fluorescence measurements show an efficient energy transfer from the polymer to QDs, resulting in white-emitting nanocomposites.

  1. Leucocyte esterase dip-stick test as a point-of-care diagnostic for urogenital chlamydia in male patients: A multi-center evaluation in two STI outpatient clinics in Paramaribo and Amsterdam

    NARCIS (Netherlands)

    Bartelsman, Menne; de Vries, Henry J. C.; Schim van der Loeff, Maarten F.; Sabajo, Leslie O. A.; van der Helm, Jannie J.

    2016-01-01

    Point-of-care (POC) tests are an important strategy to address the epidemic of sexually transmitted infections (STIs). The leucocyte esterase test (LET) can be used as a POC test for chlamydia. The aim of this study was to determine the diagnostic accuracy of the LET to detect urogenital chlamydia

  2. Free Access to Point of Care Resource Results in Increased Use and Satisfaction by Rural Healthcare Providers

    Directory of Open Access Journals (Sweden)

    Lindsay Alcock

    2016-12-01

    Full Text Available A Review of: Eldredge, J. D., Hall, L. J., McElfresh, K. R., Warner, T. D., Stromberg, T. L., Trost, J. T., & Jelinek, D. A. (2016. Rural providers’ access to online resources: A randomized controlled trial. Journal of the Medical Library Association, 104(1, 33-41. http://dx.doi.org/10.3163/1536-5050.104.1.005 Objective – To determine whether free access to the point of care (PoC resource Dynamed or the electronic book collection AccessMedicine was more useful to rural health care providers in answering clinical questions in terms of usage and satisfaction. Design – Randomized controlled trial. Setting – Rural New Mexico. Subjects – Twenty-eight health care providers (physicians, nurses, physician assistants, and pharmacists with no reported access to PoC resources, (specifically Dynamed and AccessMedicine or electronic textbook collections prior to enrollment.

  3. Results of a survey among GP practices on how they manage patient safety aspects related to point-of-care testing in every day practice

    NARCIS (Netherlands)

    de Vries, Claudette; Doggen, Catharina Jacoba Maria; Hilbers, Ellen; Verheij, Robert; IJzerman, Maarten Joost; Geertsma, Robert; Kusters, Ron

    2015-01-01

    Background Point-of-care (POC) tests are devices or test strips that can be used near or at the site where care is delivered to patients, enabling a relatively fast diagnosis. Although many general practitioners (GPs) in the Netherlands are using POC tests in their practice, little is known on how

  4. A simple and inexpensive point-of-care test for hepatitis B surface antigen detection: serological and molecular evaluation.

    Science.gov (United States)

    Gish, R G; Gutierrez, J A; Navarro-Cazarez, N; Giang, K; Adler, D; Tran, B; Locarnini, S; Hammond, R; Bowden, S

    2014-12-01

    Early identification of chronic hepatitis B is important for optimal disease management and prevention of transmission. Cost and lack of access to commercial hepatitis B surface antigen (HBsAg) immunoassays can compromise the effectiveness of HBV screening in resource-limited settings and among marginalized populations. High-quality point-of-care (POC) testing may improve HBV diagnosis in these situations. Currently available POC HBsAg assays are often limited in sensitivity. We evaluated the NanoSign(®) HBs POC chromatographic immunoassay for its ability to detect HBsAg of different genotypes and with substitutions in the 'a' determinant. Thirty-seven serum samples from patients with HBV infection, covering HBV genotypes A-G, were assessed for HBsAg titre with the Roche Elecsys HBsAg II quantification assay and with the POC assay. The POC assay reliably detected HBsAg at a concentration of at least 50 IU/mL for all genotypes, and at lower concentrations for some genotypes. Eight samples with substitutions in the HBV 'a' determinant were reliably detected after a 1/100 dilution. The POC strips were used to screen serum samples from 297 individuals at risk for HBV in local clinical settings (health fairs and outreach events) in parallel with commercial laboratory HBsAg testing (Quest Diagnostics EIA). POC testing was 73.7% sensitive and 97.8% specific for detection of HBsAg. Although the POC test demonstrated high sensitivity over a range of genotypes, false negatives were frequent in a clinical setting. Nevertheless, the POC assay offers advantages for testing in both developed and resource-limited countries due to its low cost (0.50$) and immediately available results. © 2014 John Wiley & Sons Ltd.

  5. Adaptive patch-based POCS approach for super resolution reconstruction of 4D-CT lung data

    International Nuclear Information System (INIS)

    Wang, Tingting; Cao, Lei; Yang, Wei; Feng, Qianjin; Chen, Wufan; Zhang, Yu

    2015-01-01

    Image enhancement of lung four-dimensional computed tomography (4D-CT) data is highly important because image resolution remains a crucial point in lung cancer radiotherapy. In this paper, we proposed a method for lung 4D-CT super resolution (SR) by using an adaptive-patch-based projection onto convex sets (POCS) approach, which is in contrast with the global POCS SR algorithm, to recover fine details with lesser artifacts in images. The main contribution of this patch-based approach is that the interfering local structure from other phases can be rejected by employing a similar patch adaptive selection strategy. The effectiveness of our approach is demonstrated through experiments on simulated images and real lung 4D-CT datasets. A comparison with previously published SR reconstruction methods highlights the favorable characteristics of the proposed method. (paper)

  6. The reliability of point-of-care prothrombin time testing. A comparison of CoaguChek S and XS INR measurements with hospital laboratory monitoring.

    LENUS (Irish Health Repository)

    Ryan, F

    2010-02-01

    The development of point-of-care (POC) testing devices enables patients to test their own international normalized ratio (INR) at home. However, previous studies have shown that when compared with clinical laboratory values, statistically significant differences may occur between the two methods of INR measurement. The aim of this study was to evaluate the accuracy of the CoaguChek S and XS POC meters relative to clinical laboratory measurements. As part of a randomized, crossover patient self-testing (PST) study at Cork University Hospital, patients were randomized to 6 months PST or 6 months routine care by the anticoagulation management service. During the PST arm of the study, patients measured their INR at home using the CoaguChek S or XS POC meter. External quality control was performed at enrollment, 2 months and 4 months by comparing the POC measured INR with the laboratory determined value. One hundred and fifty-one patients provided 673 paired samples. Good correlation was shown between the two methods of determination (r = 0.91), however, statistically significant differences did occur. A Bland-Altman plot illustrated good agreement of INR values between 2.0 and 3.5 INR units but there was increasing disagreement as the INR rose above 3.5. Eighty-seven per cent of all dual measurements were within the recommended 0.5 INR units of each other. This study adds to the growing evidence that POC testing is a reliable and safe alternative to hospital laboratory monitoring but highlights the importance of external quality control when these devices are used for monitoring oral anticoagulation.

  7. Routine use of point-of-care tests: usefulness and application in clinical microbiology.

    Science.gov (United States)

    Clerc, O; Greub, G

    2010-08-01

    Point-of-care (POC) tests offer potentially substantial benefits for the management of infectious diseases, mainly by shortening the time to result and by making the test available at the bedside or at remote care centres. Commercial POC tests are already widely available for the diagnosis of bacterial and viral infections and for parasitic diseases, including malaria. Infectious diseases specialists and clinical microbiologists should be aware of the indications and limitations of each rapid test, so that they can use them appropriately and correctly interpret their results. The clinical applications and performance of the most relevant and commonly used POC tests are reviewed. Some of these tests exhibit insufficient sensitivity, and should therefore be coupled to confirmatory tests when the results are negative (e.g. Streptococcus pyogenes rapid antigen detection test), whereas the results of others need to be confirmed when positive (e.g. malaria). New molecular-based tests exhibit better sensitivity and specificity than former immunochromatographic assays (e.g. Streptococcus agalactiae detection). In the coming years, further evolution of POC tests may lead to new diagnostic approaches, such as panel testing, targeting not just a single pathogen, but all possible agents suspected in a specific clinical setting. To reach this goal, the development of serology-based and/or molecular-based microarrays/multiplexed tests will be needed. The availability of modern technology and new microfluidic devices will provide clinical microbiologists with the opportunity to be back at the bedside, proposing a large variety of POC tests that will allow quicker diagnosis and improved patient care.

  8. White light-emitting nanocomposites based on an oxadiazole–carbazole copolymer (POC) and InP/ZnS quantum dots

    Energy Technology Data Exchange (ETDEWEB)

    Bruno, Annalisa, E-mail: annalisa.bruno@enea.it; Borriello, Carmela, E-mail: carmela.borriello@enea.it; Di Luccio, Tiziana, E-mail: tiziana.diluccio@enea.it; Nenna, Giuseppe [Centro Ricerche Portici, ENEA, UTTP NANO (Italy); Sessa, Lucia [University of Salerno, Department of Pharmacy (Italy); Concilio, Simona [University of Salerno, Department of Industrial Engineering (Italy); Haque, Saif A. [Imperial College London, Chemistry Department (United Kingdom); Minarini, Carla [Centro Ricerche Portici, ENEA, UTTP NANO (Italy)

    2013-11-15

    In this work, we studied energetic and optical proprieties of a polyester-containing oxadiazole and carbazole units that we will indicate as POC. This polymer is characterized by high photoluminescence activity in the blue region of the visible spectrum, making it suitable for the development of efficient white-emitting organic light emission devices. Moreover, POC polymer has been combined with two red emitters InP/ZnS quantum dots (QDs) to obtain nanocomposites with wide emission spectra. The two types of QDs have different absorption wavelengths: 570 nm [InP/ZnS(570)] and 627 nm [InP/ZnS(627)] and were inserted in the polymer at different concentrations. The optical properties of the nanocomposites have been investigated and compared to the ones of the pure polymer. Both spectral and time resolved fluorescence measurements show an efficient energy transfer from the polymer to QDs, resulting in white-emitting nanocomposites.

  9. Spatial distribution and mobility of organic carbon (POC and DOC) in a coastal Mediterranean environment (Saronikos Gulf, Greece) during 2007-2009 period.

    Science.gov (United States)

    Evangeliou, Nikolaos; Florou, Heleny

    2013-08-01

    Particulate (POC) and dissolved organic carbon (DOC) is an important parameter for the pollution assessment of coastal marine systems, especially those affected by anthropogenic, domestic, and industrial activities. In the present paper, a similar marine system (Saronikos Gulf) located in the west-central Aegean Sea (eastern Mediterranean Sea) was examined, in terms of the temporal and spatial distribution of organic carbon (POC and DOC), with respect to marine sources and pathways. POC was maximum in winter in the Saronikos Gulf, due to the bloom of phytoplankton, whereas in the Elefsis Bay (located in the north side of the Saronikos Gulf) in summer, since phytoplankton grazes in the Bay in the end of summer (except for winter). Approximately 60 % of the bulk DOC of the water column was estimated as non-refractory (labile and semi-labile), due to the major anthropogenic, domestic, and industrial effects of the region and the shallow depths. The spatial distribution of POC and DOC mainly affects the northeastern section of the Gulf, since that region has been accepted major organic discharges for a long time period, in connection to the relatively long renewal times of its waters.

  10. Evaluation of a new point-of-care test for influenza A and B virus in travellers with influenza-like symptoms.

    Science.gov (United States)

    Weitzel, T; Schnabel, E; Dieckmann, S; Börner, U; Schweiger, B

    2007-07-01

    Point-of-care (POC) tests for influenza facilitate clinical case management, and might also be helpful in the care of travellers who are at special risk for influenza infection. To evaluate influenza POC testing in travellers, a new assay, the ImmunoCard STAT! Flu A and B, was used to investigate travellers presenting with influenza-like symptoms. Influenza virus infection was diagnosed in 27 (13%) of 203 patients by influenza virus-specific PCR and viral culture. The POC test had sensitivity and specificity values of 64% and 99% for influenza A, and 67% and 100% for influenza B, respectively. Combined sensitivity and specificity were 67% and 99%, respectively, yielding positive and negative predictive values of 95%, and positive and negative likelihood ratios of 117 and 0.34, respectively. The convenient application, excellent specificity and high positive likelihood ratio of the POC test allowed rapid identification of influenza cases. However, negative test results might require confirmation by other methods because of limitations in sensitivity. Overall, influenza POC testing appeared to be a useful tool for the management of travellers with influenza-like symptoms.

  11. What Can We Learn From Point-of-Care Blood Glucose Values Deleted and Repeated by Nurses?

    Science.gov (United States)

    Corl, Dawn; Yin, Tom; Ulibarri, May; Lien, Heather; Tylee, Tracy; Chao, Jing; Wisse, Brent E

    2018-03-01

    Hospitals rely on point-of-care (POC) blood glucose (BG) values to guide important decisions related to insulin administration and glycemic control. Evaluation of POC BG in hospitalized patients is associated with measurement and operator errors. Based on a previous quality improvement (QI) project we introduced an option for operators to delete and repeat POC BG values suspected as erroneous. The current project evaluated our experience with deleted POC BG values over a 2-year period. A retrospective QI project included all patients hospitalized at two regional academic medical centers in the Pacific Northwest during 2014 and 2015. Laboratory Medicine POC BG data were reviewed to evaluate all inpatient episodes of deleted and repeated POC BG. Inpatient operators choose to delete and repeat only 0.8% of all POC BG tests. Hypoglycemic and extreme hyperglycemic BG values are more likely to be deleted and repeated. Of initial values values (18% of all values) are errors. Of values >400 mg/dL, 40% of deleted values (5% of all values) are errors. Not all repeated POC BG values are first deleted. Optimal use of the option to delete and repeat POC BG values values that are measurement/operator errors. Eliminating these errors significantly reduces documented rates of severe hypoglycemia and hyperglycemia, and has the potential to improve patient safety.

  12. Clinic flow for STI, HIV, and TB patients in an urban infectious disease clinic offering point-of-care testing services in Durban, South Africa.

    Science.gov (United States)

    Stime, Katrina J; Garrett, Nigel; Sookrajh, Yukteshwar; Dorward, Jienchi; Dlamini, Ntuthu; Olowolagba, Ayo; Sharma, Monisha; Barnabas, Ruanne V; Drain, Paul K

    2018-05-11

    Many clinics in Southern Africa have long waiting times. The implementation of point-of-care (POC) tests to accelerate diagnosis and improve clinical management in resource-limited settings may improve or worsen clinic flow and waiting times. The objective of this study was to describe clinic flow with special emphasis on the impact of POC testing at a large urban public healthcare clinic in Durban, South Africa. We used time and motion methods to directly observe patients and practitioners. We created patient flow maps and recorded individual patient waiting and consultation times for patients seeking STI, TB, or HIV care. We conducted semi-structured interviews with 20 clinic staff to ascertain staff opinions on clinic flow and POC test implementation. Among 121 observed patients, the total number of queues ranged from 4 to 7 and total visit times ranged from 0:14 (hours:minutes) to 7:38. Patients waited a mean of 2:05 for standard-of-care STI management, and approximately 4:56 for STI POC diagnostic testing. Stable HIV patients who collected antiretroviral therapy refills waited a mean of 2:42 in the standard queue and 2:26 in the fast-track queue. A rapid TB test on a small sample of patients with the Xpert MTB/RIF assay and treatment initiation took a mean of 6:56, and 40% of patients presenting with TB-related symptoms were asked to return for an additional clinic visit to obtain test results. For all groups, the mean clinical assessment time with a nurse or physician was 7 to 9 min, which accounted for 2 to 6% of total visit time. Staff identified poor clinic flow and personnel shortages as areas of concern that may pose challenges to expanding POC tests in the current clinic environment. This busy urban clinic had multiple patient queues, long clinical visits, and short clinical encounters. Although POC testing ensured patients received a diagnosis sooner, it more than doubled the time STI patients spent at the clinic and did not result in same

  13. Impact on ART initiation of point-of-care CD4 testing at HIV diagnosis among HIV-positive youth in Khayelitsha, South Africa.

    Science.gov (United States)

    Patten, Gabriela E M; Wilkinson, Lynne; Conradie, Karien; Isaakidis, Petros; Harries, Anthony D; Edginton, Mary E; De Azevedo, Virginia; van Cutsem, Gilles

    2013-07-04

    Despite the rapid expansion of antiretroviral therapy (ART) programmes in developing countries, pre-treatment losses from care remain a challenge to improving access to treatment. Youth and adolescents have been identified as a particularly vulnerable group, at greater risk of loss from both pre-ART and ART care. Point-of-care (POC) CD4 testing has shown promising results in improving linkage to ART care. In Khayelitsha township, South Africa, POC CD4 testing was implemented at a clinic designated for youth aged 12-25 years. We assessed whether there was an associated reduction in attrition between HIV testing, assessment for eligibility and ART initiation. A before-and-after observational study was conducted using routinely collected data. These were collected on patients from May 2010 to April 2011 (Group A) when baseline CD4 count testing was performed in a laboratory and results were returned to the clinic within two weeks. Same-day POC CD4 testing was implemented in June 2011, and data were collected on patients from August 2011 to July 2012 (Group B). A total of 272 and 304 youth tested HIV-positive in Group A and Group B, respectively. Group B patients were twice as likely to have their ART eligibility assessed compared to Group A patients: 275 (90%) vs. 183 (67%) [relative risk (RR)=2.4, 95% CI: 1.8-3.4, pART was 50% and 44% (p=0.6) in Groups B and A, respectively; and 50% and 43% (p=0.5) when restricted to patients with baseline CD4 count≤250 cells/µL. Time between HIV-testing and ART initiation was reduced from 36 to 28 days (p=0.6). POC CD4 testing significantly improved assessment for ART eligibility. The improvement in the proportion initiating ART and the reduction in time to initiation was not significant due to sample size limitations. POC CD4 testing reduced attrition between HIV-testing and assessment of ART eligibility. Strategies to improve uptake of ART are needed, possibly by improving patient support for HIV-positive youth immediately

  14. Comparisons between POC and zooplankton swimmer flux from sediment traps in the subarctic and subtropical North Pacific

    Science.gov (United States)

    Yokoi, Naoya; Abe, Yoshiyuki; Kitamura, Minoru; Honda, Makio C.; Yamaguchi, Atsushi

    2018-03-01

    Seasonal changes in zooplankton swimmer (ZS) abundance, biomass and community structure were evaluated based on samples collected by moored sediment traps at a depth of 200 m in the subarctic (SA) and subtropical (ST) western North Pacific. Based on these samples, we made comparisons on two topics: 1) latitudinal (subarctic vs. subtropical) changes in ZS abundance, biomass and community and 2) quantitative differences between the ZS and particle organic carbon (POC) fluxes based on data from moored or drifting sediment traps. The results showed that the ZS flux was greater in the SA (annual mean: 311 ind. m-2 day-1 or 258 mg C m-2 day-1) than in the ST (135 ind. m-2 day-1 or 38 mg C m-2 day-1). The peak ZS flux was observed from July-August in the SA and from April-May in the ST. The dominant taxa were Copepoda and Chaetognatha in the SA and Ostracoda and Mollusca in the ST. These latitudinal differences are likely related to the dominance of large-sized Copepoda in the SA, regional differences in the timing of the spring phytoplankton bloom, and the magnitude and size structure of primary producers. The percent composition of ZS to the total C flux (= ZS+POC flux) varied by region: 85-95% in the SA and 47-75% in the ST. These differences between the ZS composition and the total C flux are most likely caused by the dominance of large-sized Copepoda (Neocalanus spp. and Eucalanus bungii) in the SA.

  15. The introduction of syphilis point of care tests in resource limited settings.

    Science.gov (United States)

    Marks, Michael; Mabey, David Cw

    2017-04-01

    Syphilis remains an important and preventable cause of stillbirth and neonatal mortality. About 1 million women with active syphilis become pregnant each year. Without treatment, 25% of them will deliver a stillborn baby and 33% a low birth weight baby with an increased chance of dying in the first month of life. Adverse pregnancy outcomes due to syphilis can be prevented by screening pregnant women, and treating those who test positive with a single dose of penicillin before 28 weeks' gestation. Areas covered: This manuscript covers the impact of syphilis on pregnancy outcome, the diagnosis of syphilis, with a special focus on point of care (POC) tests, and challenges to the introduction of POC tests, and their potential impact on the control and prevention of syphilis in resource limited settings. Expert commentary: POC tests for syphilis are available which meet the ASSURED criteria, and could make syphilis screening accessible to all women anywhere in the world who attend an antenatal clinic. High quality dual POC tests for HIV and syphilis could ensure that well-funded programmes for the prevention of mother to child transmission of HIV can contribute towards increased coverage of antenatal syphilis screening, and prevent more than 300,000 adverse pregnancy outcomes due to syphilis annually. Alongside investment to increase availability of syphilis POC tests, operational research is needed to understand how best to improve screening of pregnant women and to translate test availability into improved pregnancy outcomes.

  16. Point-of-care procalcitonin test to reduce antibiotic exposure in patients hospitalized with acute exacerbation of COPD

    DEFF Research Database (Denmark)

    Corti, Caspar; Fally, Markus; Fabricius-Bjerre, Andreas

    2016-01-01

    BACKGROUND: This study was conducted to investigate whether point-of-care (POC) procalcitonin (PCT) measurement can reduce redundant antibiotic treatment in patients hospitalized with acute exacerbation of COPD (AECOPD). METHODS: One-hundred and twenty adult patients admitted with AECOPD were...... in the PCT-arm vs 8.5 (IQR 1-11) days in the control arm (P=0.0169, Wilcoxon) for the intention-to-treat population. The proportion of patients using antibiotics for ≥5 days within the 28-day follow-up was 41.9% (PCT-arm) vs 67.2% (P=0.006, Fisher's exact) in the intention-to-treat population. For the per...... no apparent difference. CONCLUSION: Our study shows that the implementation of a POC PCT-guided algorithm can be used to substantially reduce antibiotic exposure in patients hospitalized with AECOPD, with no apparent harm....

  17. Carbon cycling and POC turnover in the mesopelagic zone of the ocean: Insights from a simple model

    Science.gov (United States)

    Anderson, Thomas R.; Tang, Kam W.

    2010-08-01

    Carbon budgets of the mesopelagic zone are poorly constrained, highlighting our lack of understanding of the biota that inhabit this environment and their role in the cycling and sequestering of carbon in the deep ocean. A simple food web model of the mesopelagic zone is presented that traces the turnover of particulate organic carbon (POC), supplied as sinking detritus, through to its respiration by the biota via three pathways: colonization and solubilization of detritus by attached bacteria, production of free-living bacteria following losses of solubilization products during particle degradation, and consumption by detritivorous zooplankton. The relative consumption of detritus by attached bacteria was initially specified as 76%, with the remaining 24% by detritivores. Highlighting an asymmetry between consumption and respiration, the resulting predicted share of total respiration due to bacteria was 84.7%, with detritivores accounting for just 6.6% (with 6.5% and 2.2% by bacterivores and higher zooplankton, respectively). Bacteria thus dominated respiration and thereby acted as the principal sink for POC supplied to the mesopelagic zone, whereas zooplankton mainly recycled carbon back to the base of the food web as detritus or dissolved organic carbon rather than respiring it to CO 2. Estimates of respiration are therefore not necessarily a reliable indicator of the relative roles of bacteria and zooplankton in consuming and processing POC in the mesopelagic zone of the ocean. The work highlighted a number of major unknowns, including how little we know in general about the dynamics and metabolic budgets of bacteria and zooplankton that inhabit the mesopelagic zone and, specifically, the degree to which the solubilized products of enzymatic hydrolysis of POC by attached bacteria are lost to the surrounding water, the magnitude and factors responsible for bacterial growth efficiency, the role of microbes in the nutrition of detritivores, and the recycling

  18. A Review of Lawsuits Related to Point-of-Care Emergency Ultrasound Applications

    Directory of Open Access Journals (Sweden)

    Stolz, Lori

    2014-12-01

    Full Text Available Introduction: New medical technology brings the potential of lawsuits related to the usage of that new technology. In recent years the use of point-of-care (POC ultrasound has increased rapidly in the emergency department (ED. POC ultrasound creates potential legal risk to an emergency physician (EP either using or not using this tool. The aim of this study was to quantify and characterize reported decisions in lawsuits related to EPs performing POC ultrasound. Methods: We conducted a retrospective review of all United States reported state and federal cases in the Westlaw database. We assessed the full text of reported cases between January 2008 and December 2012. EPs with emergency ultrasound fellowship training reviewed the full text of each case. Cases were included if an EP was named, the patient encounter was in the emergency department, the interpretation or failure to perform an ultrasound was a central issue and the application was within the American College of Emergency Physician (ACEP ultrasound core applications. In order to assess deferred risk, cases that involved ultrasound examinations that could have been performed by an EP but were deferred to radiology were included. Results: We identified five cases. All reported decisions alleged a failure to perform an ultrasound study or a failure to perform it in a timely manner. All studies were within the scope of emergency medicine and were ACEP emergency ultrasound core applications. A majority of cases (n=4 resulted in a patient death. There were no reported cases of failure to interpret or misdiagnoses. Conclusion: In a five-year period from January 2008 through December 2012, five malpractice cases involving EPs and ultrasound examinations that are ACEP core emergency ultrasound applications were documented in the Westlaw database. All cases were related to failure to perform an ultrasound study or failure to perform a study in a timely manner and none involved failure to

  19. Real-Time Tele-Mentored Low Cost "Point-of-Care US" in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists.

    Directory of Open Access Journals (Sweden)

    Floriana Zennaro

    Full Text Available The use of point-of-care ultrasonography (POC US in paediatrics is increasing. This study investigated the diagnostic accuracy of POC US in children accessing the emergency department (ED when performed by paediatricians under the remote guidance of radiologists (TELE POC.Children aged 0 to 18 years accessing the ED of a third level research hospital with eight possible clinical scenarios and without emergency/severity signs at the triage underwent three subsequent US tests: by a paediatrician guided remotely by a radiologist (TELE POC; by the same radiologist (UNBLIND RAD; by an independent blinded radiologist (BLIND RAD. Tele-radiology was implemented using low cost "commercial off-the-shelf" (COTS equipment and open-source software. Data were prospectively collected on predefined templates.Fifty-two children were enrolled, for a total of 170 ultrasound findings. Sensitivity, specificity, positive and negative predictive values of TELE POC were: 93.8, 99.7, 96.8, 99.4 when compared to UNBLIND RAD and 88.2, 99.7, 96.8, 98.7 when compared to BLIND RAD. The inter-observers agreement between the paediatricians and either the unblind or blind radiologist was excellent (k = 0.93. The mean duration of TELE POC was 6.3 minutes (95% CI 4.1 to 8.5. Technical difficulties occurred in two (3.8% cases. Quality of the transmission was rated as fair, good, very good and excellent in 7.7%, 15.4%, 42.3% and 34.6% of cases respectively, while in no case was it rated as poor.POC US performed by paediatricians in ED guided via tele-radiology by an expert radiologist (TELE POC produced reliable and timely diagnoses. Findings of this study, especially for the rarer conditions under evaluation, need further confirmation. Future research should investigate the overall benefits and the cost savings of using tele-ultrasound to perform US "at children's bedsides", under remote guidance of expert radiologists.

  20. Field Observations of Changes in SST, Chlorophyll and POC Flux in the Southern East China Sea Before and After the Passage of Typhoon Jangmi

    Directory of Open Access Journals (Sweden)

    Yung-Yen Shih

    2013-01-01

    Full Text Available Severe tropical storms play an important role in triggering phytoplankton blooms, yet direct field observation of evidence of the effects of a typhoon is very rare. Sea surface temperature (SST, nitrate concentration, chlorophyll a (chl a concentration, and particulate organic carbon (POC flux were measured before and shortly after Typhoon Jangmi which affected the southern East China Sea (SECS on September 28 ~ 29, 2008. In situ SST (27.5 ~ 28.0°C on September 19 ~ 21, decreased to ~24.0°C (October 3 ~ 6 in the SECS 4 ~ 7 days after the passage of Typhoon Jangmi. In situ nitrate and chl a concentrations 7-days (on October 6 after the passage of Jangmi were 1.9 μM and 1.61 mg m-3, respectively, much higher than those (nitrate: 0.3 μM and chl a: 0.73 mg m-3 concentrations before the typhoon (September 21. The enhanced chl a concentration is thus caused by a nutrient supply via vertical mixing or upwelling in the euphotic zone. The POC flux 7-days after Jangmi¡¦s passage was 552 ± 28 mg-C m-2 d-1, a ~2.5-fold increases before the typhoon (224 ± 33 mg-C m-2 d-1, on September 21. Our results suggest that typhoons indeed can stimulate efficient POC export out of the euphotic zone, while it is still poorly understood with regard to the total effects of a typhoon on nutrient dynamics and detailed carbon sequestration due to sampling difficulty. Therefore, successional sea-going observations ought to be conducted in the affected area after the passage of typhoons.

  1. Blood glucose measurement in patients with suspected diabetic ketoacidosis: a comparison of Abbott MediSense PCx point-of-care meter values to reference laboratory values.

    Science.gov (United States)

    Blank, Fidela S J; Miller, Moses; Nichols, James; Smithline, Howard; Crabb, Gillian; Pekow, Penelope

    2009-04-01

    The purpose of this study is to compare blood glucose levels measured by a point of care (POC) device to laboratory measurement using the same sample venous blood from patients with suspected diabetic ketoacidosis (DKA). A descriptive correlational design was used for this IRB-approved quality assurance project. The study site was the 50-bed BMC emergency department (ED) which has an annual census of over 100,000 patient visits. The convenience sample consisted of 54 blood samples from suspected DKA patients with orders for hourly blood draws for glucose measurement. Spearman correlations of the glucose POC values, reference lab values, and differences between the two, were evaluated. A chi-square test was used to evaluate the association between the acidosis status and FDA acceptability of POC values. Patient age range was 10-86 years; 63% were females; 46% had a final diagnosis of DKA. POC values underestimated glucose levels 93% of the time. There was a high correlation between the lab value and the magnitude of the difference, (lab minus POC value) indicating that the higher the true glucose value, the greater the difference between the lab and the POC value. A chi-square test showed no overall association between acidosis and FDA-acceptability. The POC values underestimated lab reported glucose levels in 50 of 54 cases even with the use of same venous sample sent to the lab, which make it highly unreliable for use in monitoring suspected DKA patients.

  2. Acute pain management efficiency improves with point-of-care handheld electronic billing system.

    Science.gov (United States)

    Fahy, Brenda G

    2009-02-01

    Technology advances continue to impact patient care and physician workflow. To enable more efficient performance of billing activities, a point-of-care (POC) handheld computer technology replaced a paper-based system on an acute pain management service. Using a handheld personal digital assistant (PDA) and software from MDeverywhere (MDe, MDeverywhere, Long Island, NY), we performed a 1-yr prospective observational study of an anesthesiology acute pain management service billings and collections. Seventeen anesthesiologists providing billable acute pain services were trained and entered their charges on a PDA. Twelve months of data, just before electronic implementation (pre-elec), were compared to a 12-m period after implementation (post-elec). The total charges were 4883 for 890 patients pre-elec and 5368 for 1128 patients post-elec. With adoption of handheld billing, the charge lag days decreased from 29.3 to 7.0 (P billing using PDAs to replace a paper-based billing system improved the collection rate and decreased the number of charge lag days with a positive return on investment. The handheld PDA billing system provided POC support for physicians during their daily clinical (e.g., patient locations, rounding lists) and billing activities, improving workflow.

  3. Considering Point-of-Care Electronic Medical Resources in Lieu of Traditional Textbooks for Medical Education.

    Science.gov (United States)

    Hale, LaDonna S; Wallace, Michelle M; Adams, Courtney R; Kaufman, Michelle L; Snyder, Courtney L

    2015-09-01

    Selecting resources to support didactic courses is a critical decision, and the advantages and disadvantages must be carefully considered. During clinical rotations, students not only need to possess strong background knowledge but also are expected to be proficient with the same evidence-based POC resources used by clinicians. Students place high value on “real world” learning and therefore may place more value on POC resources that they know practicing clinicians use as compared with medical textbooks. The condensed nature of PA education requires students to develop background knowledge and information literacy skills over a short period. One way to build that knowledge and those skills simultaneously is to use POC resources in lieu of traditional medical textbooks during didactic training. Electronic POC resources offer several advantages over traditional textbooks and should be considered as viable options in PA education.

  4. Analytical validation of a new point-of-care assay for serum amyloid A in horses.

    Science.gov (United States)

    Schwartz, D; Pusterla, N; Jacobsen, S; Christopher, M M

    2018-01-17

    Serum amyloid A (SAA) is a major acute phase protein in horses. A new point-of-care (POC) test for SAA (Stablelab) is available, but studies evaluating its analytical accuracy are lacking. To evaluate the analytical performance of the SAA POC test by 1) determining linearity and precision, 2) comparing results in whole blood with those in serum or plasma, and 3) comparing POC results with those obtained using a previously validated turbidimetric immunoassay (TIA). Assay validation. Analytical validation of the POC test was done in accordance with American Society of Veterinary Clinical Pathology guidelines using residual equine serum/plasma and whole blood samples from the Clinical Pathology Laboratory at the University of California-Davis. A TIA was used as the reference method. We also evaluated the effect of haematocrit (HCT). The POC test was linear for SAA concentrations of up to at least 1000 μg/mL (r = 0.991). Intra-assay CVs were 13, 18 and 15% at high (782 μg/mL), intermediate (116 μg/mL) and low (64 μg/mL) concentrations. Inter-assay (inter-batch) CVs were 45, 14 and 15% at high (1372 μg/mL), intermediate (140 μg/mL) and low (56 μg/mL) concentrations. SAA results in whole blood were significantly lower than those in serum/plasma (P = 0.0002), but were positively correlated (r = 0.908) and not affected by HCT (P = 0.261); proportional negative bias was observed in samples with SAA>500 μg/mL. The difference between methods exceeded the 95% confidence interval of the combined imprecision of both methods (15%). Analytical validation could not be performed in whole blood, the sample most likely to be used stall side. The POC test has acceptable accuracy and precision in equine serum/plasma with SAA concentrations of up to at least 1000 μg/mL. Low inter-batch precision at high concentrations may affect serial measurements, and the use of the same test batch and sample type (serum/plasma or whole blood) is recommended. Comparison of results between the

  5. Clinical Validation of a Point-of-Care Multiplexed In Vitro Immunoassay Using Monoclonal Antibodies (the MSD Influenza Test) in Four Hospitals in Vietnam

    NARCIS (Netherlands)

    van Doorn, H. Rogier; Kinh, Nguyen Van; Tuan, Ha Manh; Tuan, Tran Anh; Minh, Ngo Ngoc Quang; Bryant, Juliet E.; Hang, Vu thi Ty; Uyen, Le thi Tham; Thinh, Le Quoc; Anh, Tran thi Ngoc; Lan, Nguyen Phu Huong; Trung, Nguyen Vu; Taylor, Walter; Merson, Laura; Wertheim, Heiman F. L.; Farrar, Jeremy; Wolbers, Marcel; Chau, Nguyen Van Vinh; de Jong, Menno D.

    2012-01-01

    Point-of-care (POC) diagnostic tests for influenza can considerably shorten the time to clinical decision making. An investigational POC test based on a multiplexed immunoassay was developed by Meso Scale Diagnostics, LLC (MSD), with the objective to make a more sensitive rapid test that can also

  6. Post Cyclone (PoC) : An innovative way to reduce the emission of fines from industrial cyclones

    NARCIS (Netherlands)

    Ray - Bhowmick, Madhumita; Luning, P.E.; Hoffmann, A.C; Plomp, A.; Beumer, M.I.L.

    A novel approach for reducing the emission of industrial-scale cyclones of particles smaller than 10 mu m is presented. Utilizing the strong swirl already present in the vortex finder of a conventional cyclone, the escaped dust from the cyclone is collected in a so-called ''Post Cyclone'' (PoC),

  7. Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?

    Science.gov (United States)

    Melnikow, Joy; Xing, Guibo; Cox, Ginger; Leigh, Paul; Mills, Lisa; Miglioretti, Diana L; Moghadassi, Michelle; Smith-Bindman, Rebecca

    2016-04-01

    Decreasing the use of high-cost tests may reduce health care costs. To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests. Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician. A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male. All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers. Initial ED visit costs were modestly lower for patients assigned to RAD US: $423 ($411, $434) compared with patients assigned to CT: $448 ($438, $459) (Pcosts were not significantly different between groups: $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from $749 to $1239. Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.

  8. Direct comparison of {sup 210}Po, {sup 234}Th and POC particle-size distributions and export fluxes at the Bermuda Atlantic Time-series Study (BATS) site

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, Gillian, E-mail: gstewart@qc.cuny.ed [Queens College, CUNY Flushing, NY 11367 (United States); Moran, S. Bradley, E-mail: moran@gso.uri.ed [Graduate School of Oceanography, URI Narragansett, RI 02882 (United States); Lomas, Michael W., E-mail: Michael.Lomas@bios.ed [Bermuda Institute for Ocean Sciences, St. George' s, GE01 (Bermuda); Kelly, Roger P., E-mail: rokelly@gso.uri.ed [Graduate School of Oceanography, URI Narragansett, RI 02882 (United States)

    2011-05-15

    Particle-reactive, naturally occurring radionuclides are useful tracers of the sinking flux of organic matter from the surface to the deep ocean. Since the Joint Global Ocean Flux Study (JGOFS) began in 1987, the disequilibrium between {sup 234}Th and its parent {sup 238}U has become widely used as a technique to measure particle export fluxes from surface ocean waters. Another radionuclide pair, {sup 210}Po and {sup 210}Pb, can be used for the same purpose but has not been as widely adopted due to difficulty with accurately constraining the {sup 210}Po/{sup 210}Pb radiochemical balance in the ocean and because of the more time-consuming radiochemical procedures. Direct comparison of particle flux estimated in different ocean regions using these short-lived radionuclides is important in evaluating their utility and accuracy as tracers of particle flux. In this paper, we present paired {sup 234}Th/{sup 238}U and {sup 210}Po/{sup 210}Pb data from oligotrophic surface waters of the subtropical Northwest Atlantic and discuss their advantages and limitations. Vertical profiles of total and particle size-fractionated {sup 210}Po and {sup 234}Th activities, together with particulate organic carbon (POC) concentrations, were measured during three seasons at the Bermuda Atlantic Time-series Study (BATS) site. Both {sup 210}Po and {sup 234}Th reasonably predict sinking POC flux caught in sediment traps, and each tracer provides unique information about the magnitude and efficiency of the ocean's biological pump.

  9. A fast method to emulate an iterative POCS image reconstruction algorithm.

    Science.gov (United States)

    Zeng, Gengsheng L

    2017-10-01

    Iterative image reconstruction algorithms are commonly used to optimize an objective function, especially when the objective function is nonquadratic. Generally speaking, the iterative algorithms are computationally inefficient. This paper presents a fast algorithm that has one backprojection and no forward projection. This paper derives a new method to solve an optimization problem. The nonquadratic constraint, for example, an edge-preserving denoising constraint is implemented as a nonlinear filter. The algorithm is derived based on the POCS (projections onto projections onto convex sets) approach. A windowed FBP (filtered backprojection) algorithm enforces the data fidelity. An iterative procedure, divided into segments, enforces edge-enhancement denoising. Each segment performs nonlinear filtering. The derived iterative algorithm is computationally efficient. It contains only one backprojection and no forward projection. Low-dose CT data are used for algorithm feasibility studies. The nonlinearity is implemented as an edge-enhancing noise-smoothing filter. The patient studies results demonstrate its effectiveness in processing low-dose x ray CT data. This fast algorithm can be used to replace many iterative algorithms. © 2017 American Association of Physicists in Medicine.

  10. Portable biosensors and point-of-care systems

    CERN Document Server

    Kintzios, Spyridon E

    2017-01-01

    This book describes the principles, design and applications of a new generation of analytical and diagnostic biomedical devices, characterized by their very small size, ease of use, multi-analytical capabilities and speed to provide handheld and mobile point-of-care (POC) diagnostics.

  11. Cost-effectiveness of point-of-care testing for dehydration in the pediatric ED.

    Science.gov (United States)

    Whitney, Rachel E; Santucci, Karen; Hsiao, Allen; Chen, Lei

    2016-08-01

    Acute gastroenteritis (AGE) and subsequent dehydration account for a large proportion of pediatric emergency department (PED) visits. Point-of-care (POC) testing has been used in conjunction with clinical assessment to determine the degree of dehydration. Despite the wide acceptance of POC testing, little formal cost-effective analysis of POC testing in the PED exists. We aim to examine the cost-effectiveness of using POC electrolyte testing vs traditional serum chemistry testing in the PED for children with AGE. This was a cost-effective analysis using data from a randomized control trial of children with AGE. A decision analysis model was constructed to calculate cost-savings from the point of view of the payer and the provider. We used parameters obtained from the trial, including cost of testing, admission rates, cost of admission, and length of stay. Sensitivity analyses were performed to evaluate the stability of our model. Using the data set of 225 subjects, POC testing results in a cost savings of $303.30 per patient compared with traditional serum testing from the point of the view of the payer. From the point-of-view of the provider, POC testing results in consistent mean savings of $36.32 ($8.29-$64.35) per patient. Sensitivity analyses demonstrated the stability of the model and consistent savings. This decision analysis provides evidence that POC testing in children with gastroenteritis-related moderate dehydration results in significant cost savings from the points of view of payers and providers compared to traditional serum chemistry testing. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. A Novel Field Deployable Point-of-Care Diagnostic Test for Cutaneous Leishmaniasis

    Science.gov (United States)

    2015-10-01

    could enhance the success of the RPA method in the field, including 1) isolation of DNA from clinical samples using a mini (portable) extractor at...the POC or FTA Whatman filter paper specially designed to improve DNA preservation and purification at POC. Aim 1: To optimize the analytical...sensitivity and specificity of the genus- and complex-specific RPA-LF tests using Leishmania isolates and clinical samples from collaborating study sites. We

  13. Point-of-care screening for hepatitis B virus infection in pregnant women at an antenatal clinic: A South African experience.

    Directory of Open Access Journals (Sweden)

    Nafiisah Chotun

    Full Text Available Elimination of HIV and syphilis mother-to-child transmission (MTCT has received much attention but little consideration has been given to the possibility of elimination of HBV MTCT. In sub-Saharan Africa, HBV vertical transmission continues to be reported and it remains an important public health problem. This study aimed to assess the feasibility of screening pregnant women for HBV using a point-of-care (POC test and implementing interventions to prevent HBV MTCT.In this observational prospective cohort study, HIV-uninfected pregnant women who consented to testing were screened for HBV using a rapid POC test for HBsAg. Positive results were laboratory-confirmed and tested for HBV DNA and serological markers. Women with viral loads ≥ 20 000 IU/ml received tenofovir (TDF treatment and all infants received birth-dose HBV vaccine. Two blood samples collected six months apart from HBV-exposed infants within their first year of life were tested for HBV DNA.Of 144 women who were approached, 134 consented to participating (93% acceptance rate of HBV POC test. Six women tested positive for HBsAg (4.5%; 95% CI 0.99%-8.01%, all confirmed by laboratory testing. Two mothers, M1 and M4, were treated with TDF during their third trimester of pregnancy. Six HBV-exposed infants received the HBV vaccine within 24 hours of birth, of whom two were lost to follow-up and four (including the two born to M1 and M4 had undetectable levels of HBV DNA when tested at the two time points.We found that HBV screening using POC testing fulfilled the criteria considered necessary for implementation. It has acceptable performance, is inexpensive, reliable, and was well accepted by the study participants. Screening pregnant women as part of the HBV MTCT prevention strategy is therefore feasible in a South African clinical setting.

  14. Miniaturized Bio-and Chemical-Sensors for Point-of-Care Monitoring of Chronic Kidney Diseases.

    Science.gov (United States)

    Tricoli, Antonio; Neri, Giovanni

    2018-03-22

    This review reports the latest achievements in point-of-care (POC) sensor technologies for the monitoring of ammonia, creatinine and urea in patients suffering of chronic kidney diseases (CKDs). Abnormal levels of these nitrogen biomarkers are found in the physiological fluids, such as blood, urine and sweat, of CKD patients. Delocalized at-home monitoring of CKD biomarkers via integration of miniaturized, portable, and low cost chemical- and bio-sensors in POC devices, is an emerging approach to improve patients' health monitoring and life quality. The successful monitoring of CKD biomarkers, performed on the different body fluids by means of sensors having strict requirements in term of size, cost, large-scale production capacity, response time and simple operation procedures for use in POC devices, is reported and discussed.

  15. Quality assurance for HIV point-of-care testing and treatment monitoring assays

    Directory of Open Access Journals (Sweden)

    Adrienne F.A. Meyers

    2016-10-01

    Full Text Available In 2015, UNAIDS launched the 90-90-90 targets aimed at increasing the number of peopleinfected with HIV to become aware of their status, access antiretroviral therapies and ultimatelybe virally suppressed. To achieve these goals, countries may need to scale up point-of-care (POC testing in addition to strengthening central laboratory services. While decentralisingtesting increases patient access to diagnostics, it presents many challenges with regard totraining and assuring the quality of tests and testing. To ensure synergies, the London Schoolof Hygiene & Tropical Medicine held a series of consultations with countries with an interestin quality assurance and their implementing partners, and agreed on an external qualityassessment (EQA programme to ensure reliable results so that the results lead to the bestpossible care for HIV patients. As a result of the consultations, EQA International wasestablished, bringing together EQA providers and implementers to develop a strategic planfor countries to establish national POC EQA programmes and to estimate the cost of setting upand maintaining the programme. With the dramatic increase in the number of proficiencytesting panels required for thousands of POC testing sites across Africa, it is important tofacilitate technology transfer from global EQA providers to a network of regional EQA centresin Africa for regional proficiency testing panel production. EQA International will continue toidentify robust and cost-effective EQA technologies for quality POC testing, integrating noveltechnologies to support sustainable country-owned EQA programmes in Africa.

  16. Use of portable blood physiology point-of-care devices for basic and applied research on vertebrates: a review.

    Science.gov (United States)

    Stoot, Lauren J; Cairns, Nicholas A; Cull, Felicia; Taylor, Jessica J; Jeffrey, Jennifer D; Morin, Félix; Mandelman, John W; Clark, Timothy D; Cooke, Steven J

    2014-01-01

    Non-human vertebrate blood is commonly collected and assayed for a variety of applications, including veterinary diagnostics and physiological research. Small, often non-lethal samples enable the assessment and monitoring of the physiological state and health of the individual. Traditionally, studies that rely on blood physiology have focused on captive animals or, in studies conducted in remote settings, have required the preservation and transport of samples for later analysis. In either situation, large, laboratory-bound equipment and traditional assays and analytical protocols are required. The use of point-of-care (POC) devices to measure various secondary blood physiological parameters, such as metabolites, blood gases and ions, has become increasingly popular recently, due to immediate results and their portability, which allows the freedom to study organisms in the wild. Here, we review the current uses of POC devices and their applicability to basic and applied studies on a variety of non-domesticated species. We located 79 individual studies that focused on non-domesticated vertebrates, including validation and application of POC tools. Studies focused on a wide spectrum of taxa, including mammals, birds and herptiles, although the majority of studies focused on fish, and typical variables measured included blood glucose, lactate and pH. We found that calibrations for species-specific blood physiology values are necessary, because ranges can vary within and among taxa and are sometimes outside the measurable range of the devices. In addition, although POC devices are portable and robust, most require durable cases, they are seldom waterproof/water-resistant, and factors such as humidity and temperature can affect the performance of the device. Overall, most studies concluded that POC devices are suitable alternatives to traditional laboratory devices and eliminate the need for transport of samples; however, there is a need for greater emphasis on rigorous

  17. The value of point-of-care CD4+ and laboratory viral load in tailoring antiretroviral therapy monitoring strategies to resource limitations.

    Science.gov (United States)

    Hyle, Emily P; Jani, Ilesh V; Rosettie, Katherine L; Wood, Robin; Osher, Benjamin; Resch, Stephen; Pei, Pamela P; Maggiore, Paolo; Freedberg, Kenneth A; Peter, Trevor; Parker, Robert A; Walensky, Rochelle P

    2017-09-24

    To examine the clinical and economic value of point-of-care CD4 (POC-CD4) or viral load monitoring compared with current practices in Mozambique, a country representative of the diverse resource limitations encountered by HIV treatment programs in sub-Saharan Africa. We use the Cost-Effectiveness of Preventing AIDS Complications-International model to examine the clinical impact, cost (2014 US$), and incremental cost-effectiveness ratio [$/year of life saved (YLS)] of ART monitoring strategies in Mozambique. We compare: monitoring for clinical disease progression [clinical ART monitoring strategy (CLIN)] vs. annual POC-CD4 in rural settings without laboratory services and biannual laboratory CD4 (LAB-CD4), biannual POC-CD4, and annual viral load in urban settings with laboratory services. We examine the impact of a range of values in sensitivity analyses, using Mozambique's 2014 per capita gross domestic product ($620) as a benchmark cost-effectiveness threshold. In rural settings, annual POC-CD4 compared to CLIN improves life expectancy by 2.8 years, reduces time on failed ART by 0.6 years, and yields an incremental cost-effectiveness ratio of $480/YLS. In urban settings, biannual POC-CD4 is more expensive and less effective than viral load. Compared to biannual LAB-CD4, viral load improves life expectancy by 0.6 years, reduces time on failed ART by 1.0 year, and is cost-effective ($440/YLS). In rural settings, annual POC-CD4 improves clinical outcomes and is cost-effective compared to CLIN. In urban settings, viral load has the greatest clinical benefit and is cost-effective compared to biannual POC-CD4 or LAB-CD4. Tailoring ART monitoring strategies to specific settings with different available resources can improve clinical outcomes while remaining economically efficient.

  18. Low pO2 Contributes to Potential Error in Oxygen Saturation Calculations Using a Point-of-Care Assay.

    Science.gov (United States)

    Gunsolus, Ian L; Love, Sara A; Kohl, Louis P; Schmidt, Martin; Apple, Fred S

    2017-12-20

    The present study addressed the accuracy of calculated oxygen saturation (sO2) using point-of-care (POC) testing compared with measured values on a blood gas analyzer. In total, 3,323 sO2 values were measured in 1,180 patients using a CO-oximeter (ABL 800 Flex; Radiometer, Copenhagen, Denmark). Measured parameters were then used to calculate an expected sO2 for the POC method (Abbott i-STAT; Abbott POC, Princeton, NJ). Cases in which calculated sO2 differed from measured sO2 by 10% or more were analyzed. Of the 3,323 comparisons performed, 260 (8%) showed discrepancies (± ≥10%) between measured and calculated sO2 values. Ninety-four of discrepant measurements (245 of 260) occurred when pO2 was less than 50 mm Hg. pH and bicarbonate distributions shifted to lower values in discrepant vs nondiscrepant cases. Our results suggest that the likelihood of discrepant sO2 is 27% among patients with pO2 less than 50 mm Hg. Direct measurement of sO2 by CO-oximetry is strongly suggested in this clinical scenario. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  19. Intraosseous blood samples for point-of-care analysis: agreement between intraosseous and arterial analyses.

    Science.gov (United States)

    Jousi, Milla; Saikko, Simo; Nurmi, Jouni

    2017-09-11

    Point-of-care (POC) testing is highly useful when treating critically ill patients. In case of difficult vascular access, the intraosseous (IO) route is commonly used, and blood is aspirated to confirm the correct position of the IO-needle. Thus, IO blood samples could be easily accessed for POC analyses in emergency situations. The aim of this study was to determine whether IO values agree sufficiently with arterial values to be used for clinical decision making. Two samples of IO blood were drawn from 31 healthy volunteers and compared with arterial samples. The samples were analysed for sodium, potassium, ionized calcium, glucose, haemoglobin, haematocrit, pH, blood gases, base excess, bicarbonate, and lactate using the i-STAT® POC device. Agreement and reliability were estimated by using the Bland-Altman method and intraclass correlation coefficient calculations. Good agreement was evident between the IO and arterial samples for pH, glucose, and lactate. Potassium levels were clearly higher in the IO samples than those from arterial blood. Base excess and bicarbonate were slightly higher, and sodium and ionised calcium values were slightly lower, in the IO samples compared with the arterial values. The blood gases in the IO samples were between arterial and venous values. Haemoglobin and haematocrit showed remarkable variation in agreement. POC diagnostics of IO blood can be a useful tool to guide treatment in critical emergency care. Seeking out the reversible causes of cardiac arrest or assessing the severity of shock are examples of situations in which obtaining vascular access and blood samples can be difficult, though information about the electrolytes, acid-base balance, and lactate could guide clinical decision making. The analysis of IO samples should though be limited to situations in which no other option is available, and the results should be interpreted with caution, because there is not yet enough scientific evidence regarding the agreement of IO

  20. Miniaturized Bio-and Chemical-Sensors for Point-of-Care Monitoring of Chronic Kidney Diseases

    Directory of Open Access Journals (Sweden)

    Antonio Tricoli

    2018-03-01

    Full Text Available This review reports the latest achievements in point-of-care (POC sensor technologies for the monitoring of ammonia, creatinine and urea in patients suffering of chronic kidney diseases (CKDs. Abnormal levels of these nitrogen biomarkers are found in the physiological fluids, such as blood, urine and sweat, of CKD patients. Delocalized at-home monitoring of CKD biomarkers via integration of miniaturized, portable, and low cost chemical- and bio-sensors in POC devices, is an emerging approach to improve patients’ health monitoring and life quality. The successful monitoring of CKD biomarkers, performed on the different body fluids by means of sensors having strict requirements in term of size, cost, large-scale production capacity, response time and simple operation procedures for use in POC devices, is reported and discussed.

  1. Point-of-Care Virologic Testing to Improve Outcomes of HIV-Infected Children in Zambia: A Clinical Trial Protocol.

    Science.gov (United States)

    Chibwesha, Carla J; Ford, Catherine E; Mollan, Katie R; Stringer, Jeffrey S A

    2016-08-01

    In the absence of early infant diagnosis (EID) and immediate antiretroviral therapy (ART), some 50% of untreated HIV-infected infants die before age 2. Conventional EID requires sophisticated instruments that are typically placed in centralized or reference laboratories. In low-resource settings, centralized systems often lead to result turnaround times of several months, long delays in diagnosis, and adverse outcomes for HIV-infected children. Our clinical trial tests the effectiveness of a new point-of-care (POC) diagnostic technology to identify HIV-infected infants and start providing them life-saving ART as soon as possible. The study uses a randomized, controlled design to test whether the Alere q platform for HIV DNA polymerase chain reaction (PCR) testing improves outcomes of HIV-infected children in Zambia. We aim to enroll 2867 HIV-exposed infants aged 4-12 weeks and to follow those who are HIV infected for 12 months as they receive HIV care at 6 public health facilities in Lusaka. The trial's primary endpoint is the proportion of HIV-infected infants in each study arm who start ART and remain alive, in care, and virally suppressed 12 months after their diagnostic blood draw. Our trial will provide evidence for the incremental benefit of implementing a POC EID strategy in low-resource settings where only off-site PCR services are currently available. The results will be useful in guiding future decisions regarding investments in POC virologic testing as part of overall pediatric AIDS mitigation strategies in sub-Saharan Africa. clinicaltrials.gov NCT02682810.

  2. Selfish mothers? An empirical test of parent-offspring conflict over extended parental care.

    Science.gov (United States)

    Paul, Manabi; Sen Majumder, Sreejani; Bhadra, Anindita

    2014-03-01

    Parent-offspring conflict (POC) theory is an interesting conceptual framework for understanding the dynamics of parental care. However, this theory is not easy to test empirically, as exact measures of parental investment in an experimental set-up are difficult to obtain. We have used free-ranging dogs Canis familiaris in India, to study POC in the context of extended parental care. We observed females and their pups in their natural habitat for the mother's tendency to share food given by humans with her pups in the weaning and post-weaning stages. Since these dogs are scavengers, and depend largely on human provided food for their sustenance, voluntary sharing of food by the mother with her pups is a good surrogate for extended parental care. Our behavioural observations convincingly demonstrate an increase of conflict and decrease of cooperation by the mother with her offspring over given food within a span of 4-6 weeks. We also demonstrate that the competition among the pups in a litter scales with litter size, an indicator of sib-sib competition. Copyright © 2013 Elsevier B.V. All rights reserved.

  3. Design of point-of-care (POC) microfluidic medical diagnostic devices

    Science.gov (United States)

    Leary, James F.

    2018-02-01

    Design of inexpensive and portable hand-held microfluidic flow/image cytometry devices for initial medical diagnostics at the point of initial patient contact by emergency medical personnel in the field requires careful design in terms of power/weight requirements to allow for realistic portability as a hand-held, point-of-care medical diagnostics device. True portability also requires small micro-pumps for high-throughput capability. Weight/power requirements dictate use of super-bright LEDs and very small silicon photodiodes or nanophotonic sensors that can be powered by batteries. Signal-to-noise characteristics can be greatly improved by appropriately pulsing the LED excitation sources and sampling and subtracting noise in between excitation pulses. The requirements for basic computing, imaging, GPS and basic telecommunications can be simultaneously met by use of smartphone technologies, which become part of the overall device. Software for a user-interface system, limited real-time computing, real-time imaging, and offline data analysis can be accomplished through multi-platform software development systems that are well-suited to a variety of currently available cellphone technologies which already contain all of these capabilities. Microfluidic cytometry requires judicious use of small sample volumes and appropriate statistical sampling by microfluidic cytometry or imaging for adequate statistical significance to permit real-time (typically medical decisions for patients at the physician's office or real-time decision making in the field. One or two drops of blood obtained by pin-prick should be able to provide statistically meaningful results for use in making real-time medical decisions without the need for blood fractionation, which is not realistic in the field.

  4. Photonic crystals: emerging biosensors and their promise for point-of-care applications.

    Science.gov (United States)

    Inan, Hakan; Poyraz, Muhammet; Inci, Fatih; Lifson, Mark A; Baday, Murat; Cunningham, Brian T; Demirci, Utkan

    2017-01-23

    Biosensors are extensively employed for diagnosing a broad array of diseases and disorders in clinical settings worldwide. The implementation of biosensors at the point-of-care (POC), such as at primary clinics or the bedside, faces impediments because they may require highly trained personnel, have long assay times, large sizes, and high instrumental cost. Thus, there exists a need to develop inexpensive, reliable, user-friendly, and compact biosensing systems at the POC. Biosensors incorporated with photonic crystal (PC) structures hold promise to address many of the aforementioned challenges facing the development of new POC diagnostics. Currently, PC-based biosensors have been employed for detecting a variety of biotargets, such as cells, pathogens, proteins, antibodies, and nucleic acids, with high efficiency and selectivity. In this review, we provide a broad overview of PCs by explaining their structures, fabrication techniques, and sensing principles. Furthermore, we discuss recent applications of PC-based biosensors incorporated with emerging technologies, including telemedicine, flexible and wearable sensing, smart materials and metamaterials. Finally, we discuss current challenges associated with existing biosensors, and provide an outlook for PC-based biosensors and their promise at the POC.

  5. Quality assurance for HIV point-of-care testing and treatment monitoring assays

    Science.gov (United States)

    Sandstrom, Paul; Denny, Thomas N.; Hurlston, Mackenzie; Ball, Terry B.; Peeling, Rosanna W.; Boeras, Debrah I.

    2016-01-01

    In 2015, UNAIDS launched the 90-90-90 targets aimed at increasing the number of people infected with HIV to become aware of their status, access antiretroviral therapies and ultimately be virally suppressed. To achieve these goals, countries may need to scale up point-of-care (POC) testing in addition to strengthening central laboratory services. While decentralising testing increases patient access to diagnostics, it presents many challenges with regard to training and assuring the quality of tests and testing. To ensure synergies, the London School of Hygiene & Tropical Medicine held a series of consultations with countries with an interest in quality assurance and their implementing partners, and agreed on an external quality assessment (EQA) programme to ensure reliable results so that the results lead to the best possible care for HIV patients. As a result of the consultations, EQA International was established, bringing together EQA providers and implementers to develop a strategic plan for countries to establish national POC EQA programmes and to estimate the cost of setting up and maintaining the programme. With the dramatic increase in the number of proficiency testing panels required for thousands of POC testing sites across Africa, it is important to facilitate technology transfer from global EQA providers to a network of regional EQA centres in Africa for regional proficiency testing panel production. EQA International will continue to identify robust and cost-effective EQA technologies for quality POC testing, integrating novel technologies to support sustainable country-owned EQA programmes in Africa. PMID:28879133

  6. Analytic evaluation of a new glucose meter system in 15 different critical care settings.

    Science.gov (United States)

    Mitsios, John V; Ashby, Lori A; Haverstick, Doris M; Bruns, David E; Scott, Mitchell G

    2013-09-01

    Maintaining appropriate glycemic control in critically ill patients reduces morbidity and mortality. The use of point-of-care (POC) glucose devices is necessary to obtain rapid results at the patient's bedside. However, the devices should be thoroughly tested in the intended population before implementation. The use of POC glucose meters in critically ill patients has been questioned both in the literature and by regulatory agencies. The aim of this study was to determine if the ACCU-CHEK® Inform II system (Roche Diagnostics) POC glucose meter demonstrated the desired accuracy and precision, as defined by Clinical and Laboratory Standards Institute guideline POCT12-A3, in a large number of critically ill patients from multiple intensive care settings at two academic medical centers. A total of 1200 whole blood meter results from 600 patients were compared with central laboratory plasma values. Whole blood aliquots from venous samples were used to obtain duplicate meter results with the remaining sample being processed to obtain plasma for central laboratory testing within 5 min of meter testing. A total of 1185 (98.8%) of the new meter's glucose values were within ± 12.5% (± 12 mg/dl for values ≥ 100 mg/dl) of the comparative laboratory glucose values, and 1198 (99.8%) were within ± 20% (± 20 mg/dl for values meter system appears to have sufficient analytic accuracy for use in critically ill patients. © 2013 Diabetes Technology Society.

  7. Connected, low-cost point-of-care diagnostics for rural South African clinics

    CSIR Research Space (South Africa)

    Smith, Suzanne

    2017-10-01

    Full Text Available sensors, Paper-based sensors, Radio frequency identification, Point-of-care diagnostics INTRODUCTION Data connectivity is an imperative consideration in the development of new POC diagnostic devices, particularly in the developing world [1... healthcare information standards. A low-cost color detector was implemented for use with existing lateral flow devices (LFDs) utilizing an RFID sensing chip (SL900A-DK-STQFN16, ams, Aus- tria), green light-emitting diode (LED), and photodetector (SFH...

  8. Screening for hypoglycemia at the bedside in the neonatal intensive care unit (NICU) with the Abbott PCx glucose meter

    OpenAIRE

    Balion, Cynthia; Grey, Vijaylaxmi; Ismaila, Afisi; Blatz, Susan; Seidlitz, Wendy

    2006-01-01

    Abstract Background Point of care (POC) glucose meters are routinely used as a screening tool for hypoglycemia in a neonatal setting. Glucose meters however, lack the same accuracy as laboratory instruments for glucose measurement. In this study we investigated potential reasons for this inaccuracy and established a cut off value for confirmatory testing. Methods In this prospective study, all patients in the neonatal intensive care unit who had a plasma glucose test ordered were eligible to ...

  9. Clinical validation of a point-of-care multiplexed in vitro immunoassay using monoclonal antibodies (the MSD influenza test) in four hospitals in Vietnam.

    Science.gov (United States)

    van Doorn, H Rogier; Kinh, Nguyen van; Tuan, Ha Manh; Tuan, Tran Anh; Minh, Ngo Ngoc Quang; Bryant, Juliet E; Hang, Vu thi Ty; Uyen, Le thi Tham; Thinh, Le Quoc; Anh, Tran thi Ngoc; Lan, Nguyen Phu Huong; Trung, Nguyen Vu; Taylor, Walter; Merson, Laura; Wertheim, Heiman F L; Farrar, Jeremy; Wolbers, Marcel; Chau, Nguyen van Vinh; de Jong, Menno D

    2012-05-01

    Point-of-care (POC) diagnostic tests for influenza can considerably shorten the time to clinical decision making. An investigational POC test based on a multiplexed immunoassay was developed by Meso Scale Diagnostics, LLC (MSD), with the objective to make a more sensitive rapid test that can also subtype influenza A viruses (1977 H1, H3, and H5). Between February and November 2010, we conducted a prospective multicenter study at four hospitals in Vietnam and compared the performance of this test to that of the WHO/CDC real-time reverse transcriptase PCR (RT-PCR) on nasal and throat swab specimens from patients presenting with influenza-like illness. Five hundred sixty-three adults and children with a median age of 25 months were enrolled. Sensitivity and specificity of the test with combined results from nasal and throat swab samples were 74.0% (131/177) and 99.7% (351/352), respectively, compared to RT-PCR. The POC test was as sensitive for influenza virus B as for influenza virus A (74.4% [64/86] versus 73.6% [67/91]). The positivity rate was associated with lower cycle threshold values (a marker for higher viral loads), sample type (73.6% for nasal swab versus 52.4% for throat swab), and younger age. A total of 210 (18.7%) out of 1,126 MSD tests failed, and for 34 (6%) of patients, both test samples failed (these were excluded from the performance analysis). Subtyping could be assessed only for influenza virus A/H3N2, as 1977 H1N1 was not circulating at the time and no H5N1-infected patients were enrolled, and was successful only in 9/54 patients infected with H3 influenza virus who had a positive POC test result for influenza virus A. This novel POC test provided highly sensitive detection of influenza viruses A and B compared to the reported sensitivities of other rapid tests. However, 18.7% of tests failed for technical reasons and subtyping for H3 was poor. Drawbacks to the technology include the requirement for a dedicated reader instrument and the need for

  10. Evaluating the effect of sample type on American alligator (Alligator mississippiensis) analyte values in a point-of-care blood analyser

    OpenAIRE

    Hamilton, Matthew T.; Finger, John W.; Winzeler, Megan E.; Tuberville, Tracey D.

    2016-01-01

    The assessment of wildlife health has been enhanced by the ability of point-of-care (POC) blood analysers to provide biochemical analyses of non-domesticated animals in the field. However, environmental limitations (e.g. temperature, atmospheric humidity and rain) and lack of reference values may inhibit researchers from using such a device with certain wildlife species. Evaluating the use of alternative sample types, such as plasma, in a POC device may afford researchers the opportunity to d...

  11. Method comparison and validation of a prototype device for measurement of ionized calcium concentrations cow-side against a point-of-care instrument and a benchtop blood-gas analyzer reference method.

    Science.gov (United States)

    Neves, R C; Stokol, T; Bach, K D; McArt, J A A

    2018-02-01

    The objective of this study was to assess an optimized ion-selective electrode Ca-module prototype as a potential cow-side device for ionized Ca (iCa) measurements in bovine blood. A linearity experiment showed no deviation from linearity over a range of iCa concentrations compared with a commercial point-of-care (POC) device commonly used in the field (POC VS ; VetScan i-STAT, Abaxis North America, Union City, CA) and a laboratory gold standard benchtop blood-gas analyzer [reference analyzer (RA); ABL-800 FLEX, Radiometer Medical, Copenhagen, Denmark]. Coefficient of variation on 3 samples with high, within-range, and low iCa concentrations ranged from 1.0 to 3.9% for the prototype. A follow-up validation experiment was performed, in which our objectives were to (1) assess the performance of the prototype cow-side against the POC VS (farm gold-standard) using fresh non-anticoagulated whole-blood samples; (2) assess the performance of the prototype and the POC VS against the RA in a diagnostic laboratory using blood collected in a heparin-balanced syringe; and (3) assess the agreement of the prototype and POC VS on-farm (fresh non-anticoagulated whole blood) against the RA on heparin-balanced blood. Finally, sensitivity and specificity of the results obtained by the prototype and the POC VS cow-side compared with the results obtained by the laboratory RA using 3 different iCa cut points for classification of subclinical hypocalcemia were calculated. A total of 101 periparturient Holstein cows from 3 dairy farms in New York State were used for the second experiment. Ionized Ca results from the prototype cow-side were, on average, 0.06 mmol/L higher than the POC VS . With heparin-balanced samples under laboratory conditions, the prototype and POC VS measured an average 0.04 mmol/L higher and lower, respectively, compared with the RA. Results from the prototype and POC VS cow-side were 0.01 mmol/L higher and 0.05 mmol/L lower, respectively, compared with results from

  12. The universe of ANA testing: a case for point-of-care ANA testing.

    Science.gov (United States)

    Konstantinov, Konstantin N; Rubin, Robert L

    2017-12-01

    Testing for total antinuclear antibodies (ANA) is a critical tool for diagnosis and management of autoimmune diseases at both the primary care and subspecialty settings. Repurposing of ANA from a test for lupus to a test for any autoimmune condition has driven the increase in ANA requests. Changes in ANA referral patterns include early or subclinical autoimmune disease detection in patients with low pre-test probability and use of negative ANA results to rule out underlying autoimmune disease. A positive result can lead to further diagnostic considerations. Currently, ANA tests are performed in centralized laboratories; an alternative would be ANA testing at the clinical point-of-care (POC). By virtue of its near real-time data collection capability, low cost, and ease of use, we believe the POC ANA has the potential to enable a new paradigm shift in autoimmune serology testing.

  13. Can the Afinion HbA1c Point-of-Care instrument be an alternative method for the Tosoh G8 in the case of Hb-Tacoma?

    Science.gov (United States)

    Lenters-Westra, Erna; Strunk, Annuska; Campbell, Paul; Slingerland, Robbert J

    2017-02-01

    Hb-variant interference when reporting HbA1c has been an ongoing challenge since HbA1c was introduced to monitor patients with diabetes mellitus. Most Hb-variants show an abnormal chromatogram when cation-exchange HPLC is used for the determination of HbA1c. Unfortunately, the Tosoh G8 generates what appears to be normal chromatogram in the presence of Hb-Tacoma, yielding a falsely high HbA1c value. The primary aim of the study was to investigate if the Afinion HbA1c point-of-care (POC) instrument could be used as an alternative method for the Tosoh G8 when testing for HbA1c in the presence of Hb-Tacoma. Whole blood samples were collected in K 2 EDTA tubes from individuals homozygous for HbA (n = 40) and heterozygous for Hb-Tacoma (n = 20). Samples were then immediately analyzed with the Afinion POC instrument. After analysis, aliquots of each sample were frozen at -80 °C. The frozen samples were shipped on dry ice to the European Reference Laboratory for Glycohemoglobin (ERL) and analyzed with three International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and National Glycohemoglobin Standardization Program (NGSP) Secondary Reference Measurement Procedures (SRMPs). The Premier Hb9210 was used as the reference method. When compared to the reference method, samples with Hb-Tacoma yielded mean relative differences of 31.8% on the Tosoh G8, 21.5% on the Roche Tina-quant Gen. 2 and 16.8% on the Afinion. The Afinion cannot be used as an alternative method for the Tosoh G8 when testing for HbA1c in the presence of Hb-Tacoma.

  14. Acceptability and Feasibility of Integrating Point-of-Care Diagnostic Testing of Sexually Transmitted Infections into a South African Antenatal Care Program for HIV-Infected Pregnant Women

    Directory of Open Access Journals (Sweden)

    E. Morikawa

    2018-01-01

    Full Text Available Background. Chlamydia trachomatis (CT, Neisseria gonorrhoeae (NG, and Trichomonas vaginalis (TV infections may increase the risk of vertical transmission of the human immunodeficiency virus (HIV. In resource-limited settings, symptomatic screening, and syndromic management of sexually transmitted infections (STIs during pregnancy continue to be the standard of care. In the absence of diagnostic testing, asymptomatic infections in pregnant women go untreated. Objective. To describe the acceptability and feasibility of integrating diagnostic STI screening into first antenatal care visits for HIV-infected pregnant women. Methods. HIV-infected pregnant women were recruited during their first antenatal care visit from three antenatal care clinics in Tshwane District, South Africa, between June 2016 and October 2017. Self-collected vaginal swabs were used to screen for CT, NG, and TV with a diagnostic point-of-care (POC nucleic acid amplification test. Those with STIs were provided treatment per South African national guidelines. Results. Of 442 eligible women, 430 (97.3% agreed to participate and were tested. Of those with a positive STI test result (n = 173; 40.2%, 159 (91.9% received same-day results and treatment; 100% of STI-infected women were treated within seven days. Conclusions. Integration of POC diagnostic STI screening into first-visit antenatal care services was feasible and highly acceptable for HIV-infected pregnant women.

  15. Harmonization activities of Noklus - a quality improvement organization for point-of-care laboratory examinations.

    Science.gov (United States)

    Stavelin, Anne; Sandberg, Sverre

    2018-05-16

    Noklus is a non-profit quality improvement organization that focuses to improve all elements in the total testing process. The aim is to ensure that all medical laboratory examinations are ordered, performed and interpreted correctly and in accordance with the patients' needs for investigation, treatment and follow-up. For 25 years, Noklus has focused on point-of-care (POC) testing in primary healthcare laboratories and has more than 3100 voluntary participants. The Noklus quality system uses different tools to obtain harmonization and improvement: (1) external quality assessment for the pre-examination, examination and postexamination phase to monitor the harmonization process and to identify areas that need improvement and harmonization, (2) manufacturer-independent evaluations of the analytical quality and user-friendliness of POC instruments and (3) close interactions and follow-up of the participants through site visits, courses, training and guidance. Noklus also recommends which tests that should be performed in the different facilities like general practitioner offices, nursing homes, home care, etc. About 400 courses with more than 6000 delegates are organized annually. In 2017, more than 21,000 e-learning programs were completed.

  16. 3D Printing and Assay Development for Point-of-Care Applications

    Science.gov (United States)

    Jagadeesh, Shreesha

    Existing centralized labs do not serve patients adequately in remote areas. To enable universal timely healthcare, there is a need to develop low cost, portable systems that can diagnose multiple disease (Point-of-Care (POC) devices). Future POC diagnostics can be more multi-functional if medical device vendors can develop interoperability standards. This thesis developed the following medical diagnostic modules: Plasma from 25 microl blood was extracted through a filter membrane to demonstrate a 3D printed sample preparation module. Sepsis biomarker, C - reactive protein, was quantified through adsorption on nylon beads to demonstrate bead-based assay suitable for 3D printed disposable cartridge module. Finally, a modular fluorescent detection kit was built using 3D printed parts to detect CD4 cells in a disposable cartridge from ChipCare Corp. Due to the modularity enabled by 3D printing technique, the developed units can be easily adapted to detect other diseases.

  17. Microfluidic-integrated biosensors: prospects for point-of-care diagnostics.

    Science.gov (United States)

    Kumar, Suveen; Kumar, Saurabh; Ali, Md Azahar; Anand, Pinki; Agrawal, Ved Varun; John, Renu; Maji, Sagar; Malhotra, Bansi D

    2013-11-01

    There is a growing demand to integrate biosensors with microfluidics to provide miniaturized platforms with many favorable properties, such as reduced sample volume, decreased processing time, low cost analysis and low reagent consumption. These microfluidics-integrated biosensors would also have numerous advantages such as laminar flow, minimal handling of hazardous materials, multiple sample detection in parallel, portability and versatility in design. Microfluidics involves the science and technology of manipulation of fluids at the micro- to nano-liter level. It is predicted that combining biosensors with microfluidic chips will yield enhanced analytical capability, and widen the possibilities for applications in clinical diagnostics. The recent developments in microfluidics have helped researchers working in industries and educational institutes to adopt some of these platforms for point-of-care (POC) diagnostics. This review focuses on the latest advancements in the fields of microfluidic biosensing technologies, and on the challenges and possible solutions for translation of this technology for POC diagnostic applications. We also discuss the fabrication techniques required for developing microfluidic-integrated biosensors, recently reported biomarkers, and the prospects of POC diagnostics in the medical industry. Copyright © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  18. Potential for Pharmacy-Public Health Collaborations Using Pharmacy-Based Point-of-Care Testing Services for Infectious Diseases.

    Science.gov (United States)

    Gubbins, Paul O; Klepser, Michael E; Adams, Alex J; Jacobs, David M; Percival, Kelly M; Tallman, Gregory B

    Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery. To provide a comprehensive literature review that explores the potential for pharmacists to collaborate with public health professionals and prescribers using pharmacy-based CLIA-waived POCT services for infectious diseases. Comprehensive literature review. PubMed and Google Scholar were searched for manuscripts and meeting abstracts for the following key words: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. All relevant manuscripts and meeting abstracts utilizing POCT in community pharmacies for infectious disease were reviewed. Information regarding the most contemporary evidence regarding CLIA-waived POC infectious diseases tests for infectious diseases and their use in community pharmacies was synthesized to highlight and identify opportunities to develop future collaborations using community pharmacy-based models for such services. Evidence demonstrates that pharmacists in collaboration with other health care professionals can leverage their knowledge and accessibility to provide CLIA-waived POCT services for infectious diseases. Testing for influenza may augment health departments' surveillance efforts, help promote rationale antiviral use, and avoid unnecessary antimicrobial therapy. Services for human immunodeficiency virus infection raise infection status awareness, increase access to health care, and facilitate linkage to appropriate care. Testing for group A streptococcal pharyngitis may curb inappropriate

  19. Experiential or behavioral processes: which one is prominent in physical activity? Examining the processes of change 1 year after an intervention of therapeutic education among adults with obesity.

    Science.gov (United States)

    Romain, A J; Attalin, V; Sultan, A; Boegner, C; Gernigon, C; Avignon, A

    2014-11-01

    Although physical activity (PA) is essential, most obese people will not engage in its practice. The transtheoretical model (TTM) and its processes of change (POC) contribute to the understanding of behavior change regarding PA. The present study aimed to test how POC are associated with a progression through the stages of change (SOC) and whether they predict BMI change. Interventional study. A total of 134 subjects participated in an education program, were called at 1 year and 62 of them provided follow-up data. Participants completed the SOC and POC questionnaires at baseline, at 1 year and were classified according to their SOC progression. Participants who progressed through SOC lost more weight (pbehavioral POC. Results support the previous cross-sectional studies showing that physically active people use more frequently POC. The present findings support the development of TTM-grounded behavioral interventions targeted to obese patients. Identifying methods to promote POC use to improve adherence to weight guidelines may lead to improved clinical outcomes and quality of life. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. Pengaruh Pemberian Urea, Tsp, Kcl Dan Pupuk Organik Cair (Poc) Kulit Pisang Terhadap Pertumbuhan Dan Produksi Tanaman Cabai Merah Keriting (Capsicum Annum L.)

    OpenAIRE

    adrian, Edo; Yetti, Husna

    2017-01-01

    This research to determine the interaction of inorganic fertilizer (Urea, TSP, KCl)and banana peelliquid organic fertilizer (POC) to find the best results on the growth and yield of red pepper (Capsicum annuum L.).This study was conducted for four months (March-June, 2016), the Experimental Station, Faculty of Agriculture, University of Riau Pekanbaru,using a completely randomized design (CRD) factorial,consists of two factors and three replications.The results were analyzed by analysis of va...

  1. "Hook-like effect" causes false-negative point-of-care urine pregnancy testing in emergency patients.

    Science.gov (United States)

    Griffey, Richard T; Trent, Caleb J; Bavolek, Rebecca A; Keeperman, Jacob B; Sampson, Christopher; Poirier, Robert F

    2013-01-01

    Failure to detect pregnancy in the emergency department (ED) can have important consequences. Urine human chorionic gonadotropin (uhCG) point-of-care (POC) assays are valued for rapidly detecting early pregnancy with high sensitivity. However, under certain conditions, POC uhCG tests can fail to detect pregnancy. In investigating a series of late first-trimester false-negative pregnancy tests in our ED, a novel and distinct causative phenomenon was recently elucidated in our institution. We discuss uhCG POC tests, review our false-negative rate, and describe mechanisms for false negatives and potential remedies. The false-negative POC uhCG rate is very low, but in the setting of a large volume of tests, the numbers are worth consideration. In positive uhCG POC tests, free and fixed antibodies bind hCG to form a "sandwich"; hCG is present in several variant forms that change in their concentrations at different stages of pregnancy. When in excess, intact hCG can saturate the antibodies, preventing sandwich formation (hook effect phenomenon). Some assays may include an antibody that does not recognize certain variants present in later stages of pregnancy. When this variant is in excess, it can bind one antibody avidly and the other not at all, resulting in a false-negative test (hook-like phenomenon). In both situations, dilution is key to an accurate test. Manufacturers should consider that uhCG tests are routinely used at many stages of pregnancy. Characterizing uhCG variants recognized by their tests and eliminating lot-to-lot variability may help improve uhCG test performance. Clinicians need to be aware of and familiarize themselves with the limitations of the specific type of uhCG POC tests used in their practice, recognizing that under certain circumstances, false-negative tests can occur. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. The clinical situation of point-of-care testing and its future development at the emergency department in Shanghai.

    Science.gov (United States)

    Leong, Waiian; Chen, Lianxiang; Yu, Ping; Wei, Bohua; Wang, Cuicui; Ying, Yilin; Jiang, Jie; Tong, Jianjing; Zhu, Dingliang; Ye, Jing; Lu, Yiming

    2014-12-01

    We assessed the efficiency of point-of-care (POC) tests in the emergency department (ED) by comparing them with the international standard. We recorded the turnaround times (TATs) for processing laboratory biomarkers to assess laboratory efficiency from 17 EDs in national/regional hospitals. We also compared patient components between national and regional hospitals. Although the 17 enrolled hospitals expanded their EDs, they contained only five POC machines among them. The P50 (P25, P75) of the TATs for POC tests was 47 min (39, 55.5 min) for cardiac troponin T, which was much longer than the international standard (30 min). The TATs of other cardiac biomarkers were also longer than 30 min. The low efficiency of TATs for POC tests was a common feature in both regional and national hospitals (p > 0.05). Myocardial infarction was diagnosed in 61% of investigated ED patients who visited national hospitals, which is more frequently than those diagnosed at regional hospitals (46%, p administrative management of EDs. This issue should be addressed in the next version of the medical reform policy. © 2014 Society for Laboratory Automation and Screening.

  3. Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study.

    Science.gov (United States)

    Houben, I P L; van Berlo, C J L Y; Bekers, O; Nijssen, E C; Lobbes, M B I; Wildberger, J E

    2017-01-01

    To evaluate whether a handheld point-of-care (POC) device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN) prior to iodine-based contrast media delivery. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM) with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT) and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m 2 , necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%), leading to (at that stage) unwanted contrast administration. Two patients subsequently developed CIN after 2-5 days, which was self-limiting after 30 days. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

  4. Evidence of accessibility and utility of point-of-care diagnostics as an integral part of prevention of mother-to-child transmission services: systematic scoping review protocol.

    Science.gov (United States)

    Katoba, Juliet; Hangulu, Lydia; Mashamba-Thompson, Tivani Phosa

    2017-11-04

    Point-of-care (POC) testing has been shown to help improve healthcare access in resource-limited settings. However, there is paucity of evidence on accessibility of POC testing for prevention of mother-to-child transmission (PMTCT) in resource-limited settings. We propose to conduct a systematic scoping review to map the evidence on POC testing services for PMTCT. A scoping review framework, proposed by Arksey and O'Malley, will guide the study. A comprehensive literature search will be performed in the following electronic databases: PubMed, Science Direct, Cochrane Central, Google Scholar and databases within EBSCOhost (Medline and CINAHL). The primary research articles published in peer-reviewed journals and grey articles addressing our question will be included. One reviewer will conduct title screening and the results will be exported to endnote library. Two independent reviewers will perform abstract, then full article screening in parallel. The same process shall be employed to extract data from eligible studies. Data analysis will involve a narrative summary of included studies and thematic content analysis aided by NVIVO software V.11. The mixed methods assessment tool will be used to assess the quality of studies that will be included. Ethical approval is not applicable to this study. The study findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences related to syphilis, HIV, PMTCT, bacterial infections and POC diagnostics. CRD42017056267. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  5. Point-of-Care Laboratory of Pathogen Diagnosis in Rural Senegal

    Science.gov (United States)

    Fenollar, Florence; Bassene, Hubert; Diatta, Georges; Tall, Adama; Trape, Jean-François; Drancourt, Michel; Raoult, Didier

    2013-01-01

    Background In tropical Africa, where the spectrum of the bacterial pathogens that cause fevers is poorly understood and molecular-based diagnostic laboratories are rare, the time lag between test results and patient care is a critical point for treatment of disease. Methodology/Principal Findings We implemented POC laboratory in rural Senegal to resolve the time lag between test results and patient care. During the first year of the study (February 2011 to January 2012), 440 blood specimens from febrile patients were collected in Dielmo and Ndiop villages. All samples were screened for malaria, dengue fever, Borrelia spp., Coxiella burnetii, Tropheryma whipplei, Rickettsia conorii, R. africae, R. felis, and Bartonella spp. Conclusions/Significance We identified DNA from at least one pathogenic bacterium in 80/440 (18.2%) of the samples from febrile patients. B. crocidurae was identified in 35 cases (9.5%), and R. felis DNA was found in 30 cases (6.8%). The DNA of Bartonella spp. was identified in 23/440 cases (4.3%), and DNA of C. burnetii was identified in 2 cases (0.5%). T. whipplei (0.2%) was diagnosed in one patient. No DNA of R. africae or R. conorii was identified. Among the 7 patients co-infected by two different bacteria, we found R. felis and B. crocidurae in 4 cases, B. crocidurae and Bartonella spp. in 2 cases, and B. crocidurae and C. burnetii in 1 case. Malaria was diagnosed in 54 cases. In total, at least one pathogen (bacterium or protozoa) was identified in 127/440 (28.9%) of studied samples. Here, the authors report the proof of concept of POC in rural tropical Africa. Discovering that 18.2% of acute infections can be successfully treated with doxycycline should change the treatment strategy for acute fevers in West Africa. PMID:23350001

  6. Integration of an optical CMOS sensor with a microfluidic channel allows a sensitive readout for biological assays in point-of-care tests.

    Science.gov (United States)

    Van Dorst, Bieke; Brivio, Monica; Van Der Sar, Elfried; Blom, Marko; Reuvekamp, Simon; Tanzi, Simone; Groenhuis, Roelf; Adojutelegan, Adewole; Lous, Erik-Jan; Frederix, Filip; Stuyver, Lieven J

    2016-04-15

    In this manuscript, a microfluidic detection module, which allows a sensitive readout of biological assays in point-of-care (POC) tests, is presented. The proposed detection module consists of a microfluidic flow cell with an integrated Complementary Metal-Oxide-Semiconductor (CMOS)-based single photon counting optical sensor. Due to the integrated sensor-based readout, the detection module could be implemented as the core technology in stand-alone POC tests, for use in mobile or rural settings. The performance of the detection module was demonstrated in three assays: a peptide, a protein and an antibody detection assay. The antibody detection assay with readout in the detection module proved to be 7-fold more sensitive that the traditional colorimetric plate-based ELISA. The protein and peptide assay showed a lower limit of detection (LLOD) of 200 fM and 460 fM respectively. Results demonstrate that the sensitivity of the immunoassays is comparable with lab-based immunoassays and at least equal or better than current mainstream POC devices. This sensitive readout holds the potential to develop POC tests, which are able to detect low concentrations of biomarkers. This will broaden the diagnostic capabilities at the clinician's office and at patient's home, where currently only the less sensitive lateral flow and dipstick POC tests are implemented. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Surface enhanced Raman spectroscopy (SERS for in vitro diagnostic testing at the point of care

    Directory of Open Access Journals (Sweden)

    Marks Haley

    2017-06-01

    Full Text Available Point-of-care (POC device development is a growing field that aims to develop low-cost, rapid, sensitive in-vitro diagnostic testing platforms that are portable, self-contained, and can be used anywhere – from modern clinics to remote and low resource areas. In this review, surface enhanced Raman spectroscopy (SERS is discussed as a solution to facilitating the translation of bioanalytical sensing to the POC. The potential for SERS to meet the widely accepted “ASSURED” (Affordable, Sensitive, Specific, User-friendly, Rapid, Equipment-free, and Deliverable criterion provided by the World Health Organization is discussed based on recent advances in SERS in vitro assay development. As SERS provides attractive characteristics for multiplexed sensing at low concentration limits with a high degree of specificity, it holds great promise for enhancing current efforts in rapid diagnostic testing. In outlining the progression of SERS techniques over the past years combined with recent developments in smart nanomaterials, high-throughput microfluidics, and low-cost paper diagnostics, an extensive number of new possibilities show potential for translating SERS biosensors to the POC.

  8. Surface enhanced Raman spectroscopy (SERS) for in vitro diagnostic testing at the point of care

    Science.gov (United States)

    Marks, Haley; Schechinger, Monika; Garza, Javier; Locke, Andrea; Coté, Gerard

    2017-06-01

    Point-of-care (POC) device development is a growing field that aims to develop low-cost, rapid, sensitive in-vitro diagnostic testing platforms that are portable, self-contained, and can be used anywhere - from modern clinics to remote and low resource areas. In this review, surface enhanced Raman spectroscopy (SERS) is discussed as a solution to facilitating the translation of bioanalytical sensing to the POC. The potential for SERS to meet the widely accepted "ASSURED" (Affordable, Sensitive, Specific, User-friendly, Rapid, Equipment-free, and Deliverable) criterion provided by the World Health Organization is discussed based on recent advances in SERS in vitro assay development. As SERS provides attractive characteristics for multiplexed sensing at low concentration limits with a high degree of specificity, it holds great promise for enhancing current efforts in rapid diagnostic testing. In outlining the progression of SERS techniques over the past years combined with recent developments in smart nanomaterials, high-throughput microfluidics, and low-cost paper diagnostics, an extensive number of new possibilities show potential for translating SERS biosensors to the POC.

  9. Assessing the Risk of Contrast-Induced Nephropathy Using a Finger Stick Analysis in Recalls from Breast Screening: The CINFIBS Explorative Study

    Directory of Open Access Journals (Sweden)

    I. P. L. Houben

    2017-01-01

    Full Text Available Purpose. To evaluate whether a handheld point-of-care (POC device is able to predict and discriminate patients at potential risk of contrast-induced nephropathy (CIN prior to iodine-based contrast media delivery. Methods and Materials. Between December 2014 and June 2016, women undergoing contrast-enhanced spectral mammography (CESM with an iodine-based contrast agent were asked to have their risk of CIN assessed by a dedicated POC device (StatSensor CREAT and a risk factor questionnaire based on national guidelines. Prior to contrast injection, a venous blood sample was drawn to compare the results of POC with regular laboratory testing. Results. A total of 351 patients were included; 344 were finally categorized as low risk patients by blood creatinine evaluation. Seven patients had a eGFR below 60 ml/min/1.73 m2, necessitating additional preparation prior to contrast delivery. The POC device failed to categorize six out of seven patients (86%, leading to (at that stage unwanted contrast administration. Two patients subsequently developed CIN after 2–5 days, which was self-limiting after 30 days. Conclusion. The POC device tested was not able to reliably assess impairment of renal function in our patient cohort undergoing CESM. Consequently, we still consider classic clinical laboratory testing preferable in patients at potential risk for developing CIN.

  10. Comparing the performance of circulating cathodic antigen and Kato-Katz techniques in evaluating Schistosoma mansoni infection in areas with low prevalence in selected counties of Kenya: a cross-sectional study.

    Science.gov (United States)

    Okoyo, Collins; Simiyu, Elses; Njenga, Sammy M; Mwandawiro, Charles

    2018-04-11

    Kato-Katz technique has been the mainstay test in Schistosoma mansoni diagnosis in endemic areas. However, recent studies have documented its poor sensitivity in evaluating Schistosoma mansoni infection especially in areas with lower rates of transmission. It's the primary diagnostic tool in monitoring impact of the Kenya national school based deworming program on infection transmission, but there is need to consider a more sensitive technique as the prevalence reduces. Therefore, this study explored the relationship between results of the stool-based Kato-Katz technique with urine-based point-of-care circulating cathodic antigen (POC-CCA) test in view to inform decision-making by the program in changing from Kato-Katz to POC-CCA test. We used two cross-sectional surveys conducted pre- and post- mass drug administration (MDA) using praziquantel in a representative random sample of children from 18 schools across 11 counties. A total of 1944 children were randomly sampled for the study. Stool and urine samples were tested for S. mansoni infection using Kato-Katz and POC-CCA methods, respectively. S. mansoni prevalence using each technique was calculated and 95% confidence intervals obtained using binomial regression model. Specificity (Sp) and sensitivity (Sn) were determined using 2 × 2 contingency tables and compared using the McNemar's chi-square test. A total of 1899 and 1878 children were surveyed at pre- and post-treatment respectively. S. mansoni infection prevalence was 26.5 and 21.4% during pre- and post-treatment respectively using POC-CCA test, and 4.9 and 1.5% for pre- and post-treatment respectively using Kato-Katz technique. Taking POC-CCA as the gold standard, Kato-Katz was found to have significantly lower sensitivity both at pre- and post-treatment, Sn = 12.5% and Sn = 5.2% respectively, McNemar test χ 2 m  = 782.0, p < 0.001. In overall, the results showed a slight/poor agreement between the two methods, kappa index (k

  11. On the slow diffusion of Point of Care systems in Therapeutic Drug Monitoring

    Directory of Open Access Journals (Sweden)

    Barbara eSanavio

    2015-02-01

    Full Text Available Recent advancements in point-of-care technologies show great transformative promises for personalized preventative and predictive medicine. However, fields like therapeutic drug monitoring, that first allowed for personalized treatment of patient’ disease, still lag behind in the widespread application of point-of-care devices for monitoring of patients. Surprisingly, very few applications in commonly monitored drugs, such as anti-epileptics, are paving the way for a point of care (PoC approach to patient’ therapy monitoring, compared to other fields –like intensive care cardiac markers monitoring, glycemic controls in diabetes, or bench-top hematological parameters analysis at the local drug store. Such delay in the development of portable fast clinically effective drug monitoring devices is in our opinion due more to an inertial drag on the pervasiveness of these new devices into the clinical field than a lack of technical capability. At the same time, some very promising technologies failed in the clinical practice for inadequate understanding of the outcome parameters necessary for a relevant technological breakthrough that has superior clinical performance. We hope, by overviewing both therapeutic drug monitoring practice and its yet unmet needs and latest advancement in micro and nanotechnology applications to PoC clinical devices, to help bridging the two communities, the one exploiting analytical technologies and the one mastering the most advanced techniques, into translating existing and forthcoming technologies in effective devices.

  12. Lab-in-a-tube: Real-time molecular point-of-care diagnostics for influenza A and B using the cobas(R) Liat(R) system

    NARCIS (Netherlands)

    Melchers, W.J.G.; Kuijpers, J; Sickler, J.J.; Rahamat-Langendoen, J.C.

    2017-01-01

    Rapid diagnosis of influenza A and B is important for direct treatment decisions in patient care and for the reduction of in-hospital transmissions. The new real-time PCR based molecular point-of-care (POC) assay, the cobas(R) Influenza A/B test on the cobas(R) Liat(R) System (cobas(R) Liat(R)

  13. Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing.

    Science.gov (United States)

    Bongard, E; Frimodt-Møller, N; Gal, M; Wootton, M; Howe, R; Francis, N; Goossens, H; Butler, C C

    2015-10-01

    Currently available point-of-care (POC) diagnostic tests for managing urinary tract infections (UTIs) in general practice are limited by poor performance characteristics, and laboratory culture generally provides results only after a few days. This laboratory evaluation compared the analytic performance of the POC UK Flexicult(™) (Statens Serum Institut) (SSI) urinary kit for quantification, identification and antibiotic susceptibility testing and routine UK National Health Service (NHS) urine processing to an advanced urine culture method. Two hundred urine samples routinely submitted to the Public Health Wales Microbiology Laboratory were divided and: (1) analysed by routine NHS microbiological tests as per local laboratory standard operating procedures, (2) inoculated onto the UK Flexicult(™) SSI urinary kit and (3) spiral plated onto Colorex Orientation UTI medium (E&O Laboratories Ltd). The results were evaluated between the NHS and Flexicult(™ )methods, and discordant results were compared to the spiral plating method. The UK Flexicult(™) SSI urinary kit was compared to routine NHS culture for identification of a pure or predominant uropathogen at ≥ 10(5) cfu/mL, with a positive discordancy rate of 13.5% and a negative discordancy rate of 3%. The sensitivity and specificity were 86.7% [95% confidence interval (CI) 73.8-93.7] and 82.6% (95% CI 75.8-87.7), respectively. The UK Flexicult(™) SSI urinary kit was comparable to routine NHS urine processing in identifying microbiologically positive UTIs in this laboratory evaluation. However, the number of false-positive samples could lead to over-prescribing of antibiotics in clinical practice. The Flexicult(™) SSI kit could be useful as a POC test for UTIs in primary care but further pragmatic evaluations are necessary.

  14. Point-of-care ultrasonography as a training milestone for internal medicine residents: the time is now.

    Science.gov (United States)

    Sabath, Bruce F; Singh, Gurkeerat

    2016-01-01

    Point-of-care (POC) ultrasonography is considered fundamental in emergency medicine training and recently has become a milestone in critical care fellowship programs as well. Currently, there is no such standard requirement for internal medicine residency programs in the United States. We present a new case and briefly review another case at our institution - a community hospital - in which internal medicine house staff trained in ultrasonography were able to uncover unexpected and critical diagnoses that significantly changed patient care and outcomes. We also review the growing evidence of the application of ultrasound in the diagnosis of a myriad of conditions encountered in general internal medicine as well as the mounting data on the ability of internal medicine residents to apply this technology accurately at the bedside. We advocate that the literature has sufficiently established the role of POC ultrasonography in general internal medicine that there should no longer be any delay in giving this an official place in the development of internal medicine trainees. This may be particularly useful in the community hospital setting where 24-h echocardiography or other sonography may not be readily available.

  15. Will a quadruple multiplexed point-of-care screening strategy for HIV-related co-infections be feasible and impact detection of new co-infections in at-risk populations? Results from cross-sectional studies.

    Science.gov (United States)

    Pai, Nitika Pant; Dhurat, Rachita; Potter, Martin; Behlim, Tarannum; Landry, Geneviève; Vadnais, Caroline; Rodrigues, Camilla; Joseph, Lawrence; Shetty, Anjali

    2014-12-15

    Multiplexed point-of-care (POC) devices can rapidly screen for HIV-related co-infections (eg, hepatitis C (HCV), hepatitis B (HBV), syphilis) in one patient visit, but global evidence for this approach remains limited. This study aimed to evaluate a multiplex POC testing strategy to expedite screening for HIV-related co-infections in at-risk populations. A multiplex strategy was developed with two subsequent versions of an investigational device Miriad. It was evaluated in two non-comparable settings and populations in two countries for feasibility of conduct, detection of new infections, preference and accuracy. Version 1 was evaluated in 375 sexually transmitted disease clinic attendees in Mumbai, India; version 2 was evaluated in 119 injection drug users in Montreal, Canada. Feasibility (completion rate) of the multiplex strategy was high (86.1% Mumbai; 92.4% Montreal). A total of 170 new infections were detected in Mumbai (56 HIV, 75 HBV, 37 syphilis, 2 HCV) versus 2 in Montreal. Preference was 60% in Mumbai and 97% in Montreal. Miriad version 1 specificities were high: HIV 99.7% (98.3% to 100%), HBV 99.3% (97.6% to 99.9%), HCV 99.7% (98.5% to 99.9%), syphilis 85.2% (80.9% to 88.8%); sensitivities were as follows: HIV 100% (94.8% to 100%), HBV 13.3% (6.6% to 23.2%), HCV 50% (1.3% to 98.7%), syphilis 86.1% (70.5% to 95.3%). With version 2, specificities improved: HIV 100% (97.2% to 100%), HBV 100% (97.3% to 100%), HCV 85.3% (73.8% to 93.0%), syphilis 98.1% (93.3% to 99.8%); sensitivities were: HIV 100% (47.3% to 100%), HCV 80.4% (66.1% to 90.6%), syphilis 100% (22.4% to 100%). A quad multiplex POC strategy for HIV and co-infections was feasible to operationalise and preferred by patients in both settings. Many new infections were identified in Mumbai and accuracy improved with version 2 of the assay. Such a strategy will help expedite screening for co-infections, particularly where baseline screening is low. These findings are valuable to practitioners

  16. A Survey on Use of Rapid Tests and Tuberculosis Diagnostic Practices by Primary Health Care Providers in South Africa: Implications for the Development of New Point-of-Care Tests.

    Directory of Open Access Journals (Sweden)

    Malika Davids

    Full Text Available Effective infectious disease control requires early diagnosis and treatment initiation. Point-of-care testing offers rapid turn-around-times, facilitating same day clinical management decisions. To maximize the benefits of such POC testing programs, we need to understand how rapid tests are used in everyday clinical practice.In this cross-sectional survey study, 400 primary healthcare providers in two cities in South Africa were interviewed on their use of rapid tests in general, and tuberculosis diagnostic practices, between September 2012 and June 2013. Public healthcare facilities were selected using probability-sampling techniques and private healthcare providers were randomly selected from the Health Professional Council of South Africa list. To ascertain differences between the two healthcare sectors 2-sample z-tests were used to compare sample proportions.The numbers of providers interviewed were equally distributed between the public (n = 200 and private sector (n = 200. The most frequently reported tests in the private sector include blood pressure (99.5%, glucose finger prick (89.5% and urine dipstick (38.5%; and in the public sector were pregnancy (100%, urine dipstick (100%, blood pressure (100%, glucose finger prick (99% and HIV rapid test (98%. The majority of TB testing occurs in the public sector, where significantly more providers prefer Xpert MTB/RIF assay, the designated clinical TB diagnostic tool by the national TB program, as compared to the private sector (87% versus 71%, p-value >0.0001. Challenges with regard to TB diagnosis included the long laboratory turn-around-time, difficulty in obtaining sputum samples and lost results. All providers indicated that a new POC test for TB should be rapid and cheap, have good sensitivity and specificity, ease of sample acquisition, detect drug-resistance and work in HIV-infected persons.The existing centralized laboratory services, poor quality assurance, and lack of staff capacity

  17. Cryptococcal antigen screening by lay cadres using a rapid test at the point of care: A feasibility study in rural Lesotho.

    Science.gov (United States)

    Rick, Fernanda; Niyibizi, Aline Aurore; Shroufi, Amir; Onami, Kazumi; Steele, Sarah-Jane; Kuleile, Malehlohonolo; Muleya, Innocent; Chiller, Tom; Walker, Tiffany; Van Cutsem, Gilles

    2017-01-01

    Cryptococcal meningitis is one of the leading causes of death among people with HIV in Africa, primarily due to delayed presentation, poor availability and high cost of treatment. Routine cryptococcal antigen (CrAg) screening of patients with a CD4 count less than 100 cells/mm3, followed by pre-emptive therapy if positive, might reduce mortality in high prevalence settings. Using the cryptococcal antigen (CrAg) lateral flow assay (LFA), screening is possible at the point of care (POC). However, critical shortages of health staff may limit adoption. This study investigates the feasibility of lay counsellors conducting CrAg LFA screening in rural primary care clinics in Lesotho. From May 2014 to June 2015, individuals who tested positive for HIV were tested for CD4 count and those with CD4 lay counsellors. CrAg-positive asymptomatic patients received fluconazole, while symptomatic patients were referred to hospital. Lay counsellors were trained and supervised by a laboratory technician and counsellor activity supervisor. Additionally, nurses and doctors were trained on CrAg screening and appropriate treatment. During the study period, 1,388 people were newly diagnosed with HIV, of whom 129 (9%) presented with a CD4 count lay counsellors followed by pre-emptive fluconazole treatment for asymptomatic cases, or referral to hospital for symptomatic cases, proved feasible. However, regular follow-up to ensure proper management of cryptococcal disease was needed. These early results support the wider use of CrAg LFA screening in remote primary care settings where upper cadres of healthcare staff may be in short supply.

  18. Should we Google it? Resource use by internal medicine residents for point-of-care clinical decision making.

    Science.gov (United States)

    Duran-Nelson, Alisa; Gladding, Sophia; Beattie, Jim; Nixon, L James

    2013-06-01

    To determine which resources residents use at the point-of-care (POC) for decision making, the drivers for selection of these resources, and how residents use Google/Google Scholar to answer clinical questions at the POC. In January 2012, 299 residents from three internal medicine residencies were sent an electronic survey regarding resources used for POC decision making. Resource use frequency and factors influencing choice were determined using descriptive statistics. Binary logistic regression analysis was performed to determine relationships between the independent variables. A total of 167 residents (56%) responded; similar numbers responded at each level of training. Residents most frequently reported using UpToDate and Google at the POC at least daily (85% and 63%, respectively), with speed and trust in the quality of information being the primary drivers of selection. Google, used by 68% of residents, was used primarily to locate Web sites and general information about diseases, whereas Google Scholar, used by 30% of residents, tended to be used for treatment and management decisions or locating a journal article. The findings suggest that internal medicine residents use UpToDate most frequently, followed by consultation with faculty and the search engines Google and Google Scholar; speed, trust, and portability are the biggest drivers for resource selection; and time and information overload appear to be the biggest barriers to resources such as Ovid MEDLINE. Residents frequently used Google and may benefit from further training in information management skills.

  19. Type 1 diabetes mellitus care and education in China: The 3C study of coverage, cost, and care in Beijing and Shantou.

    Science.gov (United States)

    McGuire, Helen C; Ji, Linong; Kissimova-Skarbek, Katarzyna; Whiting, David; Aguirre, Florencia; Zhang, Puhong; Lin, Shaoda; Gong, Chunxiu; Zhao, Weigang; Lu, Juming; Guo, Xiaohui; Ji, Ying; Seuring, Till; Hong, Tianpei; Chen, Lishu; Weng, Jianping; Zhou, Zhiguang

    2017-07-01

    The paucity of data on Type 1 diabetes in China hinders progress in care and policy-making. This study compares Type 1 diabetes care and clinical outcomes in Beijing and Shantou with current clinical guidelines. The 3C Study was a cross-sectional study of the clinical practices and outcomes of people with Type 1 diabetes. The study sequentially enrolled 849 participants from hospital records, inpatient wards, and outpatient clinics. Data were collected via face-to-face interviews with patients and health professionals, the Summary of Diabetes Self-Care Activities, medical records, and venous blood samples. Care was audited using ISPAD/IDF indicators. Data underwent descriptive analysis and tests for association. The median age was 22years (IQR=13-34years), and 48.4% of the sample had diabetes less than six years. The median HbA1c was 8.5% (69mmol/mol) (IQR 7.2-10.5%), with significant regional variance (p=0.002). Insulin treatment was predominantly two injections/day (45% of patients). The highest incidence of diabetic ketoacidosis was 14.4 events/100 patient years among adolescents. Of the 57.3% of patients with LDL-C>2.6mmol/L, only 11.2% received treatment. Of the 10.6% considered hypertensive, 47.1% received treatment. Rates of documented screening for retinopathy, nephropathy, and peripheral neuropathy were 35.2%, 42.3%, and 25.0%, respectively. The median number of days of self-monitoring/week was 3.0 (IQR=1.0-7.0). There were significant differences in care practices across regions. The study documented an overall deficit in care with significant regional differences noted compared to practice guidelines. Modifications to treatment modalities and the structure of care may improve outcomes. Copyright © 2017. Published by Elsevier B.V.

  20. Alterations in rotation thromboelastometry (ROTEM®) parameters: point-of-care testing vs analysis after pneumatic tube system transport.

    Science.gov (United States)

    Martin, J; Schuster, T; Moessmer, G; Kochs, E F; Wagner, K J

    2012-10-01

    Thromboelastometry as point-of-care (POC) testing enables the analysis of the clotting process at the bedside, providing rapid results to guide haemostatic therapy. However, POC testing utilizes medical staff who are managing critically ill patients, as non-laboratory personnel may not be sufficiently trained to run the devices. To resolve these problems, thromboelastometry can be performed in the central laboratory and rapid transport of samples can be accomplished via a pneumatic tube system (PTS). This study compares thromboelastometry parameters of blood samples analysed immediately with those analysed after PTS transport. In patients with normal haemostasis, two arterial blood samples were collected from each patient (n=92) in citrated plastic tubes to investigate the assays INTEM (n=35), EXTEM (n=27), and FIBTEM (n=30). One blood sample was analysed immediately, the other sample after PTS transport. Thromboelastometry was performed using a single ROTEM(®) device. The mean clot firmness values were significantly lower for PTS samples in both the INTEM (-0.7 mm cf. -1.1 mm) and EXTEM (-1.4 cf. -1.7 mm) assays. INTEM coagulation time (CT) was significantly lower in PTS samples with a mean difference of -13 s. EXTEM CT was significantly higher in PTS samples with a mean difference of +3.9 s. Thromboelastometry parameters of blood samples analysed after PTS transport are significantly altered compared with those analysed immediately. However, in patients with normal haemostasis, the alterations were small and without clinical consequence, implying that analysis after PTS transport is an acceptable alternative to prompt analysis at the bedside. Further studies should focus on patients with impaired haemostasis.

  1. The Success of Self-Testing for Anticoagulation Therapy

    Directory of Open Access Journals (Sweden)

    Cetin Songur

    2013-10-01

    Full Text Available Aim: The optimal therapeutic range for INR of the patient who were on warfarin therapy is narrow. There are various methods of INR monitoring to adjust the appropriate dosage of warfarin therapy. This study aims to test the reliability of POC (Point of care devices used for INR(International normalized ratio monitoring. Material and Method: Forty six  patients who were on warfarin therapy for any reasons were enrolled for this study. Their INR  were divided into 3 groups according to their laboratory INR results. Grup 1 had INR results lower than 2, group 2 had INR levels of 2 to 3.5, group 3 had INR levels of higher than 3.5 INR of the patients were remeasured with the POC device.  Results: The ages of the patients were between 24 to 84. Twenty six patients were male and 20 were female. The mean INR level of laboratory measurements was 1.26 in group 1 whereas it was 1.45 for POC device measurements. There were not statistically significant difference between two devices for group 1 (p=0.15. In group 2 the mean INR levels were measured by laboratory instrument and POC device were 2.74 and 3.51 respectively (p=0,01. In group 3 mean INR levels were measured by laboratory instrument and POC device were 4.27 and 5.25 respectively (p=0.01. Discussion: We suppose it is rational to adjust warfarin dosage by specialists using laboratory results in order to prevent hemorrhagic and thromboembolic complications.

  2. Ultra-High Gradient Channeling Acceleration in Nanostructures: Design/Progress of Proof-of-Concept (POC) Experiments

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Young Min [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Northern Illinois Univ., DeKalb, IL (United States). Northern Illinois Center for Accelerator & Detector Development; Green, A. [Northern Illinois Univ., DeKalb, IL (United States). Northern Illinois Center for Accelerator & Detector Development; Lumpkin, A. H. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Thurman-Keup, R. M. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Shiltsev, V. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Zhang, X. [Shanhai Inst. of Optics and Fine Mechanics, Shanghai (China); Farinella, D. M. [Univ. of California, Irvine, CA (United States); Taborek, P. [Univ. of California, Irvine, CA (United States); Tajima, T. [Univ. of California, Irvine, CA (United States); Wheeler, J. A. [Univ. of Michigan, Ann Arbor, MI (United States). Center for Ultrafast Optical Science and FOCUS Center; Ecole Polytechnique, CNRS, Palaiseau (France). Lab. d' Optique Appliquee; Mourou, G. [Univ. of Michigan, Ann Arbor, MI (United States). Center for Ultrafast Optical Science and FOCUS Center; Ecole Polytechnique, CNRS, Palaiseau (France). Lab. d' Optique Appliquee

    2016-09-16

    A short bunch of relativistic particles or a short-pulse laser perturbs the density state of conduction electrons in a solid crystal and excites wakefields along atomic lattices in a crystal. Under a coupling condition the wakes, if excited, can accelerate channeling particles with TeV/m acceleration gradients in principle since the density of charge carriers (conduction electrons) in solids n0 = ~ 1020 – 1023 cm-3 is significantly higher than what can be obtained in gaseous plasma. Nanostructures have some advantages over crystals for channeling applications of high power beams. The dechanneling rate can be reduced and the beam acceptance increased by the large size of the channels. For beam-driven acceleration, a bunch length with a sufficient charge density would need to be in the range of the plasma wavelength to properly excite plasma wakefields, and channeled particle acceleration with the wakefields must occur before the ions in the lattices move beyond the restoring threshold. In the case of the excitation by short laser pulses, the dephasing length is appreciably increased with the larger channel, which enables channeled particles to gain sufficient amounts of energy. This paper describes simulation analyses on beam- and laser (X-ray)-driven accelerations in effective nanotube models obtained from Vsim and EPOCH codes. Experimental setups to detect wakefields are also outlined with accelerator facilities at Fermilab and NIU. In the FAST facility, the electron beamline was successfully commissioned at 50 MeV and it is being upgraded toward higher energies for electron accelerator R&D. The 50 MeV injector beamline of the facility is used for X-ray crystal-channeling radiation with a diamond target. It has been proposed to utilize the same diamond crystal for a channeling acceleration POC test. Another POC experiment is also designed for the NIU accelerator lab with time-resolved electron diffraction. Recently, a

  3. Point-of-care diagnosis of periodontitis using saliva: technically feasible but still a challenge

    Directory of Open Access Journals (Sweden)

    Suk eJi

    2015-09-01

    Full Text Available Periodontitis is a chronic inflammation of the periodontium caused by persistent bacterial infection that leads to the breakdown of connective tissue and bone. Because the ability to reconstruct the periodontium is limited after alveolar bone loss, early diagnosis and intervention should be the primary goals of periodontal treatment. However, periodontitis often progresses without noticeable symptoms, and many patients do not seek professional dental care until the periodontal destruction progresses to the point of no return. Furthermore, the current diagnosis of periodontitis depends on time-consuming clinical measurements. Therefore, there is an unmet need for near-patient testing to diagnose periodontitis. Saliva is an optimal biological fluid to serve as a near-patient diagnostic tool for periodontitis. Recent developments in point-of-care (POC testing indicate that a diagnostic test for periodontitis using saliva is now technically feasible. A number of promising salivary biomarkers associated with periodontitis have been reported. A panel of optimal biomarkers must be carefully selected based on the pathogenesis of periodontitis. The biggest hurdle for the POC diagnosis of periodontitis using saliva may be the process of validation in a large, diverse patient population. Therefore, we propose the organization of an International Consortium for Biomarkers of Periodontitis, which will gather efforts to identify, select, and validate salivary biomarkers for the diagnosis of periodontitis.

  4. Utility of the point of care CD4 analyzer, PIMA, to enumerate CD4 counts in the field settings in India

    Directory of Open Access Journals (Sweden)

    Thakar Madhuri

    2012-09-01

    Full Text Available Abstract Background In resource limited settings non-availability of CD4 count facility at the site could adversely affect the ART roll out programme. Point of care CD4 enumerating equipments can make the CD4 count available at the site of care and improve the patients’ management considerably. This study is aimed at determining the utility of a Point of Care PIMA CD4 analyzer (Alere, Germany in the field settings in India. Method The blood samples were collected from 1790 participants at 21 ART centers from different parts of the country and tested using PIMA and the reference methods (FACSCalibur, FACSCount and CyFlow SL3. The paired finger prick and venous blood samples from 175 participants were tested by the PIMA CD4 Analyzer and then by FACSCalibur. Result The CD4 counts obtained by PIMA CD4 analyzer showed excellent correlation with the counts obtained by the reference methods; for venous blood the Pearson’s r was 0.921, p 500 cells/mm3, the differences in the median CD4 counts obtained by the reference method and the PIMA analyzer were not significant (P > 0.05 and the relative bias were low (−7 to 5.1%. The Intermachine comparison showed variation within the acceptable limit of%CV of 10%. Conclusion In the field settings, the POC PIMA CD4 analyzer gave CD4 counts comparable to the reference methods for all CD4 ranges. The POC equipment could identify the patients eligible for ART in 91% cases. Adequate training is necessary for finger prick sample collection for optimum results. Decentralization of CD4 testing by making the CD4 counts available at primary health centers, especially in remote areas with minimum or no infrastructure would reduce the missed visits and improve adherence of the patients.

  5. The 3C study: coverage cost and care of type 1 diabetes in China--study design and implementation.

    Science.gov (United States)

    McGuire, Helen; Kissimova-Skarbek, Katarzyna; Whiting, David; Ji, Linong

    2011-11-01

    To describe coverage, cost and care of type 1 diabetes (T1D) in 2 regions of China--Beijing and Shantou--including: This is a mixed-methods descriptive study with three arms--coverage, cost and care. It is taking place in 4 tertiary hospitals, 3 secondary hospitals and 4 primary health facilities in Beijing, and 2 tertiary hospitals, 2 secondary hospitals and 2 primary health centres in Shantou, China. Two additional hospitals are involved in the coverage arm of the study. T1D participants are recruited from a 3-year list generated by each hospital and from those attending the outpatient clinic or admitted to the inpatient ward. Participants also include health care professionals and government officials. To determine coverage of care, a list of people with T1D is being developed including information on diagnosis, age, sex and vital status. The age and sex distribution will be compared with the expected distribution. To estimate the economic burden of T1D three groups of costs will be calculated - direct medical costs, direct non-medical costs and indirect costs from different perspectives of analysis (patients and their families, health system, insurer and societal perspective). The data are being collected from people with T1D (patient-parents face-to-face interviews), hospital billing departments, medical records and government officials using a combined "top-down, bottom-up" approach developed to validate the data. Quality of life is assessed using the EQ-5D tool and burden of disease is measured based on clinical outcomes and complications. Standard care will be defined, costed and compared to the cost of current care identified within the study to determine the investment required to improve outcomes. The third arm includes three components - health policy, clinical care and education, and information management. Face-to-face, semi-structured interviews are conducted with people with T1D (for those implementation considerations were identified early in the

  6. Diagnostic accuracy of a prototype point-of-care test for ocular Chlamydia trachomatis under field conditions in The Gambia and Senegal.

    Directory of Open Access Journals (Sweden)

    Emma M Harding-Esch

    2011-08-01

    Full Text Available The clinical signs of active trachoma are often present in the absence of ocular Chlamydia trachomatis infection in low prevalence and mass treated settings. Treatment decisions are currently based on the prevalence of clinical signs, and this may result in the unnecessary distribution of mass antibiotic treatment. We aimed to evaluate the diagnostic accuracy of a prototype point-of-care (POC test, developed for field diagnosis of ocular C. trachomatis, in low prevalence settings of The Gambia and Senegal.Three studies were conducted, two in The Gambia and one in Senegal. Children under the age of 10 years were screened for the clinical signs of trachoma. Two ocular swabs were taken from the right eye. The first swab was tested by the POC test in the field and the result independently graded by two readers. The second swab was tested for the presence of C. trachomatis by Amplicor Polymerase Chain Reaction. In Senegal, measurements of humidity and temperature in the field were taken. A total of 3734 children were screened, 950 in the first and 1171 in the second Gambian study, and 1613 in Senegal. The sensitivity of the prototype POC test ranged between 33.3-67.9%, the specificity between 92.4-99.0%, the positive predictive value between 4.3-21.0%, and the negative predictive value between 98.0-99.8%. The rate of false-positives increased markedly at temperatures above 31.4°C and relative humidities below 11.4%.In its present format, this prototype POC test is not suitable for field diagnosis of ocular C. trachomatis as its specificity decreases in hot and dry conditions: the environment in which trachoma is predominantly found. In the absence of a suitable test for infection, trachoma diagnosis remains dependent on clinical signs. Under current WHO recommendations, this is likely resulting in the continued mass treatment of non-infected communities.

  7. Hands-free cytometry of whole blood : controlled antibody release from hydrogels for on-chip cell staining

    NARCIS (Netherlands)

    Zhang, Xichen

    2017-01-01

    Point-of-care (POC) diagnostics are designed for use at or near the patient. Shifting complex diagnostics performed in centralized laboratories to robust and easy-to-use POC diagnostics can reduce cost and time needed for tests, allow early detection of diseases for prompt treatment and extend care

  8. Estimating Implementation and Operational Costs of an Integrated Tiered CD4 Service including Laboratory and Point of Care Testing in a Remote Health District in South Africa

    Science.gov (United States)

    Cassim, Naseem; Coetzee, Lindi M.; Schnippel, Kathryn; Glencross, Deborah K.

    2014-01-01

    Background An integrated tiered service delivery model (ITSDM) has been proposed to provide ‘full-coverage’ of CD4 services throughout South Africa. Five tiers are described, defined by testing volumes and number of referring health-facilities. These include: (1) Tier-1/decentralized point-of-care service (POC) in a single site; Tier-2/POC-hub servicing processing 600 samples/day and serving >100 or >200 health-clinics, respectively. The objective of this study was to establish costs of existing and ITSDM-tiers 1, 2 and 3 in a remote, under-serviced district in South Africa. Methods Historical health-facility workload volumes from the Pixley-ka-Seme district, and the total volumes of CD4 tests performed by the adjacent district referral CD4 laboratories, linked to locations of all referring clinics and related laboratory-to-result turn-around time (LTR-TAT) data, were extracted from the NHLS Corporate-Data-Warehouse for the period April-2012 to March-2013. Tiers were costed separately (as a cost-per-result) including equipment, staffing, reagents and test consumable costs. A one-way sensitivity analyses provided for changes in reagent price, test volumes and personnel time. Results The lowest cost-per-result was noted for the existing laboratory-based Tiers- 4 and 5 ($6.24 and $5.37 respectively), but with related increased LTR-TAT of >24–48 hours. Full service coverage with TAT cost-per-result of $32.32 and $15.88 respectively. A single district Tier-3 laboratory also ensured ‘full service coverage’ and Implementing a single Tier-3/community laboratory to extend and improve delivery of services in Pixley-ka-Seme, with an estimated local ∼12–24-hour LTR-TAT, is ∼$2 more than existing referred services per-test, but 2–4 fold cheaper than implementing eight Tier-2/POC-hubs or providing twenty-seven Tier-1/POCT CD4 services. PMID:25517412

  9. Rapid and point-of-care tests for the diagnosis of Trichomonas vaginalis in women and men.

    Science.gov (United States)

    Gaydos, Charlotte A; Klausner, Jeffrey D; Pai, Nitika Pant; Kelly, Helen; Coltart, Cordelia; Peeling, Rosanna W

    2017-12-01

    Trichomonasvaginalis (TV) is a highly prevalent parasitic infection worldwide. It is associated with many adverse reproductive health outcomes. Many infections are asymptomatic and syndromic management leads to underdetection of TV. Traditional methods of TV detection such as wet preparation are insensitive. New rapid, point-of-care (POC) tests can enhance the diagnosis of trichomoniasis. The authors reviewed the literature and discuss older POC tests for TV detection, as well as the OSOM lateral flow test, the AmpliVue test, the Solana test and the GeneXpert test as well as the limitations of wet preparation and culture for detection of TV. The OSOM test is easy to perform, compared with other POC tests, and is Clinical Laboratory Improvement Amendments (CLIA)-waived, equipment-free, has sensitivities of 83%-86% compared with nucleic acid amplification tests (NAATs) and can be performed in 15 min. The AmpliVue and the Solana tests are not CLIA waived and require small pieces of equipment. They are molecular amplified assays and can be completed in TV test for women and men is a moderately complex test, requires a small platform and can be performed in women and one is available for detection of TV in men. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. Emergency medical technician-performed point-of-care blood analysis using the capillary blood obtained from skin puncture.

    Science.gov (United States)

    Kim, Changsun; Kim, Hansol

    2017-12-09

    Comparing a point-of-care (POC) test using the capillary blood obtained from skin puncture with conventional laboratory tests. In this study, which was conducted at the emergency department of a tertiary care hospital in April-July 2017, 232 patients were enrolled, and three types of blood samples (capillary blood from skin puncture, arterial and venous blood from blood vessel puncture) were simultaneously collected. Each blood sample was analyzed using a POC analyzer (epoc® system, USA), an arterial blood gas analyzer (pHOx®Ultra, Nova biomedical, USA) and venous blood analyzers (AU5800, DxH2401, Beckman Coulter, USA). Twelve parameters were compared between the epoc and reference analyzers, with an equivalence test, Bland-Altman plot analysis and linear regression employed to show the agreement or correlation between the two methods. The pH, HCO 3 , Ca 2+ , Na + , K + , Cl - , glucose, Hb and Hct measured by the epoc were equivalent to the reference values (95% confidence interval of mean difference within the range of the agreement target) with clinically inconsequential mean differences and narrow limits of agreement. All of them, except pH, had clinically acceptable agreements between the two methods (results within target value ≥80%). Of the remaining three parameters (pCO 2, pO 2 and lactate), the epoc pCO 2 and lactate values were highly correlated with the reference device values, whereas pO 2 was not. (pCO 2 : R 2 =0.824, y=-1.411+0.877·x; lactate: R 2 =0.902, y=-0.544+0.966·x; pO 2 : R 2 =0.037, y=61.6+0.431·x). Most parameters, except only pO 2 , measured by the epoc were equivalent to or correlated with those from the reference method. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Feasibility test of a UK-scalable electronic system for regular collection of patient-reported outcome measures and linkage with clinical cancer registry data: The electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system

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    Velikova Galina

    2011-10-01

    Full Text Available Abstract Background Cancer survivors can face significant physical and psychosocial challenges; there is a need to identify and predict which survivors experience what sorts of difficulties. As highlighted in the UK National Cancer Survivorship Initiative, routine post-diagnostic collection of patient reported outcome measures (PROMs is required; to be most informative, PROMs must be linked and analysed with patients' diagnostic and treatment information. We have designed and built a potentially cost-efficient UK-scalable electronic system for collecting PROMs via the internet, at regular post-diagnostic time-points, for linking these data with patients' clinical data in cancer registries, and for electronically managing the associated patient monitoring and communications; the electronic Patient-reported Outcomes from Cancer Survivors (ePOCS system. This study aims to test the feasibility of the ePOCS system, by running it for 2 years in two Yorkshire NHS Trusts, and using the Northern and Yorkshire Cancer Registry and Information Service. Methods/Design Non-metastatic breast, colorectal and prostate cancer patients (largest survivor groups, within 6 months post-diagnosis, will be recruited from hospitals in the Yorkshire Cancer Network. Participants will be asked to complete PROMS, assessing a range of health-related quality-of-life outcomes, at three time-points up to 15 months post-diagnosis, and subsequently to provide opinion on the ePOCS system via a feedback questionnaire. Feasibility will be examined primarily in terms of patient recruitment and retention rates, the representativeness of participating patients, the quantity and quality of collected PROMs data, patients' feedback, the success and reliability of the underpinning informatics, and the system running costs. If sufficient data are generated during system testing, these will be analysed to assess the health-related quality-of-life outcomes reported by patients, and to explore

  12. Feasibility Studies of Palm Oil Mill Waste Aggregates for the Construction Industry

    Directory of Open Access Journals (Sweden)

    Jegathish Kanadasan

    2015-09-01

    Full Text Available The agricultural industry in Malaysia has grown rapidly over the years. Palm oil clinker (POC is a byproduct obtained from the palm oil industry. Its lightweight properties allows for its utilization as an aggregate, while in powder form as a filler material in concrete. POC specimens obtained throughout each state in Malaysia were investigated to evaluate the physical, chemical, and microstructure characteristics. Variations between each state were determined and their possible contributory factors were assessed. POC were incorporated as a replacement material for aggregates and their engineering characteristics were ascertained. Almost 7% of density was reduced with the introduction of POC as aggregates. A sustainability assessment was made through greenhouse gas emission (GHG and cost factor analyses to determine the contribution of the addition of POC to the construction industry. Addition of POC helps to lower the GHG emission by 9.6% compared to control specimens. By channeling this waste into the construction industry, an efficient waste-management system can be promoted; thus, creating a cleaner environment. This study is also expected to offer some guides and directions for upcoming research works on the incorporation of POC.

  13. Feasibility Studies of Palm Oil Mill Waste Aggregates for the Construction Industry

    Science.gov (United States)

    Kanadasan, Jegathish; Ahmad Fauzi, Auni Filzah; Abdul Razak, Hashim; Selliah, Paramananthan; Subramaniam, Vijaya; Yusoff, Sumiani

    2015-01-01

    The agricultural industry in Malaysia has grown rapidly over the years. Palm oil clinker (POC) is a byproduct obtained from the palm oil industry. Its lightweight properties allows for its utilization as an aggregate, while in powder form as a filler material in concrete. POC specimens obtained throughout each state in Malaysia were investigated to evaluate the physical, chemical, and microstructure characteristics. Variations between each state were determined and their possible contributory factors were assessed. POC were incorporated as a replacement material for aggregates and their engineering characteristics were ascertained. Almost 7% of density was reduced with the introduction of POC as aggregates. A sustainability assessment was made through greenhouse gas emission (GHG) and cost factor analyses to determine the contribution of the addition of POC to the construction industry. Addition of POC helps to lower the GHG emission by 9.6% compared to control specimens. By channeling this waste into the construction industry, an efficient waste-management system can be promoted; thus, creating a cleaner environment. This study is also expected to offer some guides and directions for upcoming research works on the incorporation of POC. PMID:28793579

  14. Feasibility Studies of Palm Oil Mill Waste Aggregates for the Construction Industry.

    Science.gov (United States)

    Kanadasan, Jegathish; Fauzi, Auni Filzah Ahmad; Razak, Hashim Abdul; Selliah, Paramananthan; Subramaniam, Vijaya; Yusoff, Sumiani

    2015-09-22

    The agricultural industry in Malaysia has grown rapidly over the years. Palm oil clinker (POC) is a byproduct obtained from the palm oil industry. Its lightweight properties allows for its utilization as an aggregate, while in powder form as a filler material in concrete. POC specimens obtained throughout each state in Malaysia were investigated to evaluate the physical, chemical, and microstructure characteristics. Variations between each state were determined and their possible contributory factors were assessed. POC were incorporated as a replacement material for aggregates and their engineering characteristics were ascertained. Almost 7% of density was reduced with the introduction of POC as aggregates. A sustainability assessment was made through greenhouse gas emission (GHG) and cost factor analyses to determine the contribution of the addition of POC to the construction industry. Addition of POC helps to lower the GHG emission by 9.6% compared to control specimens. By channeling this waste into the construction industry, an efficient waste-management system can be promoted; thus, creating a cleaner environment. This study is also expected to offer some guides and directions for upcoming research works on the incorporation of POC.

  15. Health care sensor--based systems for point of care monitoring and diagnostic applications: a brief survey.

    Science.gov (United States)

    Tsakalakis, Michail; Bourbakis, Nicolaos G

    2014-01-01

    Continuous, real-time remote monitoring through medical point--of--care (POC) systems appears to draw the interest of the scientific community for healthcare monitoring and diagnostic applications the last decades. Towards this direction a significant merit has been due to the advancements in several scientific fields. Portable, wearable and implantable apparatus may contribute to the betterment of today's healthcare system which suffers from fundamental hindrances. The number and heterogeneity of such devices and systems regarding both software and hardware components, i.e sensors, antennas, acquisition circuits, as well as the medical applications that are designed for, is impressive. Objective of the current study is to present the major technological advancements that are considered to be the driving forces in the design of such systems, to briefly state the new aspects they can deliver in healthcare and finally, the identification, categorization and a first level evaluation of them.

  16. Metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes: a correlational study.

    Science.gov (United States)

    Greene, Maia Stoker; Mandleco, Barbara; Roper, Susanne Olsen; Marshall, Elaine S; Dyches, Tina

    2010-01-01

    The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. The mean for A1C values was 8.5%; the mean for overall self-care behaviors was 4.93 (5 = usually). Participants rated themselves highest on the self-care behaviors of giving insulin shots when indicated and adjusting insulin when eating a lot. They ranked themselves lowest on eating a low-fat diet and testing urine for ketones. Parents tended to be more authoritative in their approaches to parenting than either authoritarian or permissive. A significant relationship was found between authoritative mothering and adolescent self-care behaviors and metabolic control. Regression analyses controlling for age and length of time with diabetes confirmed the significance of these relationships. Authoritative fathering positively correlated with the self-care behaviors of monitoring blood glucose, taking insulin, and not skipping meals. A relationship was also noted between permissive parenting by mothers/fathers and poorer metabolic outcomes. However, the permissive parenting correlations did not remain significant when controlling for age and length of time with diabetes. Clinicians may help prevent declining participation in self-care behaviors and metabolic control in adolescents with type 1 diabetes by working with parents, particularly mothers, and encouraging authoritative parenting.

  17. A STUDY OF RECOVERING A REED ECOSYSTEM USING POROUS CONCRETE IN THE LAKE BIWA SHORE

    Science.gov (United States)

    Takeda, Naho; Kato, Hayato; Okamoto, Takahisa; Kojima, Takayuki

    In this study, reed planting tests were carried out at the Biyo-center, an experiment station on the Lake Biwa shore, in order to evaluate the feasibility of a planting method with porous concrete (PoC method). Reed planting tests with coconut-fiber mats (mat method), which were generally used around Lake Biwa, were simultaneously carried out to compare with the PoC method. The reeds planted by the PoC method grew better than the ones planted by the mat method, and the number of reeds which were washed away by waves was smaller than that planted by the mat method. The result of the observation of reeds planted in the PoC showed plant maturation, and reeds could ta ke root into the PoC without interference with the voids of the PoC. As a result, it was shown that the reed planting tests with the PoC method was simple and effective, so it would become in harmony with the environment around Lake Biwa.

  18. Human anti-HIV IgM detection by the OraQuick ADVANCE® Rapid HIV 1/2 Antibody Test.

    Science.gov (United States)

    Guillon, Geraldine; Yearwood, Graham; Snipes, Casey; Boschi, Daniel; Reed, Michael R

    2018-01-01

    The Centers for Disease Control and Prevention (CDC) and many public health jurisdictions continue to advocate for the most sensitive rapid HIV test that is available. Currently, the recommendation is to utilize tests that can detect HIV infection biomarkers within 30 days of infection, when initial immune responses are mounted. The infected patient's IgM response is often used to detect acute infection within a 20-25 days window after infection. This requirement applies to lab-based testing with automated analyzers and rapid, point of care (POC) testing used for screening in a non-clinical setting. A recent study has demonstrated that POC tests using a Protein A-based detection system can detect samples with predominantly HIV-1 IgM reactivity (Moshgabadi et al., 2015). The OraQuick ADVANCE ® Rapid HIV-1/2 Antibody Test (OraQuick ADVANCE ®) also uses Protein A as the detection protein in the antibody-binding colloidal gold conjugate, so it is expected that the OraQuick ADVANCE ® Test will also detect samples with predominantly IgM reactivity. This report definitively demonstrates that the OraQuick ADVANCE ® Test can detect IgM antibodies during an acute infection window period of approximately 20-25 days after infection, and is therefore suitable for use in testing environments requiring adherence to current CDC recommendations.

  19. Implementation of antimicrobial peptides for sample preparation prior to nucleic acid amplification in point-of-care settings.

    Science.gov (United States)

    Krõlov, Katrin; Uusna, Julia; Grellier, Tiia; Andresen, Liis; Jevtuševskaja, Jekaterina; Tulp, Indrek; Langel, Ülo

    2017-12-01

    A variety of sample preparation techniques are used prior to nucleic acid amplification. However, their efficiency is not always sufficient and nucleic acid purification remains the preferred method for template preparation. Purification is difficult and costly to apply in point-of-care (POC) settings and there is a strong need for more robust, rapid, and efficient biological sample preparation techniques in molecular diagnostics. Here, the authors applied antimicrobial peptides (AMPs) for urine sample preparation prior to isothermal loop-mediated amplification (LAMP). AMPs bind to many microorganisms such as bacteria, fungi, protozoa and viruses causing disruption of their membrane integrity and facilitate nucleic acid release. The authors show that incubation of E. coli with antimicrobial peptide cecropin P1 for 5 min had a significant effect on the availability of template DNA compared with untreated or even heat treated samples resulting in up to six times increase of the amplification efficiency. These results show that AMPs treatment is a very efficient sample preparation technique that is suitable for application prior to nucleic acid amplification directly within biological samples. Furthermore, the entire process of AMPs treatment was performed at room temperature for 5 min thereby making it a good candidate for use in POC applications.

  20. Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department.

    Science.gov (United States)

    Stolz, Lori A; Muruganandan, Krithika M; Bisanzo, Mark C; Sebikali, Mugisha J; Dreifuss, Bradley A; Hammerstedt, Heather S; Nelson, Sara W; Nayabale, Irene; Adhikari, Srikar; Shah, Sachita P

    2015-08-01

    To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound. The use of point-of-care ultrasound was taught to emergency care providers through lectures, bedsides teaching and hands-on practical sessions. Lectures were tailored to care providers' knowledge base and available therapeutic means. Every ultrasound examination performed by these providers was recorded over 4.5 years. Findings of these examinations were categorised as positive, negative, indeterminate or procedural. Other radiologic studies ordered over this same time period were also recorded. A total of 22,639 patients were evaluated in the emergency department by emergency care providers, and 2185 point-of-care ultrasound examinations were performed on 1886 patients. Most commonly used were the focused assessment with sonography in trauma examination (53.3%) and echocardiography (16.4%). Point-of-care ultrasound studies were performed more frequently than radiology department-performed studies. Positive findings were documented in 46% of all examinations. We describe a novel curriculum for point-of-care ultrasound education of non-physician emergency practitioners in a resource-limited setting. These non-physician clinicians integrated ultrasound into clinical practice and utilised this imaging modality more frequently than traditional radiology department imaging with a large proportion of positive findings. © 2015 John Wiley & Sons Ltd.

  1. Satellite observation of particulate organic carbon dynamics in ...

    Science.gov (United States)

    Particulate organic carbon (POC) plays an important role in coastal carbon cycling and the formation of hypoxia. Yet, coastal POC dynamics are often poorly understood due to a lack of long-term POC observations and the complexity of coastal hydrodynamic and biogeochemical processes that influence POC sources and sinks. Using field observations and satellite ocean color products, we developed a nw multiple regression algorithm to estimate POC on the Louisiana Continental Shelf (LCS) from satellite observations. The algorithm had reliable performance with mean relative error (MRE) of ?40% and root mean square error (RMSE) of ?50% for MODIS and SeaWiFS images for POC ranging between ?80 and ?1200 mg m23, and showed similar performance for a large estuary (Mobile Bay). Substantial spatiotemporal variability in the satellite-derived POC was observed on the LCS, with high POC found on the inner shelf (satellite data with carefully developed algorithms can greatly increase

  2. Implementation of Syndromic Surveillance Systems in Two Rural Villages in Senegal.

    Science.gov (United States)

    Abat, Cédric; Colson, Philippe; Chaudet, Hervé; Rolain, Jean-Marc; Bassene, Hubert; Diallo, Aldiouma; Mediannikov, Oleg; Fenollar, Florence; Raoult, Didier; Sokhna, Cheikh

    2016-12-01

    Infectious diseases still represent a major challenge for humanity. In this context, their surveillance is critical. From 2010 to 2016, two Point-Of-Care (POC) laboratories have been successfully implemented in the rural Saloum region of Senegal. In parallel, a homemade syndromic surveillance system called EPIMIC was implemented to monitor infectious diseases using data produced by the POC laboratory of the Timone hospital in Marseille, France. The aim of this study is to describe the steps necessary for implementing EPIMIC using data routinely produced by two POC laboratories (POC-L) established in rural Senegal villages. After improving EPIMIC, we started to monitor the 15 pathogens routinely diagnosed in the two POC-L using the same methodology we used in France. In 5 years, 2,577 deduplicated patients-samples couples from 775 different patients have been tested in the Dielmo and Ndiop POC-L. 739 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the Dielmo and Ndiop POC data with EPIMIC allowed to generate 443 alarms. Since January 2016, 316 deduplicated patients-samples couples collected from 298 different patients were processed in the Niakhar POC laboratory. 56 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the data of the Niakhar POC laboratory with EPIMIC allowed to generate 14 alarms. Although some improvements are still needed, EPIMIC has been successfully spread using data routinely produced by two rural POC-L in Senegal, West Africa.

  3. Implementation of Syndromic Surveillance Systems in Two Rural Villages in Senegal.

    Directory of Open Access Journals (Sweden)

    Cédric Abat

    2016-12-01

    Full Text Available Infectious diseases still represent a major challenge for humanity. In this context, their surveillance is critical. From 2010 to 2016, two Point-Of-Care (POC laboratories have been successfully implemented in the rural Saloum region of Senegal. In parallel, a homemade syndromic surveillance system called EPIMIC was implemented to monitor infectious diseases using data produced by the POC laboratory of the Timone hospital in Marseille, France. The aim of this study is to describe the steps necessary for implementing EPIMIC using data routinely produced by two POC laboratories (POC-L established in rural Senegal villages. After improving EPIMIC, we started to monitor the 15 pathogens routinely diagnosed in the two POC-L using the same methodology we used in France. In 5 years, 2,577 deduplicated patients-samples couples from 775 different patients have been tested in the Dielmo and Ndiop POC-L. 739 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the Dielmo and Ndiop POC data with EPIMIC allowed to generate 443 alarms. Since January 2016, 316 deduplicated patients-samples couples collected from 298 different patients were processed in the Niakhar POC laboratory. 56 deduplicated patients-samples couples were found to be positive to at least one of the tested pathogens. The retrospective analysis of the data of the Niakhar POC laboratory with EPIMIC allowed to generate 14 alarms. Although some improvements are still needed, EPIMIC has been successfully spread using data routinely produced by two rural POC-L in Senegal, West Africa.

  4. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices

    Directory of Open Access Journals (Sweden)

    Bart Verhees

    2017-12-01

    Full Text Available Point-of-care testing (POCT—laboratory tests performed with new mobile devices and online technologies outside of the central laboratory—is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP’s network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  5. Care Model Design for E-Health: Integration of Point-of-Care Testing at Dutch General Practices.

    Science.gov (United States)

    Verhees, Bart; van Kuijk, Kees; Simonse, Lianne

    2017-12-21

    Point-of-care testing (POCT)-laboratory tests performed with new mobile devices and online technologies outside of the central laboratory-is rapidly outpacing the traditional laboratory test market, growing at a rate of 12 to 15% each year. POCT impacts the diagnostic process of care providers by yielding high efficiency benefits in terms of turnaround time and related quality improvements in the reduction of errors. However, the implementation of this disruptive eHealth technology requires the integration and transformation of diagnostic services across the boundaries of healthcare organizations. Research has revealed both advantages and barriers of POCT implementations, yet to date, there is no business model for the integration of POCT within general practice. The aim of this article is to contribute with a design for a care model that enables the integration of POCT in primary healthcare. In this research, we used a design modelling toolkit for data collection at five general practices. Through an iterative design process, we modelled the actors and value transactions, and designed an optimized care model for the dynamic integration of POCTs into the GP's network of care delivery. The care model design will have a direct bearing on improving the integration of POCT through the connectivity and norm guidelines between the general practice, the POC technology, and the diagnostic centre.

  6. Trends in the use of perioperative chemotherapy for localized and locally advanced muscle-invasive bladder cancer: a sign of changing tides.

    Science.gov (United States)

    Reardon, Zachary D; Patel, Sanjay G; Zaid, Harras B; Stimson, C J; Resnick, Matthew J; Keegan, Kirk A; Barocas, Daniel A; Chang, Sam S; Cookson, Michael S

    2015-01-01

    Despite the documented survival benefit conferred by neoadjuvant (NAC) and adjuvant chemotherapy (AC), there has been a slow adoption of guideline recommendations for the use of perioperative chemotherapy (POC) in patients with muscle-invasive bladder cancer (MIBC). To evaluate temporal trends in POC utilization and identify factors influencing POC delivery in a representative cohort of patients with MIBC. Retrospective cohort study identifying factors associated with receipt of POC and evaluating temporal changes in NAC and AC utilization. We included patients from the National Cancer Data Base (NCDB) with no prior malignancy who ultimately underwent radical cystectomy for ≥ cT2/cN0/cM0 MIBC between 2006 and 2010. Relationships between demographic and hospital factors and the likelihood of receiving POC were evaluated using Pearson chi-square and Wilcoxon rank-sum tests, and multivariable logistic regression. Temporal changes in NAC and AC use were detected using a linear test of trend. A total of 5692 patients met our inclusion criteria. POC use increased from 29.5% in 2006 to 39.8% in 2010 (p < 0.001). NAC use increased from 10.1% in 2006 to 20.8% in 2010 (p = 0.005); AC remained stable between 18.1% and 21.3% (p = 0.68). Multivariable modeling revealed advanced age, increasing comorbidity, lack of insurance, increased travel distance, geographic location outside the northeastern United States, and lower income as negatively associated with POC receipt (all p < 0.05). Limitations include retrospective design and potential sampling bias, excluding patients treated at non-NCDB facilities. POC use for MIBC increased from 2006 to 2010, with this increase disproportionately due to rising NAC utilization. Nonetheless, there is persistent variation in the likelihood of receiving POC secondary to nonclinical factors. When retrospectively analyzing a representative cohort of patients undergoing radical cystectomy for muscle-invasive bladder cancer between 2006 and 2010

  7. Point-of-care technologies for molecular diagnostics using a drop of blood.

    Science.gov (United States)

    Song, Yujun; Huang, Yu-Yen; Liu, Xuewu; Zhang, Xiaojing; Ferrari, Mauro; Qin, Lidong

    2014-03-01

    Molecular diagnostics is crucial for prevention, identification, and treatment of disease. Traditional technologies for molecular diagnostics using blood are limited to laboratory use because they rely on sample purification and sophisticated instruments, are labor and time intensive, expensive, and require highly trained operators. This review discusses the frontiers of point-of-care (POC) diagnostic technologies using a drop of blood obtained from a finger prick. These technologies, including emerging biotechnologies, nanotechnologies, and microfluidics, hold the potential for rapid, accurate, and inexpensive disease diagnostics. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Comparative study of 2 oral care protocols in intensive care units.

    Science.gov (United States)

    Ory, Jérôme; Raybaud, Evelyne; Chabanne, Russell; Cosserant, Bernard; Faure, Jean Sébastien; Guérin, Renaud; Calvet, Laure; Pereira, Bruno; Mourgues, Charline; Guelon, Dominique; Traore, Ousmane

    2017-03-01

    The quality of oral care is important in limiting the emergence of ventilator-associated pneumonia (VAP) in intubated patients. Our main objective was to measure the quality improvement in oral care following the implementation of a new oral care protocol. We also monitored VAP rates. This was a cohort study of patients in 5 adult ICUs covering different specialties. During period 1, caregivers used a foam stick for oral care and during period 2 a stick and tooth brushing with aspiration. Oral chlorhexidine was used during both periods. The caregivers rated improvement in oral health on the basis of 4 criteria (tongue, mucous membranes, gingivae, and teeth). Caregiver satisfaction was also assessed. The incidence of VAP was monitored. A total of 2,030 intubated patients admitted to intensive care units benefited from oral care. The patient populations during the 2 periods were similar with regard to demographic data and VAP potential risk factors. Oral health was significantly better from the third day of oral care in period 2 onward (period 1, 6.4 ± 2.1; period 2, 5.6 ± 1.8; P = .043). Caregivers found the period 2 protocol easier to implement and more effective. VAP rates decreased significantly between the 2 periods (period 1, 12.8%; period 2, 8.5%; P = .002). Our study showed that the implementation of a simple strategy improved the quality of oral care of patients in intensive care units, and decreased VAP rates. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Rural providers' access to online resources: a randomized controlled trial

    Science.gov (United States)

    Hall, Laura J.; McElfresh, Karen R.; Warner, Teddy D.; Stromberg, Tiffany L.; Trost, Jaren; Jelinek, Devin A.

    2016-01-01

    Objective The research determined the usage and satisfaction levels with one of two point-of-care (PoC) resources among health care providers in a rural state. Methods In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants' attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA), paired t tests, and Cohen's d statistic to compare pre- and post-study effects sizes. Results Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to “about right amounts of information” at the completion of the study. DynaMed users reported a Cohen's d increase of +1.50 compared to AccessMedicine users' reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen's d. Conclusion Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine. PMID:26807050

  10. Point-of-care coagulation monitoring: first clinical experience using a paper-based lateral flow diagnostic device.

    Science.gov (United States)

    Hegener, Michael A; Li, Hua; Han, Daewoo; Steckl, Andrew J; Pauletti, Giovanni M

    2017-09-01

    Vitamin K antagonists such as warfarin are the most widely used class of oral anticoagulants. Due to a narrow therapeutic window, patients on warfarin require regular monitoring. Self-testing using point-of-care (POC) diagnostic devices is available, but cost makes this monitoring method beyond reach for many. The main objective of this research was to assess the clinical utility of a low-cost, paper-based lateral flow POC diagnostic device developed for anticoagulation monitoring without the need for a separate electronic reader. Custom-fabricated lateral flow assay (LFA) test strips comprised of a glass fiber sample pad, a nitrocellulose analytical membrane, a cellulose wicking pad, and a plastic backing card were assembled in a plastic cassette. Healthy volunteers and patients on warfarin therapy were recruited for this prospective study. For each participant, a whole blood sample was collected via fingerstick to determine: (1) international normalized ratio (INR) using the CoaguChek® XS coagulometer, (2) hematocrit by centrifugation, and (3) red blood cell (RBC) travel distance on the experimental LFA device after 240 s using digital image analysis. RBC travel distance measured on the LFA device using blood samples obtained from warfarin patients positively correlated with increasing INR value and the LFA device had the capability to statistically distinguish between healthy volunteer INR values and those for patients groups with INR ≥ 2.6. From these data, it is predicted that this low-cost, paper-based LFA device can have clinical utility for identifying anticoagulated patients taking vitamin K antagonists who are outside of the desired therapeutic efficacy window.

  11. Coverage of HIV prevention components among people with long-standing diagnosed HIV infection in El Salvador.

    Science.gov (United States)

    Jacobson, Jerry O; Creswell, Jacob; Guardado, Maria Elena; Lee, Janet C; Isabel Nieto, Ana; Paz-Bailey, Gabriela

    2012-09-01

    There is scarce information on prevention coverage and management of sexually transmitted infections (STIs) in people with HIV in resource-limited settings. Six hundred eighty nine sexually active people diagnosed with HIV ≥12 months before the study, including 110 men who have sex with men, 237 heterosexual men, and 342 women, were recruited from HIV support groups and hospitals in El Salvador and completed self-administered computer-assisted questionnaires and STI testing. Logistic models identified correlates of exposure to posttest counseling (POC) and subsequent prevention interventions (PIs). Past-year transmission risk factors included unprotected sex with noncommercial partners (28.7%), having multiple sex partners (76.4%), a casual sex partner (31.4%), selling (3.5%) and purchasing sex (6.4%), herpes simplex virus type 2 (86.3%), and treatable STIs (18.6%). Men who have sex with men reported more recent casual partners, sex work, and alcohol and drug use than other subgroups. POC (22.8%), PIs (31.3%), and access to advice and information regarding HIV at the point of HIV care (24.1%) were limited. Of subjects with past-year STI symptoms (N = 267), 44.1% had sought medical attention. In multivariate analysis, POC was negatively associated with multiple partners. PI was associated with self-initiated testing, treatable STIs, and female sex. Both outcomes were associated with HIV-related discrimination outside of the health services context. Coverage of POC, PIs, and treatment-seeking for STI symptoms was low among individuals with diagnosed HIV infection, although most were in regular contact with care and treatment. Prevention programs at testing and treatment sites should be intensified and should incorporate risk behavior screening to improve targeting.

  12. Cellphone-based hand-held microplate reader for point-of-care ELISA testing (Conference Presentation)

    Science.gov (United States)

    Berg, Brandon; Cortazar, Bingen; Tseng, Derek; Ozkan, Haydar; Feng, Steve; Wei, Qingshan; Chan, Raymond Y.; Burbano, Jordi; Farooqui, Qamar; Lewinski, Michael; Di Carlo, Dino; Garner, Omai B.; Ozcan, Aydogan

    2016-03-01

    Enzyme-linked immunosorbent assay (ELISA) in a microplate format has been a gold standard first-line clinical test for diagnosis of various diseases including infectious diseases. However, this technology requires a relatively large and expensive multi-well scanning spectrophotometer to read and quantify the signal from each well, hindering its implementation in resource-limited-settings. Here, we demonstrate a cost-effective and handheld smartphone-based colorimetric microplate reader for rapid digitization and quantification of immunoserology-related ELISA tests in a conventional 96-well plate format at the point of care (POC). This device consists of a bundle of 96 optical fibers to collect the transmitted light from each well of the microplate and direct all the transmission signals from the wells onto the camera of the mobile-phone. Captured images are then transmitted to a remote server through a custom-designed app, and both quantitative and qualitative diagnostic results are returned back to the user within ~1 minute per 96-well plate by using a machine learning algorithm. We tested this mobile-phone based micro-plate reader in a clinical microbiology lab using FDA-approved mumps IgG, measles IgG, and herpes simplex virus IgG (HSV-1 and HSV-2) ELISA tests on 1138 remnant patient samples (roughly 50% training and 50% testing), and achieved an overall accuracy of ~99% or higher for each ELISA test. This handheld and cost-effective platform could be immediately useful for large-scale vaccination monitoring in low-infrastructure settings, and also for other high-throughput disease screening applications at POC.

  13. Impact of Rapid Susceptibility Testing and Antibiotic Selection Strategy on the Emergence and Spread of Antibiotic Resistance in Gonorrhea.

    Science.gov (United States)

    Tuite, Ashleigh R; Gift, Thomas L; Chesson, Harrell W; Hsu, Katherine; Salomon, Joshua A; Grad, Yonatan H

    2017-11-27

    Increasing antibiotic resistance limits treatment options for gonorrhea. We examined the impact of a hypothetical point-of-care (POC) test reporting antibiotic susceptibility profiles on slowing resistance spread. A mathematical model describing gonorrhea transmission incorporated resistance emergence probabilities and fitness costs associated with resistance based on characteristics of ciprofloxacin (A), azithromycin (B), and ceftriaxone (C). We evaluated time to 1% and 5% prevalence of resistant strains among all isolates with the following: (1) empiric treatment (B and C), and treatment guided by POC tests determining susceptibility to (2) A only and (3) all 3 antibiotics. Continued empiric treatment without POC testing was projected to result in >5% of isolates being resistant to both B and C within 15 years. Use of either POC test in 10% of identified cases delayed this by 5 years. The 3 antibiotic POC test delayed the time to reach 1% prevalence of triply-resistant strains by 6 years, whereas the A-only test resulted in no delay. Results were less sensitive to assumptions about fitness costs and test characteristics with increasing test uptake. Rapid diagnostics reporting antibiotic susceptibility may extend the usefulness of existing antibiotics for gonorrhea treatment, but ongoing monitoring of resistance patterns will be critical. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  14. Insignificant enhancement of export flux in the highly productive subtropical front, east of New Zealand: a high resolution study of particle export fluxes based on 234Th: 238U disequilibria

    Directory of Open Access Journals (Sweden)

    J. A. Hall

    2012-03-01

    Full Text Available We evaluated the export fluxes of Particulate Organic Carbon (POC in the Subtropical Frontal zone (STF of the SW Pacific sector of the Southern Ocean. The site is characterized by enhanced primary productivity, which has been suggested to be stimulated through so-called natural iron fertilization processes where iron-depleted subantarctic water (SAW mixes with mesotrophic, iron-replete subtropical water (STW. We adopted the small-volume 234Th method to achieve the highest possible spatial sampling resolution in austral late autumn-early winter, May–June, 2008. Inventories of chlorophyll-a, particulate 234Th and POC observed in the upper 100 m were all elevated in the mid-salinity water type (34.5 34.8 salinity waters which were of STW origin with low macronutrients. However, Steady-State 234Th fluxes were similar across the salinity gradient being, 25 ± 0.78 ((1.5 ± 0.047 × 103 in the mid-salinity, and 29 ± 0.53 ((1.8 ± 0.032 × 103 and 22 ± 1.1 Bq m−2 d−1 ((1.3 ± 0.066 × 103 dpm m−2 d–1 in the high and low salinity waters respectively. Bottle POC/Th ratios at the depth of 100 m were used to convert 234Th fluxes into POC export fluxes. The derived POC flux did not appear to be enhanced in mid-salinity waters where the primary productivity was inferred to be the highest at the time of sampling, with a flux of 11 ± 0.45 mmol C m−2 d−1, compared to 14 ± 0.39 mmol C m−2 d−1 in high salinity waters and 8.5 ± 0.66 mmol C m−2 d−1 in low salinity waters. This study thus implied that natural iron fertilization does not necessarily lead to an enhancement of POC export in STF regions.

  15. Multi point of care instrument evaluation for use in anti-retroviral clinics in South Africa.

    Science.gov (United States)

    Gounden, Verena; George, Jaya

    2012-01-01

    South Africa has the largest prevalence of HIV infected individuals in the world. The introduction of point of care testing to anti-retroviral (ARV) clinic sites is hoped to fast track initiation of patients on ARVs and to allow for earlier recognition of adverse effects such as dyslipidaemia, renal and hepatic dysfunction. We evaluated six instruments for the following analytes: glucose, lactate, creatinine, cholesterol, triglycerides, HDL-cholesterol, alanine transaminase (ALT), and glycated haemoglobin. Comparisons with the central laboratory analyser were performed as well as precision studies. A scoring system was developed by the authors to evaluate the instruments in terms of analytical performance, cost, ease of use, and other operational characteristics. As one of the goals of the placement of these instruments was that their operation was simple enough to be used by non-laboratory staff, ease of use contributed a large proportion to the final scoring. Analytical performance of the POC analysers were generally similar, however, there were significant differences in operational characteristics and ease of use. Bias for the different analytes when compared to the laboratory analyser ranged from -27% to 14%. Calculated total errors for all analytes except for HDL cholesterol were within total allowable error recommendations. The two instruments (Roche Reflotron and Cholestech LDX) with the highest overall total points achieved the highest scores for ease of use. This pilot study has led to the development of a scoring system for the evaluation of POC instruments.

  16. Effects of environmental conditions on point-of-care cardiac biomarker test performance during a simulated rescue: implications for emergency and disaster response.

    Science.gov (United States)

    Louie, Richard F; Ferguson, William J; Curtis, Corbin M; Vy, John H; Tang, Chloe S; Kost, Gerald J

    2013-01-01

    To characterize the effects of environmental stress on point-of-care (POC) cardiac biomarker testing during a simulated rescue. Multiplex test cassettes for cardiac troponin I (cTnI), brain natriuretic peptide (BNP), CK-MB, myoglobin, and D-dimer were exposed to environmental stresses simulating a 24-hour rescue from Hawaii to the Marshall Islands and back. We used Tenney environmental chambers (T2RC and BTRC) to simulate flight conditions (20°C, 10 percent relative humidity) and ground conditions (22.3-33.9°C, 73-77 percent). We obtained paired measurements using stressed versus control (room temperature) cassettes at seven time points (T1-7 with T1,2,6,7 during flight and T3-5 on ground). We analyzed paired differences (stressed minus control) with Wilcoxon signed rank test. We assessed the impact on decision-making at clinical thresholds. cTnI results from stressed test cassettes (n = 10) at T4 (p 100 ng/L. With sample median concentration of 108 pg/mL, BNP results from stressed test cassettes differed significantly from controls (p < 0.05). Despite modest, short-term temperature elevation, environmental stresses led to erroneous results. False negative cTnI and BNP results potentially could miss acute myocardial infarction and congestive heart failure, confounded treatment, and increased mortality and morbidity. Therefore, rescuers should protect POC reagents from temperature extremes.

  17. Estimation of the optimal brachytherapy utilisation rate in the treatment of vaginal cancer and comparison with patterns of care

    International Nuclear Information System (INIS)

    Thompson, Stephen R.; Delaney, Geoff P.; Gabriel, Gabriel S.; Barton, Michael B.; Jacob, Susannah

    2012-01-01

    Having previously modelled the optimal proportion of uterine cervix and corpus cancers that should be treated with brachytherapy (BT), we aimed to complete the assessment of the role of BT for gynaecological cancers by estimating the optimal proportion of vaginal cancer cases that should be treated with BT, the optimal BT utilisation (BTU) rate for vaginal cancer. We compared this with actual vaginal BTU and assessed quality of BT for vaginal cancer by a Patterns-of-Care Study (POCS). Evidence-based guidelines were used to construct an optimal BTU decision tree for vaginal cancer. Searches of the epidemiological literature to ascertain the proportion of patients who fulfilled the criteria for BT were conducted. The robustness of the model was tested by sensitivity analyses and by peer review. A retrospective POCS of BT in New South Wales (NSW) for 2003 was conducted, and actual BTU for vaginal cancer was determined. Differences between optimal and actual BTU were assessed. Quality of BT for vaginal cancer was compared with published benchmarks. The optimal vaginal cancer BTU rate was estimated to be 85% (range 81–87%). In NSW in 2003, actual vaginal cancer BTU was only 42% (95% confidence interval 22–62%). In NSW, only nine patients were treated, all with intra-vaginal cylinders, and two of four to lower than recommended doses. BT for vaginal cancers is under utilised in NSW compared with the proposed optimal models of care. BT quality may have been suboptimal and this may relate to the rarity of this disease.

  18. Particulate organic carbon mass distribution at the Bermuda Atlantic Time-series Study (BATS) site

    Science.gov (United States)

    Gundersen, Kjell; Orcutt, Karen M.; Purdie, Duncan A.; Michaels, Anthony F.; Knap, Anthony H.

    Errors in total particulate organic carbon (total POC) measurements caused by particles settling in Niskin water samplers, loss of bacterial cells during filtration and undersampling of rare particles such as the diazotrophic cyanobacterium Trichodesmium spp. were investigated at the Bermuda Atlantic Time-series Study (BATS) site. Regular core samples of temperature, primary production, bacterial abundance, chlorophyll- a (Chl- a) and POC were collected at monthly intervals from 1991 to 1996. During this period of time, shorter investigations of particles settling in water samples (1991-1992), bacterial cells lost during filtration (1992-1993), and Trichodesmium abundance (1995-1996) were performed at the BATS site. The BATS site shows striking seasonal patterns in hydrography and phytoplankton primary productivity, with a strong maximum immediately following the deep winter mixing of the water column. Following the peak in primary production, bacterial abundance showed only slightly elevated levels in spring. Maxima of Chl- a and POC also were associated with the primary production peaks, but these particle concentrations became less pronounced through summer and fall. An average of 26% of total POC collected in Niskin water bottles settled below the spigot before it could be sampled. An average of 47% of all bacterial cells passed the nominal pore size of a Whatman GF/F filter, and total POC measurements generated from GF/F filtered seawater samples had to be corrected for this loss. The average integrated stocks of total POC in the upper 65 m of the water column was 32% pigmented phytoplankton, 15% microheterotrophs, 54% other detrital matter (32 : 15 : 54). Phytoplankton C equaled bacterial C in the 65-135 m depth range (16 : 19 : 65), but phytoplankton C was virtually non-existent deeper than 135 m (2 : 14 : 74). Bacterial C biomass was higher than phytoplankton in surface waters outside the spring bloom period, but carbon not accounted for by phytoplankton

  19. Nature and sources of suspended particulate organic matter in a tropical estuary during the monsoon and pre-monsoon: Insights from stable isotopes (delta 13C POC, delta 15 N TPN) and carbohydrate signature compounds

    Digital Repository Service at National Institute of Oceanography (India)

    Khodse, V.B.; Bhosle, N.B.

    zooplankton, and then known aliquots (0.25 to 1.5 L) were filtered through pre-combusted (450 °C, 4h) 47 mm GF/F filter papers (0.7 µm, Whatman) for the measurements of suspended particulate matter (SPM), particulate organic carbon (POC), δ13CPOC, δ15NTPN... analysis. 2.3. Determination of bulk parameters and stable isotopes GF/F (0.7 µm, 47 mm) filter containing particulate matter was washed with UV-Milli-Q- water to remove salt and the filter was dried at 40 °C for 24 h. Filter was cooled and weighed...

  20. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control.

    Science.gov (United States)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin; Lu, Tian Jian; Xu, Feng

    2016-09-07

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed "U shape" reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. A flexible mobile-device biosensing instrumentation platform for point-of-care medical diagnostics applications

    DEFF Research Database (Denmark)

    Patou, François; Pfreundt, Andrea; Zulfiqar, Azeem

    2014-01-01

    helping to address this challenge. Specifically, Lab-on-Chip (LoC) devices have a key role to play in the advent of Point-of-Care (PoC) medical applications, driving a shift of the medical diagnostics paradigm and the transition from a centralized, technical, high-throughput biological sample analysis...... programmable electrical readout from LoCs potentially comprehending varied transducers addressing different targeted biological markers. A smart-phone/tablet docking-station embeds the hardware interface necessary for the implementation of a smart-phone digital lock-in amplifier. The platform is tested...

  2. Point-of-care washing of allogeneic red blood cells for the prevention of transfusion-related respiratory complications (WAR-PRC): a protocol for a multicenter randomised clinical trial in patients undergoing cardiac surgery

    Science.gov (United States)

    Warner, Matthew A; Welsby, Ian J; Norris, Phillip J; Silliman, Christopher C; Armour, Sarah; Wittwer, Erica D; Santrach, Paula J; Meade, Laurie A; Liedl, Lavonne M; Nieuwenkamp, Chelsea M; Douthit, Brian; van Buskirk, Camille M; Schulte, Phillip J; Kor, Daryl J

    2017-01-01

    Introduction The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are no effective preventive strategies with red blood cell (RBC) transfusion. Although mechanisms remain incompletely defined, soluble biological response modifiers (BRMs) within the RBC storage solution may play an important role. Point-of-care (POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating their impact on post-transfusion respiratory complications. Methods and analysis This is a multicenter randomised clinical trial of standard allogeneic versus washed allogeneic RBC transfusion for adult patients undergoing cardiac surgery testing the hypothesis that POC RBC washing is feasible, safe, and efficacious and will reduce recipient immune and physiologic responses associated with transfusion-related respiratory complications. Relevant clinical outcomes will also be assessed. This investigation will enrol 170 patients at two hospitals in the USA. Simon’s two-stage design will be used to assess the feasibility of POC RBC washing. The primary safety outcomes will be assessed using Wilcoxon Rank-Sum tests for continuous variables and Pearson chi-square test for categorical variables. Standard mixed modelling practices will be employed to test for changes in biomarkers of lung injury following transfusion. Linear regression will assess relationships between randomised group and post-transfusion physiologic measures. Ethics and dissemination Safety oversight will be conducted under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained by the DSMB as well as the institutional review boards at each institution prior to enrolling the first study participant. This study aims to provide important information regarding the feasibility of POC

  3. Calcium-binding capacity of centrin2 is required for linear POC5 assembly but not for nucleotide excision repair.

    Directory of Open Access Journals (Sweden)

    Tiago J Dantas

    Full Text Available Centrosomes, the principal microtubule-organising centres in animal cells, contain centrins, small, conserved calcium-binding proteins unique to eukaryotes. Centrin2 binds to xeroderma pigmentosum group C protein (XPC, stabilising it, and its presence slightly increases nucleotide excision repair (NER activity in vitro. In previous work, we deleted all three centrin isoforms present in chicken DT40 cells and observed delayed repair of UV-induced DNA lesions, but no centrosome abnormalities. Here, we explore how centrin2 controls NER. In the centrin null cells, we expressed centrin2 mutants that cannot bind calcium or that lack sites for phosphorylation by regulatory kinases. Expression of any of these mutants restored the UV sensitivity of centrin null cells to normal as effectively as expression of wild-type centrin. However, calcium-binding-deficient and T118A mutants showed greatly compromised localisation to centrosomes. XPC recruitment to laser-induced UV-like lesions was only slightly slower in centrin-deficient cells than in controls, and levels of XPC and its partner HRAD23B were unaffected by centrin deficiency. Interestingly, we found that overexpression of the centrin interactor POC5 leads to the assembly of linear, centrin-dependent structures that recruit other centrosomal proteins such as PCM-1 and NEDD1. Together, these observations suggest that assembly of centrins into complex structures requires calcium binding capacity, but that such assembly is not required for centrin activity in NER.

  4. Advances Afoot in Microbiology.

    Science.gov (United States)

    Patel, Robin; Karon, Brad S

    2017-07-01

    In 2016, the American Academy of Microbiology convened a colloquium to examine point-of-care (POC) microbiology testing and to evaluate its effects on clinical microbiology. Colloquium participants included representatives from clinical microbiology laboratories, industry, and the government, who together made recommendations regarding the implementation, oversight, and evaluation of POC microbiology testing. The colloquium report is timely and well written (V. Dolen et al., Changing Diagnostic Paradigms for Microbiology , 2017, https://www.asm.org/index.php/colloquium-reports/item/6421-changing-diagnostic-paradigms-for-microbiology?utm_source=Commentary&utm_medium=referral&utm_campaign=diagnostics). Emerging POC microbiology tests, especially nucleic acid amplification tests, have the potential to advance medical care. Copyright © 2017 American Society for Microbiology.

  5. Early Bayesian modeling of a potassium lab-on-a-chip for monitoring of heart failure patients at increased risk of hyperkalaemia.

    NARCIS (Netherlands)

    van de Wetering, Gijs; Steuten, Lotte Maria Gertruda; von Birgelen, Clemens; Adang, E.M.; IJzerman, Maarten Joost

    2012-01-01

    Objectives: Innovative point-of-care (POC) diagnostics are likely to have a strong impact on 18 health care. The aim of this study is to conduct an early assessment of a point-of-care chip 19 for the detection of a pathological deviation of the potassium levels in patients at increased 20 risk,

  6. Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care.

    Science.gov (United States)

    Earle, Sarah; Tariq, Anisah; Komaromy, Carol; Lloyd, Cathy E; Karamat, M Ali; Webb, Jackie; Gill, Paramjit S

    2017-03-01

    Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. Mixed methods encompassing a systematic review and qualitative interviews. Two secondary care sites and 11 primary care sites. Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. None. A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. Owing to significant challenges with recruitment of participants

  7. Skin Cancer Concerns in People of Color: Risk Factors and Prevention

    Science.gov (United States)

    Gupta, Alpana K; Bharadwaj, Mausumi; Mehrotra, Ravi

    2016-01-01

    Background: Though people of color (POC) are less likely to become afflicted with skin cancer, they are much more likely to die from it due to delay in detection or presentation. Very often, skin cancer is diagnosed at a more advanced stage in POC, making treatment difficult. The purpose of this research was to improve awareness regarding skin cancers in people of color by providing recommendations to clinicians and the general public for early detection and photo protection preventive measures. Methods: Data on different types of skin cancers were presented to POC. Due to limited research, there are few resources providing insights for evaluating darkly pigmented lesions in POC. Diagnostic features for different types of skin cancers were recorded and various possible risk factors were considered. Results: This study provided directions for the prevention and early detection of skin cancer in POC based on a comprehensive review of available data. Conclusions: The increased morbidity and mortality rate associated with skin cancer in POC is due to lack of awareness, diagnosis at a more advanced stage and socioeconomic barriers hindering access to care. Raising public health concerns for skin cancer prevention strategies for all people, regardless of ethnic background and socioeconomic status, is the key to timely diagnosis and treatment. PMID:28125871

  8. Social media to supplement point-of-care ultrasound courses: the "sandwich e-learning" approach. A randomized trial.

    Science.gov (United States)

    Hempel, Dorothea; Haunhorst, Stephanie; Sinnathurai, Sivajini; Seibel, Armin; Recker, Florian; Heringer, Frank; Michels, Guido; Breitkreutz, Raoul

    2016-12-01

    Point-of-care ultrasound (POC-US) is gaining importance in almost all specialties. E-learning has been used to teach theoretical knowledge and pattern recognition. As social media are universally available, they can be utilized for educational purposes. We wanted to evaluate the utility of the sandwich e-learning approach defined as a pre-course e-learning and a post-course learning activity using Facebook after a one-day point-of-care ultrasound (POC-US) course and its effect on the retention of knowledge. A total of 62 medial students were recruited for this study and randomly assigned to one of four groups. All groups received an identical hands-on training and performed several tests during the study period. The hands-on training was performed in groups of five students per instructor with the students scanning each other. Group 1 had access to pre-course e-learning, but not to post-course e-learning. Instead of a pre-course e-learning, group 2 listened to presentations at the day of the course (classroom teaching) and had access to the post-course learning activity using Facebook. Group 3 had access to both pre- and post-course e-learning (sandwich e-learning) activities, while group 4 listened classroom presentations only (classroom teaching only). Therefore only groups 2 and 3 had access to post-course learning via Facebook by joining a secured group. Posts containing ultrasound pictures and videos were published to this group. The students were asked to "like" the posts to monitor attendance. Knowledge retention was assessed 6 weeks after the course. After 6 weeks, group 3 achieved comparable results when compared to group 2 (82.2 % + -8.2 vs. 84.3 + -8.02) (p = 0.3). Students who participated in the post-course activity were more satisfied with the overall course than students without post-course learning (5.5 vs. 5.3 on a range from 1 to 6). In this study, the sandwich e-learning approach led to equal rates of knowledge retention compared to

  9. Rural providers’ access to online resources: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Jonathan D. Eldredge

    2016-01-01

    Full Text Available Objective: The research determined the usage and satisfaction levels with one of two point-of-care (PoC resources among health care providers in a rural state. Methods: In this randomized controlled trial, twenty-eight health care providers in rural areas were stratified by occupation and region, then randomized into either the DynaMed or the AccessMedicine study arm. Study participants were physicians, physician assistants, and nurses. A pre- and post-study survey measured participants’ attitudes toward different information resources and their information-seeking activities. Medical student investigators provided training and technical support for participants. Data analyses consisted of analysis of variance (ANOVA, paired t tests, and Cohen’s d statistic to compare pre- and post-study effects sizes. Results: Participants in both the DynaMed and the AccessMedicine arms of the study reported increased satisfaction with their respective PoC resource, as expected. Participants in both arms also reported that they saved time in finding needed information. At baseline, both arms reported too little information available, which increased to ‘‘about right amounts of information’’ at the completion of the study. DynaMed users reported a Cohen’s d increase of þ1.50 compared to AccessMedicine users’ reported use of 0.82. DynaMed users reported d2 satisfaction increases of 9.48 versus AccessMedicine satisfaction increases of 0.59 using a Cohen’s d. Conclusion: Participants in the DynaMed arm of the study used this clinically oriented PoC more heavily than the users of the textbook-based AccessMedicine. In terms of user satisfaction, DynaMed users reported higher levels of satisfaction than the users of AccessMedicine.

  10. Study protocol: identifying and delivering point-of-care information to improve care coordination.

    Science.gov (United States)

    Hysong, Sylvia J; Che, Xinxuan; Weaver, Sallie J; Petersen, Laura A

    2015-10-19

    The need for deliberately coordinated care is noted by many national-level organizations. The Department of Veterans Affairs (VA) recently transitioned primary care clinics nationwide into Patient Aligned Care Teams (PACTs) to provide more accessible, coordinated, comprehensive, and patient-centered care. To better serve this purpose, PACTs must be able to successfully sequence and route interdependent tasks to appropriate team members while also maintaining collective situational awareness (coordination). Although conceptual frameworks of care coordination exist, few explicitly articulate core behavioral markers of coordination or the related information needs of team members attempting to synchronize complex care processes across time for a shared patient population. Given this gap, we partnered with a group of frontline primary care personnel at ambulatory care sites to identify the specific information needs of PACT members that will enable them to coordinate their efforts to provide effective, coordinated care. The study has three objectives: (1) development of measurable, prioritized point-of-care criteria for effective PACT coordination; (2) identifying the specific information needed at the point of care to optimize coordination; and (3) assessing the effect of adopting the aforementioned coordination standards on PACT clinicians' coordination behaviors. The study consists of three phases. In phase 1, we will employ the Productivity Measurement and Enhancement System (ProMES), a structured approach to performance measure creation from industrial/organizational psychology, to develop coordination measures with a design team of 6-10 primary care personnel; in phase 2, we will conduct focus groups with the phase 1 design team to identify point-of-care information needs. Phase 3 is a two-arm field experiment (n PACT = 28/arm); intervention arm PACTs will receive monthly feedback reports using the measures developed in phase 1 and attend brief monthly

  11. Accuracy of urine circulating cathodic antigen test for the diagnosis of Schistosoma mansoni in preschool-aged children before and after treatment.

    Directory of Open Access Journals (Sweden)

    Jean T Coulibaly

    Full Text Available BACKGROUND: The Kato-Katz technique is widely used for the diagnosis of Schistosoma mansoni, but shows low sensitivity in light-intensity infections. We assessed the accuracy of a commercially available point-of-care circulating cathodic antigen (POC-CCA cassette test for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration. METHODOLOGY: A 3-week longitudinal survey with a treatment intervention was conducted in Azaguié, south Côte d'Ivoire. Overall, 242 preschoolers (age range: 2 months to 5.5 years submitted two stool and two urine samples before praziquantel administration, and 86 individuals were followed-up posttreatment. Stool samples were examined with duplicate Kato-Katz thick smears for S. mansoni. Urine samples were subjected to POC-CCA cassette test for S. mansoni, and a filtration method for S. haematobium diagnosis. PRINCIPAL FINDINGS: Before treatment, the prevalence of S. mansoni, as determined by quadruplicate Kato-Katz, single CCA considering 'trace' as negative (t-, and single CCA with 'trace' as positive (t+, was 23.1%, 34.3% and 64.5%, respectively. Using the combined results (i.e., four Kato-Katz and duplicate CCA(t- as diagnostic 'gold' standard, the sensitivity of a single Kato-Katz, a single CCA(t- or CCA(t+ was 28.3%, 69.7% and 89.1%, respectively. Three weeks posttreatment, the sensitivity of a single Kato-Katz, single CCA(t- and CCA(t+ was 4.0%, 80.0% and 84.0%, respectively. The intensity of the POC-CCA test band reaction was correlated with S. mansoni egg burden (odds ratio = 1.2, p = 0.04. CONCLUSIONS/SIGNIFICANCE: A single POC-CCA cassette test appears to be more sensitive than multiple Kato-Katz thick smears for the diagnosis of S. mansoni in preschool-aged children before and after praziquantel administration. The POC-CCA cassette test can be recommended for the rapid identification of S. mansoni infections before treatment. Additional studies are warranted

  12. Comparison of portable oxygen concentrators in a simulated airplane environment.

    Science.gov (United States)

    Fischer, Rainald; Wanka, Eva R; Einhaeupl, Franziska; Voll, Klaus; Schiffl, Helmut; Lang, Susanne M; Gruss, Martin; Ferrari, Uta

    2013-01-01

    Portable oxygen concentrators (POC) are highly desirable for patients with lung disease traveling by airplane, as these devices allow theoretically much higher travel times if additional batteries can be used. However, it is unclear whether POCs produce enough oxygen in airplanes at cruising altitude, even if complying with aviation regulations. We evaluated five frequently used POCs (XPO2 (Invacare, USA), Freestyle (AirSep C., USA), Evergo (Philipps Healthcare, Germany), Inogen One (Inogen, USA), Eclipse 3 (Sequal, USA)) at an altitude of 2650 m (as simulated airplane environment) in 11 patients with chronic obstructive lung disease (COPD) and compared theses POCs with the standard oxygen system (WS120, EMS Ltd., Germany) used by Lufthansa. Oxygen was delivered by each POC for 30 min to each patient at rest, blood gases were then drawn from the arterialized ear lobe. All POCs were able to deliver enough oxygen to increase the PaO(2) of our subjects by at least 1.40 kPa (10 mmHg). However, to achieve this increase, the two most lightweight POCs (Freestyle and Invacare XPO2) had to be run at their maximum level. This causes a significant reduction of battery life. The three other POCs (EverGo, Inogen One, Eclipse 3) and the WS120 were able to increase the PaO(2) by more than 2.55 kPa (20 mmHg), which provides extra safety for patients with more severe basal hypoxemia. When choosing the right oxygen system for air travel in patients in COPD, not only weight, but also battery life and maximum possible oxygen output must be considered carefully. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. An easy-to-build, low-budget point-of-care ultrasound simulator: from Linux to a web-based solution.

    Science.gov (United States)

    Damjanovic, Domagoj; Goebel, Ulrich; Fischer, Benedikt; Huth, Martin; Breger, Hartmut; Buerkle, Hartmut; Schmutz, Axel

    2017-12-01

    Hands-on training in point-of-care ultrasound (POC-US) should ideally comprise bedside teaching, as well as simulated clinical scenarios. High-fidelity phantoms and portable ultrasound simulation systems are commercially available, however, at considerable costs. This limits their suitability for medical schools. A Linux-based software for Emergency Department Ultrasound Simulation (edus2TM) was developed by Kulyk and Olszynski in 2011. Its feasibility for POC-US education has been well-documented, and shows good acceptance. An important limitation to an even more widespread use of edus2, however, may be due to the need for a virtual machine for WINDOWS ® systems. Our aim was to adapt the original software toward an HTML-based solution, thus making it affordable and applicable in any simulation setting. We created an HTML browser-based ultrasound simulation application, which reads the input of different sensors, triggering an ultrasound video to be displayed on a respective device. RFID tags, NFC tags, and QR Codes™ have been integrated into training phantoms or were attached to standardized patients. The RFID antenna was hidden in a mock ultrasound probe. The application is independent from the respective device. Our application was used successfully with different trigger/scanner combinations and mounted readily into simulated training scenarios. The application runs independently from operating systems or electronic devices. This low-cost, browser-based ultrasound simulator is easy-to-build, very adaptive, and independent from operating systems. It has the potential to facilitate POC-US training throughout the world, especially in resource-limited areas.

  14. Towards Detection and Diagnosis of Ebola Virus Disease at Point-of-Care

    Science.gov (United States)

    Kaushik, Ajeet; Tiwari, Sneham; Jayant, Rahul Dev; Marty, Aileen; Nair, Madhavan

    2015-01-01

    Ebola outbreak-2014 (mainly Zaire strain related Ebola virus) has been declared most widely spread deadly persistent epidemic due to unavailability of rapid diagnostic, detection, and therapeutics. Ebola virus disease (EVD), a severe viral hemorrhagic fever syndrome caused by Ebola virus (EBOV) is transmitted by direct contact with the body fluids of infected person and objects contaminated with virus or infected animals. World Health Organization (WHO) has declared EVD epidemic as public health emergency of international concern with severe global economic burden. At fatal EBOV infection stage, patients usually die before the antibody response. Currently, rapid blood tests to diagnose EBOV infection include the antigen or antibodies capture using ELISA and RNA detection using RT/Q-PCR within 3–10 days after the onset of symptoms. Moreover, few nanotechnology-based colorimetric and paper-based immunoassay methods have been recently reported to detect Ebola virus. Unfortunately, these methods are limited to laboratory only. As state-of-the art (SoA) diagnostics time to confirm Ebola infection, varies from 6 hours to about 3 days, it causes delay in therapeutic approaches. Thus developing a cost-effective, rapid, sensitive, and selective sensor to detect EVD at point-of-care (POC) is certainly worth exploring to establish rapid diagnostics to decide therapeutics. This review highlights SoA of Ebola diagnostics and also a call to develop rapid, selective and sensitive POC detection of EBOV for global health care. We propose that adopting miniaturized electrochemical EBOV immunosensing can detect virus level at pM concentration within ~40 minute compared to 3 days of ELISA test at nM levels. PMID:26319169

  15. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control

    International Nuclear Information System (INIS)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin; Lu, Tian Jian; Xu, Feng

    2016-01-01

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed “U shape” reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. - Highlights: • The meter chip is a standalone point-of-care diagnostic tool with visible readouts of quantification results. • A fast and low cost fabrication protocol (~3 min and ~$0.2 per chip) of meter chip was proposed. • The chip may hold the potential for rapid scaning of bovine mastitis in cattle farms for food safety control.

  16. A volumetric meter chip for point-of-care quantitative detection of bovine catalase for food safety control

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Xingye; Hu, Jie; Choi, Jane Ru; Huang, Yalin; Wang, Xuemin [The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi' an Jiaotong University, Xi' an, 710049 (China); Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China); Lu, Tian Jian, E-mail: tjlu@mail.xjtu.edu.cn [Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China); Xu, Feng, E-mail: fengxu@mail.xjtu.edu.cn [The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi' an Jiaotong University, Xi' an, 710049 (China); Bioinspired Engineering and Biomechanics Center (BEBC), Xi' an Jiaotong University, Xi' an, 710049 (China)

    2016-09-07

    A volumetric meter chip was developed for quantitative point-of-care (POC) analysis of bovine catalase, a bioindicator of bovine mastitis, in milk samples. The meter chip displays multiplexed quantitative results by presenting the distance of ink bar advancement that is detectable by the naked eye. The meter chip comprises a poly(methyl methacrylate) (PMMA) layer, a double-sided adhesive (DSA) layer and a glass slide layer fabricated by the laser-etching method, which is typically simple, rapid (∼3 min per chip), and cost effective (∼$0.2 per chip). Specially designed “U shape” reaction cells are covered by an adhesive tape that serves as an on-off switch, enabling the simple operation of the assay. As a proof of concept, we employed the developed meter chip for the quantification of bovine catalase in raw milk samples to detect catalase concentrations as low as 20 μg/mL. The meter chip has great potential to detect various target analytes for a wide range of POC applications. - Highlights: • The meter chip is a standalone point-of-care diagnostic tool with visible readouts of quantification results. • A fast and low cost fabrication protocol (~3 min and ~$0.2 per chip) of meter chip was proposed. • The chip may hold the potential for rapid scaning of bovine mastitis in cattle farms for food safety control.

  17. Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 1.

    Science.gov (United States)

    Weiner, S L; Tu, R; Javan, R; Taheri, M R

    2018-01-01

    Few resources are available in the medical literature for a comprehensive review of current health care economics as it relates to radiologists, specifically framed by topics defined by the Accreditation Council for Graduate Medical Education in the evaluation of neuroradiology fellows. Therefore, we present a comprehensive review article as a study guide for fellows to learn from and gain competence in the Accreditation Council for Graduate Medical Education neuroradiology milestones on health care economics. © 2018 by American Journal of Neuroradiology.

  18. [Distribution and source of particulate organic carbon and particulate nitrogen in the Yangtze River Estuary in summer 2012].

    Science.gov (United States)

    Xing, Jian-Wei; Xian, Wei-Wei; Sheng, Xiu-Zhen

    2014-07-01

    Based on the data from the cruise carried out in August 2012 in the Yangtze River Estuary and its adjacent waters, spatial distributions of particulate organic carbon (POC), particulate nitrogen (PN) and their relationships with environmental factors were studied, and the source of POC and the contribution of phytoplankton to POC were analyzed combined with n (C)/n (N) ratio and chlorophyll a (Chl a) in the Yangtze River Estuary in summer 2012. The results showed that the concentrations of POC in the Yangtze River Estuary ranged from 0.68 mg x L(-1) to 34.80 mg x L(-1) in summer and the average content was 3.74 mg x L(-1), and PN contents varied between 0.03 mg x L(-1) and 9.13 mg x L(-1) with an average value of 0.57 mg x L(-1). Both of them presented that the concentrations in bottom layers were higher than those in the surface. POC and PN as well as total suspended matter (TSM) showed a extremel similar horizontal distribution trend that the highest values appeared in the near of the mouth and southwest of the survey waters, and decreased rapidly as toward the open seas, both of them showed higher contents in coastal zones and lower in outer sea. There was a fairly good positive linear relationship between POC and PN, which indicated that they had the same source. POC and PN expressed significantly positive correlations with TSM and chemical oxygen demand (COD), but showed relatively weak correlations with salinit and chlorophyll a, which demonstrated that terrestrial inputs had a strong influence on the distribution of POC and PN, and phytoplankton production was not the major source of organic matters in the Yangtze River Estuary. Both the n (C)/n (N) ratio and POC/Chl a analysis showed that the main source of POC was terrestrial inputs, and organic debris was the main existence form of POC. Quantitative analysis showed the biomass of phytoplankton only made an average of 2.54% contribution to POC in the Yangtze Rive Estuary in summer and non-living POC

  19. A retrospective study of two populations to test a simple rule for spirometry.

    Science.gov (United States)

    Ohar, Jill A; Yawn, Barbara P; Ruppel, Gregg L; Donohue, James F

    2016-06-04

    Chronic lung disease is common and often under-diagnosed. To test a simple rule for conducting spirometry we reviewed spirograms from two populations, occupational medicine evaluations (OME) conducted by Saint Louis and Wake Forest Universities at 3 sites (n = 3260, mean age 64.14 years, 95 % CI 58.94-69.34, 97 % men) and conducted by Wake Forest University preop clinic (POC) at one site (n = 845, mean age 62.10 years, 95 % CI 50.46-73.74, 57 % men). This retrospective review of database information that the first author collected prospectively identified rates, types, sensitivity, specificity and positive and negative predictive value for lung function abnormalities and associated mortality rate found when conducting spirometry based on the 20/40 rule (≥20 years of smoking in those aged ≥ 40 years) in the OME population. To determine the reproducibility of the 20/40 rule for conducting spirometry, the rule was applied to the POC population. A lung function abnormality was found in 74 % of the OME population and 67 % of the POC population. Sensitivity of the rule was 85 % for an obstructive pattern and 77 % for any abnormality on spirometry. Positive and negative predictive values of the rule for a spirometric abnormality were 74 and 55 %, respectively. Patients with an obstructive pattern were at greater risk of coronary heart disease (odds ratio (OR) 1.39 [confidence interval (CI) 1.00-1.93] vs. normal) and death (hazard ratio (HR) 1.53, 95 % CI 1.20-1.84) than subjects with normal spirometry. Restricted spirometry patterns were also associated with greater risk of coronary disease (odds ratio (OR) 1.7 [CI 1.23-2.35]) and death (Hazard ratio 1.40, 95 % CI 1.08-1.72). Smokers (≥ 20 pack years) age ≥ 40 years are at an increased risk for lung function abnormalities and those abnormalities are associated with greater presence of coronary heart disease and increased all-cause mortality. Use of the 20/40 rule could provide a

  20. Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1)

    International Nuclear Information System (INIS)

    Schymura, Maria J; Kahn, Amy R; German, Robert R; Hsieh, Mei-Chin; Cress, Rosemary D; Finch, Jack L; Fulton, John P; Shen, Tiefu; Stuckart, Erik

    2010-01-01

    Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival. The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively. Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%), radiation therapy (31.4%), hormone therapy (10.3%), or watchful waiting (18.6%). After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting): older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4), comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy), older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black race in patients under 60 years of age, were

  1. Factors associated with initial treatment and survival for clinically localized prostate cancer: results from the CDC-NPCR Patterns of Care Study (PoC1

    Directory of Open Access Journals (Sweden)

    Fulton John P

    2010-04-01

    Full Text Available Abstract Background Despite the large number of men diagnosed with localized prostate cancer, there is as yet no consensus concerning appropriate treatment. The purpose of this study was to describe the initial treatment patterns for localized prostate cancer in a population-based sample and to determine the clinical and patient characteristics associated with initial treatment and overall survival. Methods The analysis included 3,300 patients from seven states, diagnosed with clinically localized prostate cancer in 1997. We examined the association of sociodemographic and clinical characteristics with four treatment options: radical prostatectomy, radiation therapy, hormone therapy, and watchful waiting. Diagnostic and treatment information was abstracted from medical records. Socioeconomic measures were derived from the 2000 Census based on the patient's residence at time of diagnosis. Vital status through December 31, 2002, was obtained from medical records and linkages to state vital statistics files and the National Death Index. Multiple logistic regression analysis and Cox proportional hazards models identified factors associated with initial treatment and overall survival, respectively. Results Patients with clinically localized prostate cancer received the following treatments: radical prostatectomy (39.7%, radiation therapy (31.4%, hormone therapy (10.3%, or watchful waiting (18.6%. After multivariable adjustment, the following variables were associated with conservative treatment (hormone therapy or watchful waiting: older age, black race, being unmarried, having public insurance, having non-screen detected cancer, having normal digital rectal exam results, PSA values above 20, low Gleason score (2-4, comorbidity, and state of residence. Among patients receiving definitive treatment (radical prostatectomy or radiation therapy, older age, being unmarried, PSA values above 10, unknown Gleason score, state of residence, as well as black

  2. Point-of-care washing of allogeneic red blood cells for the prevention of transfusion-related respiratory complications (WAR-PRC): a protocol for a multicenter randomised clinical trial in patients undergoing cardiac surgery.

    Science.gov (United States)

    Warner, Matthew A; Welsby, Ian J; Norris, Phillip J; Silliman, Christopher C; Armour, Sarah; Wittwer, Erica D; Santrach, Paula J; Meade, Laurie A; Liedl, Lavonne M; Nieuwenkamp, Chelsea M; Douthit, Brian; van Buskirk, Camille M; Schulte, Phillip J; Carter, Rickey E; Kor, Daryl J

    2017-08-18

    The transfusion-related respiratory complications, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), are leading causes of transfusion-related morbidity and mortality. At present, there are no effective preventive strategies with red blood cell (RBC) transfusion. Although mechanisms remain incompletely defined, soluble biological response modifiers (BRMs) within the RBC storage solution may play an important role. Point-of-care (POC) washing of allogeneic RBCs may remove these BRMs, thereby mitigating their impact on post-transfusion respiratory complications. This is a multicenter randomised clinical trial of standard allogeneic versus washed allogeneic RBC transfusion for adult patients undergoing cardiac surgery testing the hypothesis that POC RBC washing is feasible, safe, and efficacious and will reduce recipient immune and physiologic responses associated with transfusion-related respiratory complications. Relevant clinical outcomes will also be assessed. This investigation will enrol 170 patients at two hospitals in the USA. Simon's two-stage design will be used to assess the feasibility of POC RBC washing. The primary safety outcomes will be assessed using Wilcoxon Rank-Sum tests for continuous variables and Pearson chi-square test for categorical variables. Standard mixed modelling practices will be employed to test for changes in biomarkers of lung injury following transfusion. Linear regression will assess relationships between randomised group and post-transfusion physiologic measures. Safety oversight will be conducted under the direction of an independent Data and Safety Monitoring Board (DSMB). Approval of the protocol was obtained by the DSMB as well as the institutional review boards at each institution prior to enrolling the first study participant. This study aims to provide important information regarding the feasibility of POC washing of allogeneic RBCs and its potential impact on ameliorating

  3. Beyond syndromic management: Opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries.

    Science.gov (United States)

    Garrett, Nigel J; Osman, Farzana; Maharaj, Bhavna; Naicker, Nivashnee; Gibbs, Andrew; Norman, Emily; Samsunder, Natasha; Ngobese, Hope; Mitchev, Nireshni; Singh, Ravesh; Abdool Karim, Salim S; Kharsany, Ayesha B M; Mlisana, Koleka; Rompalo, Anne; Mindel, Adrian

    2018-01-01

    In light of the limited impact the syndromic management approach has had on the global sexually transmitted infection (STI) epidemic, we assessed a care model comprising point-of-care (POC) STI testing, immediate treatment, and expedited partner therapy (EPT) among a cohort of young women at high HIV risk in South Africa. HIV negative women presenting for STI care underwent POC testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV), and swabs were sent for NG culture and susceptibility testing. Results were available within 2 hours and women with STIs were immediately treated and offered EPT packs, including medication, condoms, and information for sexual partners. An EPT questionnaire was administered after one week, and women retested for STIs after 6 and 12 weeks. 267 women, median age 23 (IQR 21-26), were recruited and 88.4% (236/267) reported genital symptoms. STI prevalence was CT 18.4% (95%CI 13.7-23.0), NG 5.2% (95%CI 2.6-7.9) and TV 3.0% (95%CI 1.0-5.0). After 12 weeks, all but one NG and two CT infections were cleared. No cephalosporin-resistant NG was detected. Of 63/267 women (23.6%) diagnosed with STIs, 98.4% (62/63) were offered and 87.1% (54/62) accepted EPT. At one week 88.9% (48/54) stated that their partner had taken the medication. No allergic reactions or social harms were reported. Of 51 women completing 6-week follow up, detection rates were lower amongst women receiving EPT (2.2%, 1/46) compared to those who did not (40.0%, 2/5), p = 0.023. During focus group discussions women supported the care model, because they received a rapid, specific diagnosis, and could facilitate their partners' treatment. POC STI testing and EPT were acceptable to young South African women and their partners, and could play an important role in reducing STI reinfection rates and HIV risk. Larger studies should evaluate the feasibility and cost-effectiveness of implementing this strategy at population level.

  4. Preliminary Results of a Multicentre Study of the UBC Rapid Test for Detection of Urinary Bladder Cancer.

    Science.gov (United States)

    Ecke, Thorsten H; Arndt, Christian; Stephan, Carsten; Hallmann, Steffen; Lux, Oliver; Otto, Thomas; Ruttloff, Jürgen; Gerullis, Holger

    2015-05-01

    UBC Rapid is a test detecting fragments of cytokeratins 8 and 18 in urine. These are cytokeratins frequently overexpressed in tumor cells. We present the first results of a multi-centre study using UBC Rapid in patients with bladder cancer and healthy controls. Clinical urine samples from 92 patients with tumors of the urinary bladder (45 low-grade and 47 high-grade tumors) and from 33 healthy controls were used. Urine samples were analyzed by the UBC Rapid point-of-care (POC) system and evaluated both visually and quantitatively using a concile Omega 100 POC reader. For visual evaluation, different thresholds of band intensity for considering a test as positive were applied. Sensitivities and specificities were calculated by contingency analyses. We found that pathological concentrations by UBC Rapid are detectable in urine of patients with bladder cancer. The calculated diagnostic sensitivity of UBC Rapid in urine was 68.1% for high-grade, but only 46.2% for low-grade tumors. The specificity was 90.9%. The area under the curve (AUC) after receiver-operated curve (ROC) analysis was 0.733. Pathological levels of UBC Rapid in urine are higher in patients with bladder cancer in comparison to the control group (pbladder cancer and controls. Further studies with a greater number of patients will show how valuable these results are. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  5. 3D printed auto-mixing chip enables rapid smartphone diagnosis of anemia.

    Science.gov (United States)

    Plevniak, Kimberly; Campbell, Matthew; Myers, Timothy; Hodges, Abby; He, Mei

    2016-09-01

    Clinical diagnosis requiring central facilities and site visits can be burdensome for patients in resource-limited or rural areas. Therefore, development of a low-cost test that utilizes smartphone data collection and transmission would beneficially enable disease self-management and point-of-care (POC) diagnosis. In this paper, we introduce a low-cost i POC 3D diagnostic strategy which integrates 3D design and printing of microfluidic POC device with smartphone-based disease diagnosis in one process as a stand-alone system, offering strong adaptability for establishing diagnostic capacity in resource-limited areas and low-income countries. We employ smartphone output (AutoCAD 360 app) and readout (color-scale analytical app written in-house) functionalities for rapid 3D printing of microfluidic auto-mixers and colorimetric detection of blood hemoglobin levels. The auto-mixing of reagents with blood via capillary force has been demonstrated in 1 second without the requirement of external pumps. We employed this i POC 3D system for point-of-care diagnosis of anemia using a training set of patients (n anemia  = 16 and n healthy  = 6), which showed consistent measurements of blood hemoglobin levels (a.u.c. = 0.97) and comparable diagnostic sensitivity and specificity, compared with standard clinical hematology analyzer. Capable of 3D fabrication flexibility and smartphone compatibility, this work presents a novel diagnostic strategy for advancing personalized medicine and mobile healthcare.

  6. Ultra low-cost, portable smartphone optosensors for mobile point-of-care diagnostics

    Science.gov (United States)

    Wang, Li-Ju; Chang, Yu-Chung; Sun, Rongrong; Li, Lei

    2018-02-01

    Smartphone optosensors with integrated optical components make mobile point-of-care (MPoC) diagnostics be done near patients' side. It'll especially have a significant impact on healthcare delivery in rural or remote areas. Current FDA-approved PoC devices achieving clinical level are still at high cost and not affordable in rural hospitals. We present a series of ultra low-cost smartphone optical sensing devices for mobile point-of-care diagnosis. Aiming different targeting analytes and sensing mechanisms, we developed custom required optical components for each smartphone optosensros. These optical devices include spectrum readers, colorimetric readers for microplate, lateral flow device readers, and chemiluminescence readers. By integrating our unique designed optical components into smartphone optosening platform, the anlaytes can be precisely detected. Clinical testing results show the clinical usability of our smartphone optosensors. Ultra low-cost portable smartphone optosensors are affordable for rural/remote doctors.

  7. Persistent organohalogen contaminant burdens in Antarctic krill (Euphausia superba) from the eastern Antarctic sector: A baseline study

    International Nuclear Information System (INIS)

    Bengtson Nash, S.M.; Poulsen, A.H.; Kawaguchi, S.; Vetter, W.; Schlabach, M.

    2008-01-01

    A baseline for persistent organohalogen compound (POC) accumulation in the Antarctic keystone species, Antarctic krill (Euphausia superba) has been established for a 50 deg. longitudinal range of the eastern Antarctic sector. Samples of adult krill, caught from 12 sites distributed between 30 deg. and 80 deg. E (60-70 deg. S), were analysed for > 100 organohalogen compounds including chlorinated pesticides, polychlorinated biphenyls (PCBs), polybrominated organic compounds and polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs). Organochlorine pesticides dominated measured krill contaminant burdens with hexachlorobenzene (HCB) as the single most abundant compound quantified. Krill HCB concentrations were comparable to those detected at this trophic level in both the Arctic and temperate northwest Atlantic, lending support for the hypothesis that HCB will approach global equilibrium at a faster rate than other POCs. Para, para'-dichlorodiphenylethene (p,p'-DDE) was detected at notable concentrations. Measurements of DDT and its degradation products provide an important baseline for monitoring the temporal and geographical influence of renewed, DDT usage for malaria-control in affected southern hemisphere countries. In contrast to the Arctic, PCBs did not feature prominently in contaminant burdens of Antarctic krill. The major commercial polybrominated diphenyl ether (PBDE) congeners -99 and -47 were quantified at low background levels with clear concentration spikes observed at around 70 deg. E , in the vicinity of modern, active research stations. The likelihood that local anthropogenic activities are supplementing low PBDE levels, delivered otherwise primarily via long range environmental transport, is discussed. The suspected naturally occurring brominated organic compound, 2,4,6-tribromoanisole (TBA), was a ubiquitous contaminant in all samples whereas the only PCDD/Fs quantifiable were trace levels of octachlorodibenzo-p-dioxin (OCDD) and 1,2,3,4,7,8/1

  8. Stable carbon isotope signals in particulate organic and inorganic carbon of coccolithophores - A numerical model study for Emiliania huxleyi.

    Science.gov (United States)

    Holtz, Lena-Maria; Wolf-Gladrow, Dieter; Thoms, Silke

    2017-05-07

    A recent numerical cell model, which explains observed light and carbonate system effects on particulate organic and inorganic carbon (POC and PIC) production rates under the assumption of internal pH homeostasis, is extended for stable carbon isotopes ( 12 C, 13 C). Aim of the present study is to mechanistically understand the stable carbon isotopic fractionation signal (ε) in POC and PIC and furthermore the vital effect(s) included in measured ε PIC values. The virtual cell is divided into four compartments, for each of which the 12 C as well as the 13 C carbonate system kinetics are implemented. The compartments are connected to each other via trans-membrane fluxes. In contrast to existing carbon fractionation models, the presented model calculates the disequilibrium state for both carbonate systems and for each compartment. It furthermore calculates POC and PIC production rates as well as ε POC and ε PIC as a function of given light conditions and the compositions of the external carbonate system. Measured POC and PIC production rates as well as ε PIC values are reproduced well by the model (comparison with literature data). The observed light effect on ε POC (increase of ε POC with increasing light intensities), however, is not reproduced by the basic model set-up, which is solely based on RubisCO fractionation. When extending the latter set-up by assuming that biological fractionation includes further carbon fractionation steps besides the one of RubisCO, the observed light effect on ε POC is also reproduced. By means of the extended model version, four different vital effects that superimpose each other in a real cell can be detected. Finally, we discuss potential limitations of the ε PIC proxy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Fluxes of particulate organic carbon in the East China Sea in summer

    Directory of Open Access Journals (Sweden)

    C.-C. Hung

    2013-10-01

    Full Text Available To understand carbon cycling in marginal seas better, particulate organic carbon (POC concentrations, POC fluxes and primary production (PP were measured in the East China Sea (ECS in summer 2007. Higher concentrations of POC were observed in the inner shelf, and lower POC values were found in the outer shelf. Similar to POC concentrations, elevated uncorrected POC fluxes (720–7300 mg C m−2 d−1 were found in the inner shelf, and lower POC fluxes (80–150 mg C m−2 d−1 were in the outer shelf, respectively. PP values (~ 340–3380 mg C m−2 d−1 had analogous distribution patterns to POC fluxes, while some of PP values were significantly lower than POC fluxes, suggesting that contributions of resuspended particles to POC fluxes need to be appropriately corrected. A vertical mixing model was used to correct effects of bottom sediment resuspension, and the lowest and highest corrected POC fluxes were in the outer shelf (58 ± 33 mg C m−2 d−1 and the inner shelf (785 ± 438 mg C m−2 d−1, respectively. The corrected POC fluxes (486 to 785 mg C m−2 d−1 in the inner shelf could be the minimum value because we could not exactly distinguish the effect of POC flux from Changjiang influence with turbid waters. The results suggest that 27–93% of the POC flux in the ECS might be from the contribution of resuspension of bottom sediments rather than from the actual biogenic carbon sinking flux. While the vertical mixing model is not a perfect model to solve sediment resuspension because it ignores biological degradation of sinking particles, Changjiang plume (or terrestrial inputs and lateral transport, it makes significant progress in both correcting the resuspension problem and in assessing a reasonable quantitative estimate of POC flux in a marginal sea.

  10. A POC Clinical Trial for PTSD with a First-In-Class Vasopressin 1a Receptor Antagonist

    Science.gov (United States)

    2017-10-01

    clinical benefit of SRX246 for the treatment of anger, irritability, and aggression; major depression ; disturbed sleep; and quality of life that...safety and tolerability of SRX246 (160 mg PO BID) and ii) clinical benefit of SRX246 for the treatment of major depression , anger, irritability, and...colleagues. Changes that had a significant impact on expenditures Nothing to Report Significant changes in use or care of human subjects, vertebrate

  11. Designing a Care Pathway Model - A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway.

    Science.gov (United States)

    Oosterholt, Robin I; Simonse, Lianne Wl; Boess, Stella U; Vehmeijer, Stephan Bw

    2017-03-09

    Although the clinical attributes of total hip arthroplasty (THA) care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. The outpatient THA care pathway enables patients to be discharged on the day of surgery, shortening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi-structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1) and mobilisation & discharge (4). The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. The design addressed existing problems and is an optimisation of the case hospital's pathway. The network of actors consists of the patient (1), radiologist (1), anaesthetist (1), nurse specialist (1), pharmacist (1), orthopaedic surgeon (1,4), physiotherapist (1,4), nurse (4), doctor (4) and patient application (1,4). The critical value exchanges include patient preparation (mental and practical), patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  12. Seasonal distribution of organic matter in mangrove environment of Goa

    Digital Repository Service at National Institute of Oceanography (India)

    Jagtap, T.G.

    Water and sediments were studied for the distribution of suspended matter, organic carbon and nitrogen Suspended matter ranged from 3-373 mg.l-1 while particulate organic carbon (POC) from 0.03-9.94 mg.l-1 POC value showed significant correlation...

  13. Printed wireless devices for low-cost, connected sensors for point-of-care applications

    CSIR Research Space (South Africa)

    Smith, Suzanne

    2017-11-01

    Full Text Available reading ranges, faster data transfer, and multiple, simultaneous tag reading. Passive RFID tags draw energy from the electromagnetic field radiating from the reader when the tags are within the reader range, a favourable implementation that does... read-out and communication of a test result is required. This work explores these aspects towards the long-term goal of a fully integrated POC diagnostic solution. Different RFID categories are suited to different POC diagnostic applications. NFC can...

  14. A single FPGA-based portable ultrasound imaging system for point-of-care applications.

    Science.gov (United States)

    Kim, Gi-Duck; Yoon, Changhan; Kye, Sang-Bum; Lee, Youngbae; Kang, Jeeun; Yoo, Yangmo; Song, Tai-kyong

    2012-07-01

    We present a cost-effective portable ultrasound system based on a single field-programmable gate array (FPGA) for point-of-care applications. In the portable ultrasound system developed, all the ultrasound signal and image processing modules, including an effective 32-channel receive beamformer with pseudo-dynamic focusing, are embedded in an FPGA chip. For overall system control, a mobile processor running Linux at 667 MHz is used. The scan-converted ultrasound image data from the FPGA are directly transferred to the system controller via external direct memory access without a video processing unit. The potable ultrasound system developed can provide real-time B-mode imaging with a maximum frame rate of 30, and it has a battery life of approximately 1.5 h. These results indicate that the single FPGA-based portable ultrasound system developed is able to meet the processing requirements in medical ultrasound imaging while providing improved flexibility for adapting to emerging POC applications.

  15. Uncertainty in estimating probability of causation in a cross-sectional study: joint effects of radiation and hepatitis-C virus on chronic liver disease

    Energy Technology Data Exchange (ETDEWEB)

    Cologne, John B [Department of Statistics, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815 (Japan); Pawel, David J [Office of Radiation and Indoor Air, US Environmental Protection Agency, 1200 Pennsylvania Ave NW, Washington DC 20460 (United States); Sharp, Gerald B [Department of Epidemiology, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815 (Japan); Fujiwara, Saeko [Department of Clinical Studies, Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815 (Japan)

    2004-06-01

    Exposure to other risk factors is an important consideration in assessing the role played by radiation in producing disease. A cross-sectional study of atomic-bomb survivors suggested an interaction between whole-body radiation exposure and chronic hepatitis-C viral (HCV) infection in the etiology of chronic liver disease (chronic hepatitis and cirrhosis), but did not allow determination of the joint-effect mechanism. Different estimates of probability of causation (POC) conditional on HCV status resulted from additive and multiplicative models. We therefore estimated the risk for radiation conditional on HCV status using a more general, mixture model that does not require choosing between additivity or multiplicativity, or deciding whether there is interaction, in the face of the large uncertainty. The results support the conclusion that POC increases with radiation dose in persons without HCV infection, but are inconclusive regarding individuals with HCV infection, the lower confidence bound on estimated POC for radiation with HCV infection being zero over the entire dose range. Although the mixture model may not reflect the true joint-effect mechanism, it avoids restrictive model assumptions that cannot be validated using the available data yet have a profound influence on estimated POC. These considerations apply more generally, given that the additive and multiplicative models are often used in POC related work. We therefore consider that an empirical approach may be preferable to assuming a specific mechanistic model for estimating POC in epidemiological studies where the joint-effect mechanism is in doubt.

  16. Uncertainty in estimating probability of causation in a cross-sectional study: joint effects of radiation and hepatitis-C virus on chronic liver disease

    International Nuclear Information System (INIS)

    Cologne, John B; Pawel, David J; Sharp, Gerald B; Fujiwara, Saeko

    2004-01-01

    Exposure to other risk factors is an important consideration in assessing the role played by radiation in producing disease. A cross-sectional study of atomic-bomb survivors suggested an interaction between whole-body radiation exposure and chronic hepatitis-C viral (HCV) infection in the etiology of chronic liver disease (chronic hepatitis and cirrhosis), but did not allow determination of the joint-effect mechanism. Different estimates of probability of causation (POC) conditional on HCV status resulted from additive and multiplicative models. We therefore estimated the risk for radiation conditional on HCV status using a more general, mixture model that does not require choosing between additivity or multiplicativity, or deciding whether there is interaction, in the face of the large uncertainty. The results support the conclusion that POC increases with radiation dose in persons without HCV infection, but are inconclusive regarding individuals with HCV infection, the lower confidence bound on estimated POC for radiation with HCV infection being zero over the entire dose range. Although the mixture model may not reflect the true joint-effect mechanism, it avoids restrictive model assumptions that cannot be validated using the available data yet have a profound influence on estimated POC. These considerations apply more generally, given that the additive and multiplicative models are often used in POC related work. We therefore consider that an empirical approach may be preferable to assuming a specific mechanistic model for estimating POC in epidemiological studies where the joint-effect mechanism is in doubt

  17. Accuracy of diagnostic antibody tests for coeliac disease in children

    DEFF Research Database (Denmark)

    Giersiepen, Klaus; Lelgemann, Monika; Stuhldreher, Nina

    2012-01-01

    The aim of this study was to summarise the evidence from 2004 to September 2009 on the performance of laboratory-based serological and point of care (POC) tests for diagnosing coeliac disease (CD) in children using histology as reference standard....

  18. Validation of the TTM processes of change measure for physical activity in an adult French sample.

    Science.gov (United States)

    Bernard, Paquito; Romain, Ahmed-Jérôme; Trouillet, Raphael; Gernigon, Christophe; Nigg, Claudio; Ninot, Gregory

    2014-04-01

    Processes of change (POC) are constructs from the transtheoretical model that propose to examine how people engage in a behavior. However, there is no consensus about a leading model explaining POC and there is no validated French POC scale in physical activity This study aimed to compare the different existing models to validate a French POC scale. Three studies, with 748 subjects included, were carried out to translate the items and evaluate their clarity (study 1, n = 77), to assess the factorial validity (n = 200) and invariance/equivalence (study 2, n = 471), and to analyze the concurrent validity by stage × process analyses (study 3, n = 671). Two models displayed adequate fit to the data; however, based on the Akaike information criterion, the fully correlated five-factor model appeared as the most appropriate to measure POC in physical activity. The invariance/equivalence was also confirmed across genders and student status. Four of the five existing factors discriminated pre-action and post-action stages. These data support the validation of the POC questionnaire in physical activity among a French sample. More research is needed to explore the longitudinal properties of this scale.

  19. Leucocyte esterase dip-stick test as a point-of-care diagnostic for urogenital chlamydia in male patients: A multi-center evaluation in two STI outpatient clinics in Paramaribo and Amsterdam

    Directory of Open Access Journals (Sweden)

    Menne Bartelsman

    2016-11-01

    Full Text Available Abstract Background Point-of-care (POC tests are an important strategy to address the epidemic of sexually transmitted infections (STIs. The leucocyte esterase test (LET can be used as a POC test for chlamydia. The aim of this study was to determine the diagnostic accuracy of the LET to detect urogenital chlamydia among men at STI clinics in Paramaribo, Suriname and Amsterdam, the Netherlands. Methods Recruitment of patients took place in 2008–2010 in Suriname and in 2009–2010 in the Netherlands. Urine of patients was examined with the LET. The reference test was a nucleic acid amplification test (NAAT. Results We included 412 patients in Suriname and 645 in the Netherlands. Prevalence of chlamydia in Suriname and the Netherlands was respectively 22.8 and 13.6 %. The sensitivity of the LET was 92.6 % (95 % CI = 85.3–97.0 and 77.3 % (95 % CI = 67.1–85.5 respectively, the specificity was 38.1 % (95 % CI = 32.7–43.6 % and 58.1 % (95 % CI = 53.9–62.3 respectively. The positive predictive value was 30.6 % (95 % CI = 27.3–36.4 and 22.6 % (95 % CI = 18.0–27.7 respectively and the negative predictive value was 94.5 % (95 % CI = 89.1–97.8 and 94.2 % (95 % CI = 91.1–96.4 respectively. The kappa was respectively 0.179 and 0.176. Conclusions To diagnose urogenital chlamydia in men the LET performs poorly. It has a high negative but low positive predictive value. If the LET result is negative, chlamydia is accurately excluded, yet a positive result has a low predictive value. Whether the advantages of direct management based on LET outweigh the disadvantages of overtreatment is a subject for further studies.

  20. Postconditioning attenuates acute intestinal ischemia–reperfusion injury

    Directory of Open Access Journals (Sweden)

    Ilker Sengul

    2013-03-01

    Full Text Available The aim of this study was to test the hypothesis that postconditioning (POC would reduce the detrimental effects of the acute intestinal ischemia–reperfusion (I/R compared to those of the abrupt onset of reperfusion. POC has a protective effect on intestinal I/R injury by inhibiting events in the early minutes of reperfusion in rats. Twenty-four Wistar–Albino rats were subjected to the occlusion of superior mesenteric artery for 30 minutes, then reperfused for 120 minutes, and randomized to the four different modalities of POC: (1 control (no intervention; (2 POC-3 (three cycles of 10 seconds of reperfusion–reocclusion, 1 minute total intervention; (3 POC-6 (six cycles of 10 seconds of reperfusion–reocclusion, 2 minutes total intervention; and (4 sham operation (laparotomy only. The arterial blood samples [0.3 mL total creatine kinase (CK and 0.6 mL malondialdehyde (MDA] and the intestinal mucosal MDA were collected from each after reperfusion. POC, especially POC-6, was effective in attenuating postischemic pathology by decreasing the intestinal tissue MDA levels, serum total CK activity, inflammation, and total histopathological injury scores. POC exerted a protective effect on the intestinal mucosa by reducing the mesenteric oxidant generation, lipid peroxidation, and neutrophil accumulation. The six-cycle algorithm demonstrated the best protection.

  1. Point of care diagnostics for HIV in resource limited settings: an overview

    CSIR Research Space (South Africa)

    Manoto, Sello L

    2018-03-01

    Full Text Available result. In the case of HIV, the analytical targets can include human cells, proteins as well as nucleic acids and the samples can be blood, saliva and urine [8]. Irrespective of where these POC tests are used, they allow a sample with little... measurement. Viral Load Tool POC Analyte Detection Method Time to Result Sample Type andVolume Additional Information SAMBA Yes RNA Isothermic amplification and Hapten-based signal detection 90 min (SI 4 sample throughput, 24–48 tests/day), (SII 4 tests a day...

  2. Advances Afoot in Microbiology

    OpenAIRE

    Patel, Robin; Karon, Brad S.

    2017-01-01

    In 2016, the American Academy of Microbiology convened a colloquium to examine point-of-care (POC) microbiology testing and to evaluate its effects on clinical microbiology. Colloquium participants included representatives from clinical microbiology laboratories, industry, and the government, who together made recommendations regarding the implementation, oversight, and evaluation of POC microbiology testing. The colloquium report is timely and well written (V. Dolen et al., Changing Diagnost...

  3. Designing a Care Pathway Model – A Case Study of the Outpatient Total Hip Arthroplasty Care Pathway

    Directory of Open Access Journals (Sweden)

    Robin I. Oosterholt

    2017-03-01

    Full Text Available Introduction: Although the clinical attributes of total hip arthroplasty (THA care pathways have been thoroughly researched, a detailed understanding of the equally important organisational attributes is still lacking. The aim of this article is to contribute with a model of the outpatient THA care pathway that depicts how the care team should be organised to enable patient discharge on the day of surgery. Theory: The outpatient THA care pathway enables patients to be discharged on the day of surgery, short- ening the length of stay and intensifying the provision and organisation of care. We utilise visual care modelling to construct a visual design of the organisation of the care pathway. Methods: An embedded case study was conducted of the outpatient THA care pathway at a teaching hospital in the Netherlands. The data were collected using a visual care modelling toolkit in 16 semi- structured interviews. Problems and inefficiencies in the care pathway were identified and addressed in the iterative design process. Results: The results are two visual models of the most critical phases of the outpatient THA care pathway: diagnosis & preparation (1 and mobilisation & discharge (4. The results show the care team composition, critical value exchanges, and sequence that enable patient discharge on the day of surgery. Conclusion: The design addressed existing problems and is an optimisation of the case hospital’s pathway. The network of actors consists of the patient (1, radiologist (1, anaesthetist (1, nurse specialist (1, pharmacist (1, orthopaedic surgeon (1,4, physiotherapist (1,4, nurse (4, doctor (4 and patient applica- tion (1,4. The critical value exchanges include patient preparation (mental and practical, patient education, aligned care team, efficient sequence of value exchanges, early patient mobilisation, flexible availability of the physiotherapist, functional discharge criteria, joint decision making and availability of the care team.

  4. Evaluating the effect of sample type on American alligator (Alligator mississippiensis) analyte values in a point-of-care blood analyser.

    Science.gov (United States)

    Hamilton, Matthew T; Finger, John W; Winzeler, Megan E; Tuberville, Tracey D

    2016-01-01

    The assessment of wildlife health has been enhanced by the ability of point-of-care (POC) blood analysers to provide biochemical analyses of non-domesticated animals in the field. However, environmental limitations (e.g. temperature, atmospheric humidity and rain) and lack of reference values may inhibit researchers from using such a device with certain wildlife species. Evaluating the use of alternative sample types, such as plasma, in a POC device may afford researchers the opportunity to delay sample analysis and the ability to use banked samples. In this study, we examined fresh whole blood, fresh plasma and frozen plasma (sample type) pH, partial pressure of carbon dioxide (PCO2), bicarbonate (HCO3 (-)), total carbon dioxide (TCO2), base excess (BE), partial pressure of oxygen (PO2), oxygen saturation (sO2) and lactate concentrations in 23 juvenile American alligators (Alligator mississippiensis) using an i-STAT CG4+ cartridge. Our results indicate that sample type had no effect on lactate concentration values (F 2,65 = 0.37, P = 0.963), suggesting that the i-STAT analyser can be used reliably to quantify lactate concentrations in fresh and frozen plasma samples. In contrast, the other seven blood parameters measured by the CG4+ cartridge were significantly affected by sample type. Lastly, we were able to collect blood samples from all alligators within 2 min of capture to establish preliminary reference ranges for juvenile alligators based on values obtained using fresh whole blood.

  5. Results from 15years of quality surveillance for a National Indigenous Point-of-Care Testing Program for diabetes.

    Science.gov (United States)

    Shephard, Mark; Shephard, Anne; McAteer, Bridgit; Regnier, Tamika; Barancek, Kristina

    2017-12-01

    Diabetes is a major health problem for Australia's Aboriginal and Torres Strait Islander peoples. Point-of-care testing for haemoglobin A1c (HbA1c) has been the cornerstone of a long-standing program (QAAMS) to manage glycaemic control in Indigenous people with diabetes and recently, to diagnose diabetes. The QAAMS quality management framework includes monthly testing of quality control (QC) and external quality assurance (EQA) samples. Key performance indicators of quality include imprecision (coefficient of variation [CV%]) and percentage acceptable results. This paper reports on the past 15years of quality testing in QAAMS and examines the performance of HbA1c POC testing at the 6.5% cut-off recommended for diagnosis. The total number of HbA1c EQA results submitted from 2002 to 2016 was 29,093. The median imprecision for EQA testing by QAAMS device operators averaged 2.81% (SD 0.50; range 2.2 to 3.9%) from 2002 to 2016 and 2.44% (SD 0.22; range 2.2 to 2.9%) from 2009 to 2016. No significant difference was observed between the median imprecision achieved in QAAMS and by Australasian laboratories from 2002 to 2016 (p=0.05; two-tailed paired t-test) and from 2009 to 2016 (p=0.17; two-tailed paired t-test). For QC testing from 2009 to 2016, imprecision averaged 2.5% and 3.0% for the two levels of QC tested. Percentage acceptable results averaged 90% for QA testing from 2002 to 2016 and 96% for QC testing from 2009 to 2016. The DCA Vantage was able to measure a patient and an EQA sample with an HbA1c value close to 6.5% both accurately and precisely. HbA1c POC testing in QAAMS has remained analytically sound, matched the quality achieved by Australasian laboratories and met profession-derived analytical goals for 15years. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  6. Particulate and dissolved organic carbon and chlorophyll A in the Zaire river, estuary and plume

    Science.gov (United States)

    Cadée, G. C.

    Data were collected on POC, DOC and phytoplankton in the Zaire river, estuary and plume. Mean river value for POC was 1.1 mg·l -1, 4.7% of the suspended matter. Average DOC content of the river water was 8.5 mg·l -1. These values are in accordance with the calculations of TOC input from rivers to the world's ocean. Within the estuary POC and chlorophyll decreased regularly up to a salinity of 20. Between salinities of 20 and 32 small phytoplankton bloom occurred resulting also in higher POC values. DOC mixed conservatively up to a salinity of 25; at salinities above 25, values indicate DOC production. This DOC production occurred partly in the bottom water of the canyon where low oxygen values indicated mineralization and conversion of the accumulated POC into DOC. Another area of DOC production observed inside and outside the surface waters of the plume, was partly related to autolysis and degradation of the phytoplankton bloom. This study shows that the influence of rivers on the organic carbon in the ocean will not be confined to the amount introduced directly, but that we have to add the amounts of POC and DOC resulting from enhanced phytoplankton primary production by nutrient input from rivers and by river induced upwelling.

  7. Construction and Validation of the Perceived Opportunity to Craft Scale.

    Science.gov (United States)

    van Wingerden, Jessica; Niks, Irene M W

    2017-01-01

    We developed and validated a scale to measure employees' perceived opportunity to craft (POC) in two separate studies conducted in the Netherlands (total N = 2329). POC is defined as employees' perception of their opportunity to craft their job. In Study 1, the perceived opportunity to craft scale (POCS) was developed and tested for its factor structure and reliability in an explorative way. Study 2 consisted of confirmatory analyses of the factor structure and reliability of the scale as well as examination of the discriminant and criterion-related validity of the POCS. The results indicated that the scale consists of one dimension and could be reliably measured with five items. Evidence was found for the discriminant validity of the POCS. The scale also showed criterion-related validity when correlated with job crafting (+), job resources (autonomy +; opportunities for professional development +), work engagement (+), and the inactive construct cynicism (-). We discuss the implications of these findings for theory and practice.

  8. Temporal variability in terrestrially-derived sources of particulate organic carbon in the lower Mississippi River and its upper tributaries

    Science.gov (United States)

    Bianchi, Thomas S.; Wysocki, Laura A.; Stewart, Mike; Filley, Timothy R.; McKee, Brent A.

    2007-09-01

    In this study, we examined the temporal changes of terrestrially-derived particulate organic carbon (POC) in the lower Mississippi River (MR) and in a very limited account, the upper tributaries (Upper MR, Ohio River, and Missouri River). We used for the first time a combination of lignin-phenols, bulk stable carbon isotopes, and compound-specific isotope analyses (CSIA) to examine POC in the lower MR and upper tributaries. A lack of correlation between POC and lignin phenol abundances ( Λ8) was likely due to dilution effects from autochthonous production in the river, which has been shown to be considerably higher than previously expected. The range of δ 13C values for p-hydroxycinnamic and ferulic acids in POC in the lower river do support that POM in the lower river does have a significant component of C 4 in addition to C 3 source materials. A strong correlation between δ 13C values of p-hydroxycinnamic, ferulic, and vanillyl phenols suggests a consistent input of C 3 and C 4 carbon to POC lignin while a lack of correlation between these same phenols and POC bulk δ 13C further indicates the considerable role of autochthonous carbon in the lower MR POC budget. Our estimates indicate an annual flux of POC of 9.3 × 10 8 kg y -1 to the Gulf of Mexico. Total lignin fluxes, based on Λ8 values of POC, were estimated to be 1.2 × 10 5 kg y -1. If we include the total dissolved organic carbon (DOC) flux (3.1 × 10 9 kg y -1) reported by [Bianchi T. S., Filley T., Dria K. and Hatcher, P. (2004) Temporal variability in sources of dissolved organic carbon in the lower Mississippi River. Geochim. Cosmochim. Acta68, 959-967.], we get a total organic carbon flux of 4.0 × 10 9 kg y -1. This represents 0.82% of the annual total organic carbon supplied to the oceans by rivers (4.9 × 10 11 kg).

  9. Fluvial organic carbon flux from an eroding peatland catchment, southern Pennines, UK

    Directory of Open Access Journals (Sweden)

    R. R. Pawson

    2008-03-01

    Full Text Available This study investigates for the first time the relative importance of dissolved organic carbon (DOC and particulate organic carbon (POC in the fluvial carbon flux from an actively eroding peatland catchment in the southern Pennines, UK. Event scale variability in DOC and POC was examined and the annual flux of fluvial organic carbon was estimated for the catchment. At the event scale, both DOC and POC were found to increase with discharge, with event based POC export accounting for 95% of flux in only 8% of the time. On an annual cycle, exports of 35.14 t organic carbon (OC are estimated from the catchment, which represents an areal value of 92.47 g C m−2 a1. POC was the most significant form of organic carbon export, accounting for 80% of the estimated flux. This suggests that more research is required on both the fate of POC and the rates of POC export in eroding peatland catchments.

  10. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

    Science.gov (United States)

    Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

    2018-04-01

    As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Swallowing Function and Nutritional Status in Japanese Elderly People Receiving Home-care Services: A 1-year Longitudinal Study.

    Science.gov (United States)

    Okabe, Y; Furuta, M; Akifusa, S; Takeuchi, K; Adachi, M; Kinoshita, T; Kikutani, T; Nakamura, S; Yamashita, Y

    2016-01-01

    Malnutrition is a serious health concern for frail elderly people. Poor oral function leading to insufficient food intake can contribute to the development of malnutrition. In the present study, we explored the longitudinal association of malnutrition with oral function, including oral health status and swallowing function, in elderly people receiving home nursing care. Prospective observational cohort study with 1-year follow-up. Two mid-sized cities in Fukuoka, Japan from November 2010 to March 2012. One hundred and ninety-seven individuals, aged ≥ 60 years, living at home and receiving home-care services because of physical disabilities, without malnutrition. Oral health status, swallowing function, taking modified-texture diets such as minced or pureed foods, nutritional status, cognitive function, and activities of daily living were assessed at baseline. The associations between malnutrition at 1-year follow-up and these related factors were analyzed using a logistic regression model. Swallowing disorders [risk ratio (RR): 5.21, 95% confidence interval (95% CI): 1.65-16.43] were associated with malnutrition. On the other hand, oral health status did not have a direct association with malnutrition. Swallowing disorders may be associated with the incidence of malnutrition in elderly people receiving home-care. The findings indicate that maintaining swallowing function may contribute to the prevention of malnutrition in frail elderly people.

  12. Childhood maternal care is associated with DNA methylation of the genes for brain-derived neurotrophic factor (BDNF) and oxytocin receptor (OXTR) in peripheral blood cells in adult men and women.

    Science.gov (United States)

    Unternaehrer, Eva; Meyer, Andrea Hans; Burkhardt, Susan C A; Dempster, Emma; Staehli, Simon; Theill, Nathan; Lieb, Roselind; Meinlschmidt, Gunther

    2015-01-01

    In adults, reporting low and high maternal care in childhood, we compared DNA methylation in two stress-associated genes (two target sequences in the oxytocin receptor gene, OXTR; one in the brain-derived neurotrophic factor gene, BDNF) in peripheral whole blood, in a cross-sectional study (University of Basel, Switzerland) during 2007-2008. We recruited 89 participants scoring  33 (n = 42, 35 women) on the maternal care subscale of the Parental Bonding Instrument (PBI) at a previous assessment of a larger group (N = 709, range PBI maternal care = 0-36, age range = 19-66 years; median 24 years). 85 participants gave blood for DNA methylation analyses (Sequenom(R) EpiTYPER, San Diego, CA) and cell count (Sysmex PocH-100i™, Kobe, Japan). Mixed model statistical analysis showed greater DNA methylation in the low versus high maternal care group, in the BDNF target sequence [Likelihood-Ratio (1) = 4.47; p = 0.035] and in one OXTR target sequence Likelihood-Ratio (1) = 4.33; p = 0.037], but not the second OXTR target sequence [Likelihood-Ratio (1) BDNF (estimate = -0.005, 95% CI = -0.025 to 0.015; p = 0.626) or OXTR DNA methylation (estimate = -0.015, 95% CI = -0.038 to 0.008; p = 0.192). Hence, low maternal care in childhood was associated with greater DNA methylation in an OXTR and a BDNF target sequence in blood cells in adulthood. Although the study has limitations (cross-sectional, a wide age range, only three target sequences in two genes studied, small effects, uncertain relevance of changes in blood cells to gene methylation in brain), the findings may indicate components of the epiphenotype from early life stress.

  13. Metabolic syndrome and health-related behaviours associated with pre-oral cancerous lesions among adults aged 20-80 years in Yunlin County, Taiwan: a cross-sectional study.

    Science.gov (United States)

    Chang, Chang-Cheng; Lin, Ming-Shyan; Chen, Yu-Tsung; Tu, Liang-Tse; Jane, Su-Whi; Chen, Mei-Yen

    2015-12-18

    To explore the associations of health-related behaviours, metabolic syndrome and risk factors in adults with pre-oral cancerous (POC) lesions in rural, disadvantaged communities with a high prevalence of oral cancer. A cross-sectional observational study. Community-based health survey in the western coastal area of Yunlin County, Taiwan. 5161 adult residents participated in this study. Assessed parameters included oral leukoplakia, oral submucous fibrosis, fasting blood glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and waist circumference. Statistical analyses included descriptive statistics, χ(2) tests and multivariate binary logistic regression. A high percentage of participants were found to have metabolic syndrome (40%) and POC lesions (7.3%). Participants with POC lesions tended to be male (psocioeconomic status are non-modifiable factors associated with POC and metabolic syndrome in adults, several factors, notably health behaviours, are modifiable. Clinicians can reduce the incidence and consequences of POC by developing programmes for early detection, encouraging regular dental check-ups, and initiating individualised, health-promoting behaviour modification programmes for reducing risky behaviours associated with oral cancer. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  14. Organizational effects of information and communication technology (ICT) in elderly homecare: a case study.

    Science.gov (United States)

    Vimarlund, Vivian; Olve, Nils-Göran; Scandurra, Isabella; Koch, Sabine

    2008-09-01

    The use of information and communication technology (ICT) to support integrated healthcare services in elderly homecare is becoming more established. In particular, ICT can enable information exchange, knowledge sharing and documentation at the point-of-care (POC). The aim of this study was to explore these effects using the Old@Home prototype. Old@Home was perceived to contribute in developing horizontal links for communication between individuals who work together, independent of geographical distance or organizational affiliation, and to contribute to increased work efficiency. The prototype was further seen to reduce professional isolation by providing a holistic overview of the care process. User centred design and implementation of Old@Home was considered key to facilitating acceptance of organizational changes. Participation of care professionals not only led to a better understanding of the needs of involved organizations, but also increased end-users' involvement and commitment, stimulating them to test and improve the prototype until the final version.

  15. Patient's Satisfaction with Health Care: a Questionnaire Study of Different Aspects of Care.

    Science.gov (United States)

    Spasojevic, Nada; Hrabac, Boris; Huseinagic, Senad

    2015-08-01

    To determine the influence of sociodemographic factors on patients´ satisfaction with health care system. In a cross-sectional study, 1,995 patients from 12 municipalities of Zenica-Doboj Canton were interviewed after a visit to the practice. Individual interviews were conducted and the questionnaire was made on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Out of the total number patients, 47.1% were females, 47.9% were from urban population and median of age was 42.0 years (IQR = 30.0 to 53.0 years). The rural population was more likely to buy drugs for medical treatment (p buy drugs for medical treatment (p = 0.001), to buy parenteral injections in primary care practice (p buy drugs for medical treatment (p = 0.004); more likely to buy parenteral injections in primary care practice (p < 0.001). The following variables: gender, age, overall perception of health status and financial status appear to be predictors of patients´ satisfaction.

  16. Ultra-High-Throughput Sample Preparation System for Lymphocyte Immunophenotyping Point-of-Care Diagnostics.

    Science.gov (United States)

    Walsh, David I; Murthy, Shashi K; Russom, Aman

    2016-10-01

    Point-of-care (POC) microfluidic devices often lack the integration of common sample preparation steps, such as preconcentration, which can limit their utility in the field. In this technology brief, we describe a system that combines the necessary sample preparation methods to perform sample-to-result analysis of large-volume (20 mL) biopsy model samples with staining of captured cells. Our platform combines centrifugal-paper microfluidic filtration and an analysis system to process large, dilute biological samples. Utilizing commercialization-friendly manufacturing methods and materials, yielding a sample throughput of 20 mL/min, and allowing for on-chip staining and imaging bring together a practical, yet powerful approach to microfluidic diagnostics of large, dilute samples. © 2016 Society for Laboratory Automation and Screening.

  17. Feasibility of using microbiology diagnostic tests of moderate or high complexity at the point - of - care in a delivery suite.

    Science.gov (United States)

    Gray, J W; Milner, P J; Edwards, E H; Daniels, J P; Khan, K S

    2012-07-01

    Point-of-care testing (POCT) is one of the fastest growing sectors of laboratory diagnostics. Most tests in routine use are haematology or biochemistry tests that are of low complexity. Microbiology POCT has been constrained by a lack of tests that are both accurate and of low complexity. We describe our experience of the practical issues around using more complex POCT for detection of Group B streptococci (GBS) in swabs from labouring women. We evaluated two tests for their feasibility in POCT: an optical immune assay (Biostar OIA Strep B, Inverness Medical, Princetown, NJ) and a PCR (IDI-Strep B, Cepheid, Sunnyvale, CA), which have been categorised as being of moderate and high complexity, respectively. A total of 12 unqualified midwifery assistants (MA) were trained to undertake testing on the delivery suite. A systematic approach to the introduction and management of POC testing was used. Modelling showed that the probability of test results being available within a clinically useful timescale was high. However, in the clinical setting, we found it impossible to maintain reliable availability of trained testers. Implementation of more complex POC testing is technically feasible, but it is expensive, and may be difficult to achieve in a busy delivery suite.

  18. The experience of intensive care nurses caring for patients with delirium: A phenomenological study.

    Science.gov (United States)

    LeBlanc, Allana; Bourbonnais, Frances Fothergill; Harrison, Denise; Tousignant, Kelly

    2018-02-01

    The purpose of this research was to seek to understand the lived experience of intensive care nurses caring for patients with delirium. The objectives of this inquiry were: 1) To examine intensive care nurses' experiences of caring for adult patients with delirium; 2) To identify factors that facilitate or hinder intensive care nurses caring for these patients. This study utilised an interpretive phenomenological approach as described by van Manen. Individual conversational interviews were conducted with eight intensive care nurses working in a tertiary level, university-affiliated hospital in Canada. The essence of the experience of nurses caring for patients with delirium in intensive care was revealed to be finding a way to help them come through it. Six main themes emerged: It's Exhausting; Making a Picture of the Patient's Mental Status; Keeping Patients Safe: It's aReally Big Job; Everyone Is Unique; Riding It Out With Families and Taking Every Experience With You. The findings contribute to an understanding of how intensive care nurses help patients and their families through this complex and distressing experience. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Late summer particulate organic carbon export and twilight zone remineralisation in the Atlantic sector of the Southern Ocean

    Science.gov (United States)

    Planchon, F.; Cavagna, A.-J.; Cardinal, D.; André, L.; Dehairs, F.

    2013-02-01

    .05, are attributed to remineralisation/disaggregation of 234Th-bearing particles. The accumulation of excess 234Th in the 100-600 m depth interval ranged from 458 ± 633 dpm m-2 d-1 to 3068 ± 897 dpm m-2 d-1, assuming steady state. Using the POC/234Thp ratio of sinking particles (> 53 μm), this 234Th accumulation flux was converted into a POC remineralisation flux which ranged between 0.9 ± 1.2 mmol C m-2 d-1 and 9.2 ± 2.9 mmol C m-2 d-1. Mesopelagic particulate biogenic Ba has been reported to reflect bacterial degradation of organic matter and to be related to oxygen consumption and bacterial carbon respiration. We observed that the highest Baxs contents (reaching up to > 1000 pM), in general, occurred between 200 and 400 m. Depth-weighted average mesopelagic Baxs (meso-Baxs) values were converted into respired C fluxes, which ranged between 0.23 and 6.4 mmol C m-2 d-1, in good agreement with 234Th-based remineralisation fluxes. A major outcome from this study is the observed significant positive correlation between POC remineralisation as estimated from meso-Baxs contents and from 234Th excess (R2 = 0.73; excluding 2 outliers). Remineralisation of POC in the twilight zone was particularly efficient relative to POC export resulting in negligible bathypelagic (> 600 m) POC export fluxes in the sub-Antarctic zone, the Polar Front zone and the northern Weddell Gyre, while the subtropical zone as well as the vicinity of the SACCF had significant deep POC fluxes.

  20. Enhancing the Usability of an Optical Reader System to Support Point-of-Care Rapid Diagnostic Testing: An Iterative Design Approach.

    Science.gov (United States)

    Hohenstein, Jess; O'Dell, Dakota; Murnane, Elizabeth L; Lu, Zhengda; Erickson, David; Gay, Geri

    2017-11-21

    In today's health care environment, increasing costs and inadequate medical resources have created a worldwide need for more affordable diagnostic tools that are also portable, fast, and easy to use. To address this issue, numerous research and commercial efforts have focused on developing rapid diagnostic technologies; however, the efficacy of existing systems has been hindered by usability problems or high production costs, making them infeasible for deployment in at-home, point-of-care (POC), or resource-limited settings. The aim of this study was to create a low-cost optical reader system that integrates with any smart device and accepts any type of rapid diagnostic test strip to provide fast and accurate data collection, sample analysis, and diagnostic result reporting. An iterative design methodology was employed by a multidisciplinary research team to engineer three versions of a portable diagnostic testing device that were evaluated for usability and overall user receptivity. Repeated design critiques and usability studies identified a number of system requirements and considerations (eg, software compatibility, biomatter contamination, and physical footprint) that we worked to incrementally incorporate into successive system variants. Our final design phase culminated in the development of Tidbit, a reader that is compatible with any Wi-Fi-enabled device and test strip format. The Tidbit includes various features that support intuitive operation, including a straightforward test strip insertion point, external indicator lights, concealed electronic components, and an asymmetric shape, which inherently signals correct device orientation. Usability testing of the Tidbit indicates high usability for potential user communities. This study presents the design process, specification, and user reception of the Tidbit, an inexpensive, easy-to-use, portable optical reader for fast, accurate quantification of rapid diagnostic test results. Usability testing suggests

  1. Toward unstained cytology and complete blood counts at the point of care (Conference Presentation)

    Science.gov (United States)

    Zuluaga, Andres F.; Pierce, Mark C.; MacAulay, Calum E.

    2017-02-01

    Cytology tests, whether performed on body fluids, aspirates, or scrapings are commonly used to detect, diagnose, and monitor a wide variety of health conditions. Complete blood counts (CBCs) quantify the number of red and white blood cells in a blood volume, as well as the different types of white blood cells. There is a critical unmet need for an instrument that can perform CBCs at the point of care (POC), and there is currently no product in the US that can perform this test at the bedside. We have developed a system that is capable of tomographic images with sub-cellular resolution with consumer-grade broadband (LED) sources and CMOS detectors suitable for POC implementation of CBC tests. The systems consists of cascaded static Michelson and Sagnac interferometers that map phase (encoding depth) and a transverse spatial dimension onto a two-dimensional output plane. Our approach requires a 5 microliter sample, can be performed in 5 minutes or less, and does not require staining or other processing as it relies on intrinsic contrast. We will show results directly imaging and differentiating unstained blood cells using supercontinuum fiber lasers and LEDs as sources and CMOS cameras as sensors. We will also lay out the follow up steps needed, including image segmentation, analysis and classification, to verify performance and advance toward CBCs that can be performed bedside and do not require CLIA-certified laboratories.

  2. Low level of sequence diversity at merozoite surface protein-1 locus of Plasmodium ovale curtisi and P. ovale wallikeri from Thai isolates.

    Science.gov (United States)

    Putaporntip, Chaturong; Hughes, Austin L; Jongwutiwes, Somchai

    2013-01-01

    The merozoite surface protein-1 (MSP-1) is a candidate target for the development of blood stage vaccines against malaria. Polymorphism in MSP-1 can be useful as a genetic marker for strain differentiation in malarial parasites. Although sequence diversity in the MSP-1 locus has been extensively analyzed in field isolates of Plasmodium falciparum and P. vivax, the extent of variation in its homologues in P. ovale curtisi and P. ovale wallikeri, remains unknown. Analysis of the mitochondrial cytochrome b sequences of 10 P. ovale isolates from symptomatic malaria patients from diverse endemic areas of Thailand revealed co-existence of P. ovale curtisi (n = 5) and P. ovale wallikeri (n = 5). Direct sequencing of the PCR-amplified products encompassing the entire coding region of MSP-1 of P. ovale curtisi (PocMSP-1) and P. ovale wallikeri (PowMSP-1) has identified 3 imperfect repeated segments in the former and one in the latter. Most amino acid differences between these proteins were located in the interspecies variable domains of malarial MSP-1. Synonymous nucleotide diversity (πS) exceeded nonsynonymous nucleotide diversity (πN) for both PocMSP-1 and PowMSP-1, albeit at a non-significant level. However, when MSP-1 of both these species was considered together, πS was significantly greater than πN (pdiversity at this locus prior to speciation. Phylogenetic analysis based on conserved domains has placed PocMSP-1 and PowMSP-1 in a distinct bifurcating branch that probably diverged from each other around 4.5 million years ago. The MSP-1 sequences support that P. ovale curtisi and P. ovale wallikeri are distinct species. Both species are sympatric in Thailand. The low level of sequence diversity in PocMSP-1 and PowMSP-1 among Thai isolates could stem from persistent low prevalence of these species, limiting the chance of outcrossing at this locus.

  3. The Long and Winding Road to Optimal HbA1c Measurement

    Science.gov (United States)

    Little, Randie R.; Rohlfing, Curt

    2016-01-01

    The importance of hemoglobin A1c (HbA1c) as an indicator of mean glycemia and risks for complications in patients with diabetes mellitus was established by the results of long-term clinical trials, most notably the Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS), published in 1993 and 1998 respectively. However, clinical application of recommended HbA1c targets that were based on these studies was difficult due to lack of comparability of HbA1c results among assay methods and laboratories. Thus, the National Glycohemoglobin Standardization Program (NGSP) was initiated in 1996 with the goal of standardizing HbA1c results to those of the DCCT/UKPDS. HbA1c standardization efforts have been highly successful; however, a number of issues have emerged on the “long and winding road” to better HbA1c, including the development of a higher-order HbA1c reference method by the International Federation of Clinical Chemistry (IFCC), recommendations to use HbA1c to diagnose as well as monitor diabetes, and point-of-care (POC) HbA1c testing. Here, we review the past, present and future of HbA1c standardization and describe the current status of HbA1c testing, including limitations that healthcare providers need to be aware of when interpreting HbA1c results. PMID:23318564

  4. Antenatal care strengthening for improved quality of care in Jimma, Ethiopia: an effectiveness study.

    Science.gov (United States)

    Villadsen, Sarah Fredsted; Negussie, Dereje; GebreMariam, Abebe; Tilahun, Abebech; Friis, Henrik; Rasch, Vibeke

    2015-04-11

    Interventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia. The intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression. The continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0

  5. Are Treponema pallidum specific rapid and point-of-care tests for syphilis accurate enough for screening in resource limited settings? Evidence from a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Yalda Jafari

    Full Text Available Rapid and point-of-care (POC tests for syphilis are an invaluable screening tool, yet inadequate evaluation of their diagnostic accuracy against best reference standards limits their widespread global uptake. To fill this gap, a systematic review and meta-analysis was conducted to evaluate the sensitivity and specificity of rapid and POC tests in blood and serum samples against Treponema pallidum (TP specific reference standards.Five electronic databases (1980-2012 were searched, data was extracted from 33 articles, and Bayesian hierarchical models were fit.In serum samples, against a TP specific reference standard point estimates with 95% credible intervals (CrI for the sensitivities of popular tests were: i Determine, 90.04% (80.45, 95.21, ii SD Bioline, 87.06% (75.67, 94.50, iii VisiTect, 85.13% (72.83, 92.57, and iv Syphicheck, 74.48% (56.85, 88.44, while specificities were: i Syphicheck, 99.14% (96.37, 100, ii Visitect, 96.45% (91.92, 99.29, iii SD Bioline, 95.85% (89.89, 99.53, and iv Determine, 94.15% (89.26, 97.66. In whole blood samples, sensitivities were: i Determine, 86.32% (77.26, 91.70, ii SD Bioline, 84.50% (78.81, 92.61, iii Syphicheck, 74.47% (63.94, 82.13, and iv VisiTect, 74.26% (53.62, 83.68, while specificities were: i Syphicheck, 99.58% (98.91, 99.96, ii VisiTect, 99.43% (98.22, 99.98, iii SD Bioline, 97.95%(92.54, 99.33, and iv Determine, 95.85% (92.42, 97.74.Rapid and POC treponemal tests reported sensitivity and specificity estimates comparable to laboratory-based treponemal tests. In resource limited settings, where access to screening is limited and where risk of patients lost to follow up is high, the introduction of these tests has already been shown to improve access to screening and treatment to prevent stillbirths and neonatal mortality due to congenital syphilis. Based on the evidence, it is concluded that rapid and POC tests are useful in resource limited settings with poor access to laboratories or screening

  6. Self-reported care needs of Dutch homeless people with and without a suspected intellectual disability: a 1.5-year follow-up study.

    Science.gov (United States)

    Van Straaten, Barbara; Rodenburg, Gerda; Van der Laan, Jorien; Boersma, Sandra N; Wolf, Judith R L M; Van de Mheen, Dike

    2017-01-01

    Cognitive impairment is a prevalent problem among the homeless and seems related to more psychosocial problems. However, little is known about the care needs of the subgroup of homeless people with an intellectual disability compared to those without an intellectual disability and how their care needs develop over time. This study explores self-reported care needs within a broad range of life domains among Dutch homeless people with and without a suspected intellectual disability to gain insight into the transition of self-reported care needs from baseline to follow-up in both subgroups. This longitudinal study is part of a cohort study among homeless people who had been accepted for an individual programme plan in four major Dutch cities. The initial cohort consisted of 513 participants who were interviewed in 2011. At 1.5-year follow-up, 336 participants (65.5%) were also interviewed and screened for intellectual disability. Of these participants, 31% (95% CI 26.2-36.1) had a suspected intellectual disability. For both groups, between baseline and follow-up, the number of 'unmet care needs' decreased significantly and the number of 'no care needs' increased significantly, while at follow-up, participants with a suspected intellectual disability reported 'no care needs' on significantly fewer life domains than those without a suspected intellectual disability (mean numbers 16.4 vs. 17.5). Between baseline and follow-up, 'met care needs' decreased significantly on housing for both groups, and increased on finances and dental care for participants with a suspected intellectual disability. At follow-up, participants with a suspected intellectual disability more often preferred housing support available by appointment than those without a suspected intellectual disability. These findings suggest that homeless people who had been accepted for an individual programme plan with a suspected intellectual disability have care needs for a longer period of time than those

  7. Feasibility and Pilot Studies in Palliative Care Research: A Systematic Review.

    Science.gov (United States)

    Jones, Terry A; Olds, Timothy S; Currow, David C; Williams, Marie T

    2017-07-01

    Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult. In feasibility and pilot studies in palliative care research, to determine 1) how commonly a priori feasibility are criteria reported and whether results are subsequently reported against these criteria? and 2) how commonly are participants' views on acceptability of burden of the study protocol assessed? Four databases (OVID Medline, EMBASE, CINAHL, and PubMed via caresearch.com.au.) were searched. Search terms included palliative care, terminal care, advance care planning, hospice, pilot, feasibility, with a publication date between January 1, 2012 and December 31, 2013. Articles were selected and appraised by two independent reviewers. Fifty-six feasibility and/or pilot studies were included in this review. Only three studies had clear a priori criteria to measure success. Sixteen studies reported participant acceptability or burden with measures. Forty-eight studies concluded feasibility. The terms "feasibility" and "pilot" are used synonymously in palliative care research when describing studies that test for feasibility. Few studies in palliative care research outline clear criteria for success. The assessment of participant acceptability and burden is uncommon. A gold standard for feasibility study design in palliative care research that includes both clear criteria for success and testing of the study protocol for participant acceptability and burden is needed. Such a standard would assist with consistency in the design, conduct and reporting of feasibility and pilot studies. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

  8. Using wound care algorithms: a content validation study.

    Science.gov (United States)

    Beitz, J M; van Rijswijk, L

    1999-09-01

    Valid and reliable heuristic devices facilitating optimal wound care are lacking. The objectives of this study were to establish content validation data for a set of wound care algorithms, to identify their associated strengths and weaknesses, and to gain insight into the wound care decision-making process. Forty-four registered nurse wound care experts were surveyed and interviewed at national and regional educational meetings. Using a cross-sectional study design and an 83-item, 4-point Likert-type scale, this purposive sample was asked to quantify the degree of validity of the algorithms' decisions and components. Participants' comments were tape-recorded, transcribed, and themes were derived. On a scale of 1 to 4, the mean score of the entire instrument was 3.47 (SD +/- 0.87), the instrument's Content Validity Index was 0.86, and the individual Content Validity Index of 34 of 44 participants was > 0.8. Item scores were lower for those related to packing deep wounds (P valid and reliable definitions. The wound care algorithms studied proved valid. However, the lack of valid and reliable wound assessment and care definitions hinders optimal use of these instruments. Further research documenting their clinical use is warranted. Research-based practice recommendations should direct the development of future valid and reliable algorithms designed to help nurses provide optimal wound care.

  9. Pentalogy of Cantrell: Complete expression with mediastinal teratoma

    Directory of Open Access Journals (Sweden)

    Michał Błaszczyński

    2015-08-01

    Full Text Available Pentalogy of Cantrell (POC is a rare, and often fatal congenital disorder that is characterized by a pentad consisting of ectopia cordis, omphalocele, sternal cleft, congenital diaphragmatic hernia, and various intra-cardiac defects. Although the hallmark of POC consists of these five anomalies, only a handful of cases have been reported with the full spectrum of this disorder. This case report presents a full term female with complete expression of POC and a mediastinal teratoma. Two days after birth, this infant underwent correction of the omphalocele and diaphragmatic defect, with repositioning of the cardiac apex within the thoracic cavity. Three months later surgical correction of the intra-cardiac defects took place. At initiation of cardiac by-pass a mediastinal mass at the superior cavopulmonary junction was identified and excised. This mass on histopathology was a teratoma, which makes this case unique as the occurrence of POC and mediastinal teratoma is unreported. This infant has survived the series of corrective surgeries, and is now functioning well. Conclusion: when POC is suspected further investigation for associated anomalies is required for a planned multidisciplinary surgical approach combined with neonatal intensive care to afford the opportunity for a successful outcome.

  10. A study of the swine flu (H1N1 epidemic among health care providers of a medical college hospital of Delhi

    Directory of Open Access Journals (Sweden)

    Om Prakash Rajoura

    2011-01-01

    Full Text Available Background: Influenza viruses cause annual epidemics and occasional pandemics that have claimed the lives of millions. Understanding the role of specific perceptions in motivating people to engage in precautionary behavior may help health communicators to improve their messages about outbreaks of new infectious disease generally and swine flu specifically. Objectives: To study the knowledge and practices of health care providers regarding swine flu and to study the attitudes and practices of health care providers toward the prevention of the swine flu epidemic. Materials and Methods: The present study was a cross-sectional (descriptive study and was conducted in the month of September, 2009, among doctors and nurses. A maximum of 40% of the total health care providers of GTB Hospital were covered because of feasibility and logistics, and, therefore, the sample size was 334. Results: Around 75% of the health care providers were aware about the symptoms of swine flu. Mostly, all study subjects were aware that it is transmitted through droplet infection. Correct knowledge of the incubation period of swine flu was known to 80% of the doctors and 69% of the nurses. Knowledge about high-risk groups (contacts, travelers, health care providers was observed among 88% of the doctors and 78.8% of the nurses. Practice of wearing mask during duty hours was observed among 82.6% of doctors and 85% of nurses, whereas of the total study population, only 40% were correctly using mask during duty hours. Conclusions: Significant gaps observed between knowledge and actual practice of the Health Care Provider regarding swine flu need to be filled by appropriate training. Data indicate that the health care providers are very intellectual, but they do not themselves practice what they preach.

  11. Public and private pregnancy care in Reggio Emilia Province: an observational study on appropriateness of care and delivery outcomes.

    Science.gov (United States)

    Bonvicini, Laura; Candela, Silvia; Evangelista, Andrea; Bertani, Daniela; Casoli, Morena; Lusvardi, Annarella; Messori, Antonella; Giorgi Rossi, Paolo

    2014-02-17

    In industrialized countries, improvements have been made in both maternal and newborn health. While attention to antenatal care is increasing, excessive medicalization is also becoming more common.The aim of this study is to compare caesarean section (CS) frequency and ultrasound scan utilization in a public model of care involving both midwives and obstetricians with a private model in which care is provided by obstetricians only. Observational population-based study. Reggio Emilia Province. 5957 women resident in the province who delivered between October 2010 and November 2011. CS frequency and ultrasound scan utilization, stillbirths, and other negative perinatal outcomes. Women in the study were searched in the public family and reproductive health clinic medical records to identify those cared for in the public system. Outcomes of the two antenatal care models were compared through multivariate logistic regression adjusting for maternal characteristics and, for CS only, by stratifying by Robson's Group. Compared to women cared for in private services (N = 3,043), those in public service (N = 2,369) were younger, less educated, more frequently non-Italian, and multiparous. The probability of CS was slightly higher for women cared for by private obstetricians than for those cared for in the public system (31.8% vs. 27.1%; adjusted odds ratio: 1.10; 95% CI: 0.93-1.29): The probability of having more than 3 ultrasound scans was higher in private care (89.6% vs. 49.8%; adjusted odds ratio: 5.11; 95% CI: 4.30-6.08). CS frequency was higher in private care for all Robson's classes except women who underwent CS during spontaneous labour. Among negative perinatal outcomes only a higher risk of pre-term birth was observed for pregnancies cared for in private services. The public model provides less medicalized and more guidelines-oriented care than does the private model, with no increase in negative perinatal outcomes.

  12. OLED Hybrid Integrated Polymer Microfluidic Biosensing for Point of Care Testing

    Directory of Open Access Journals (Sweden)

    Ashwin Acharya

    2015-09-01

    Full Text Available This paper reports a microfluidic platform with external hybrid integration of an organic light emitting diode (OLED as an excitation source. This device can be used as a simple and cost effective biosensing element. The device is capable of rapid in-situ detection of biological elements such as sensing of interaction of antigen with fluorescent tagged antibody conjugates. These portable microfluidic systems have great potential for use an OLED in a single chip with very high accuracy and sensitivity for various point-of-care (POC diagnosis and lab on a chip (LOC applications, as the miniaturization of the biosensor is essential for handling smaller sample volumes in order to achieve high throughput. The biosensing element was successfully tested to detect anti-sheep IgG conjugates tagged to Alexafluor using a fluorescence based immunoassay method.

  13. Evaluating care from a care ethical perspective:: A pilot study.

    Science.gov (United States)

    Kuis, Esther E; Goossensen, Anne

    2017-08-01

    Care ethical theories provide an excellent opening for evaluation of healthcare practices since searching for (moments of) good care from a moral perspective is central to care ethics. However, a fruitful way to translate care ethical insights into measurable criteria and how to measure these criteria has as yet been unexplored: this study describes one of the first attempts. To investigate whether the emotional touchpoint method is suitable for evaluating care from a care ethical perspective. An adapted version of the emotional touchpoint interview method was used. Touchpoints represent the key moments to the experience of receiving care, where the patient recalls being touched emotionally or cognitively. Participants and research context: Interviews were conducted at three different care settings: a hospital, mental healthcare institution and care facility for older people. A total of 31 participants (29 patients and 2 relatives) took part in the study. Ethical considerations: The research was found not to be subject to the (Dutch) Medical Research Involving Human Subjects Act. A three-step care ethical evaluation model was developed and described using two touchpoints as examples. A focus group meeting showed that the method was considered of great value for partaking institutions in comparison with existing methods. Reflection and discussion: Considering existing methods to evaluate quality of care, the touchpoint method belongs to the category of instruments which evaluate the patient experience. The touchpoint method distinguishes itself because no pre-defined categories are used but the values of patients are followed, which is an essential issue from a care ethical perspective. The method portrays the insider perspective of patients and thereby contributes to humanizing care. The touchpoint method is a valuable instrument for evaluating care; it generates evaluation data about the core care ethical principle of responsiveness.

  14. Catalog of Completed Health Care and Dental Care Studies.

    Science.gov (United States)

    1987-12-01

    Army Oral lie ith jaintenanc, AD A0()’ )’rtjr, ur, on 1x--ntal Itealth Status of Army lersonnel Jun 79 Current Dental Officer Practice and Uti ...HCSD Report No. 80-001B) Sep 80 Decentralized Inpatient Pharmacy Service Study AD) A)OU’,()’, (Job Satisfaction Between Pharmacists Perfotm irj Patient...Care Activities and Pharmacists Perfotrninq Dispensary or Supervisory Flinctions): Part C (HCSD Report No. 80-001C) Jun 30 Non-Poductive Factor

  15. Seeking Humanizing Care in Patient-Centered Care Process: A Grounded Theory Study.

    Science.gov (United States)

    Cheraghi, Mohammad Ali; Esmaeili, Maryam; Salsali, Mahvash

    Patient-centered care is both a goal in itself and a tool for enhancing health outcomes. The application of patient-centered care in health care services globally however is diverse. This article reports on a study that sought to introduce patient-centered care. The aim of this study is to explore the process of providing patient-centered care in critical care units. The study used a grounded theory method. Data were collected on 5 critical care units in Tehran University of Medical Sciences. Purposive and theoretical sampling directed the collection of data using 29 semistructured interviews with 27 participants (nurses, patients, and physician). Data obtained were analyzed according to the analysis stages of grounded theory and constant comparison to identify the concepts, context, and process of the study. The core category of this grounded theory is "humanizing care," which consisted of 4 interrelated phases, including patient acceptance, purposeful patient assessment and identification, understanding patients, and patient empowerment. A core category of humanizing care integrated the theory. Humanizing care was an outcome and process. Patient-centered care is a dynamic and multifaceted process provided according to the nurses' understanding of the concept. Patient-centered care does not involve repeating routine tasks; rather, it requires an all-embracing understanding of the patients and showing respect for their values, needs, and preferences.

  16. Origin and composition of particulate organic matter in a macrotidal turbid estuary: The Gironde Estuary, France

    Science.gov (United States)

    Savoye, Nicolas; David, Valérie; Morisseau, François; Etcheber, Henri; Abril, Gwenaël; Billy, Isabelle; Charlier, Karine; Oggian, Georges; Derriennic, Hervé; Sautour, Benoît

    2012-08-01

    At the interface between continent and ocean, estuaries receive particles, and especially particulate organic matter (POM) originating from these two reservoirs, but also produce POM, through autochthonous primary production. The origin and composition of surface POM in the Gironde Estuary (SW France) and the environmental forcing of its variability was investigated using the data set produced by the French Coastal Monitoring Network SOMLIT (Service d'Observation en Milieu LITtoral; monthly like sampling during years 2007-2009). This estuary is considered as a model of macrotidal turbid estuaries. Using elemental and isotopic composition of the POM, we estimated that, at the inner estuary space scale and inter-annual time scale, surface particulate organic carbon (POC) was composed of terrestrial POM originated from the turbidity maximum (96.4%; refractory POC) and flood events (1.6%; labile and refractory POC), and of riverine (0.1%), estuarine (0.8%) and marine (1.1%) phytoplankton, i.e. that POC was 98% and 2% of terrestrial and phytoplankton origin, respectively. However, there was a clear spatial gradient: the phytoplankton contribution increases from ca. 1% in the upper and middle estuary to 8.5% in the lower estuary, where light condition is more favourable to plankton growth. The low contribution of phytoplankton to the POC is a characteristic of the Gironde estuary and contrast with other large temperate estuaries. Statistical analysis indicates that salinity, river flow and SPM concentration, and thus associated hydro-dynamic and sedimentary processes, were the only environmental forcings to the composition of surface POC in this system, at intra- and inter-annual time scale. In contrast, temperature and nutrient concentrations, and thus associated processes, do not force this composition of POC. By combining POC fluxes entering the inner estuary (literature data), POC loss as dissolved organic carbon and CO2 and as sediment trapping within the inner

  17. Badlands as a major source of petrogenic particulate Organic Carbon and sediments to the Gulf of Lion (NW Mediterranean Sea)

    Science.gov (United States)

    Copard, Y.; Eyrolle-Boyer, F.; Radakovitch, O.; Poirel, A.; Raimbault, P.; Gairoard, S.; Di-Giovanni, C.

    2017-12-01

    Rivers feed the marine environments both in term of sediments and nutrients and consequently, the characterization of their nature, sources and changes over a different spatial and time ranges is a critical for many scientific (e.g. biogeochemical cycles, contaminants transfer, geomorphology, ecology) and societal issues (e.g. food security, catastrophic floods). Specifically, continental sources showing some high erosion rates deserve to be studied since their fingerprint can be significant for the rivers fluxes. These included some sedimentary rocks (e.g. marls) forming badlands and containing a significant amount of petrogenic particulate organic carbon (pPOC) for which its contribution to the Rivers still remains evasive. Our study focuses on the Mediterranean area considered as very sensitive to the Global Change and particularly the Gulf of Lion mainly fed by the Rhône River, one of the major conveyors of sediments to this Sea. Based on radiocarbon data performed on a set of riverine samples and time series analyses from monitoring stations from French CZOs, we (i) update the POC flux of the Rhône River, (ii) determine the pPOC content and flux in suspended sediments and (iii) estimate the badlands contribution from the Durance catchment (a major tributary of the Rhône River) to the pPOC flux and to sediment discharge. Sediment discharge by the Rhône River to the Sea is 6.5 ± 4.3 Tg yr-1 (period 1990-2014) , its POC discharge reaches 0.145 ± 0.095 Tg yr-1 (period 2007-2014) while pPOC (0.44 wt. %) contributes to 30 % of this POC flux. Despite their insignificant surfaces (0.2 %) regarding the Rhône catchment area, badlands presently in erosion from the Durance catchment provide respectively, 16, 5 and 20 % of the pPOC, POC and sediment fluxes to the Rhône River. Consequently, badlands can be considered as a major source of sediments and pPOC for the NW Mediterranean Sea. We suggest that river-dominated ocean margins, such as the Rhône River, with

  18. How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care

    Directory of Open Access Journals (Sweden)

    Goetz K

    2015-11-01

    Full Text Available Katja Goetz,1 Jessica Bungartz,2 Joachim Szecsenyi,1 Jost Steinhaeuser3 1Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany; 2Praxis Medizin im Zentrum, München, Germany; 3Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany Background: Patients’ evaluation of medical care is an essential dimension of quality of care and an important aspect of the feedback cycle for health care providers. The aim of this study was to document how patients with a Turkish background evaluate primary care in Germany and determine which aspects of care are associated with language abilities.Methods: The study was based on an observational design. Patients with a Turkish background from German primary care practices completed the EUROPEP (European Project on Patient Evaluation of General Practice Care questionnaire consisting of 23 items. Seventeen primary care practices were involved with either German (n=8 or Turkish (n=9 general practitioners (GPs.Results: A convenience sample of 472 patients with a Turkish background from 17 practices participated in the study (response rate 39.9%. Practices with a German GP had a lower response rate (19.6% than those with a Turkish GP (57.5%. Items evaluated the highest were “keeping data confidential” (73.4% and “quick services for urgent health problems” (69.9%. Subgroup analysis showed lower evaluation scores from patients with good or excellent German language abilities. Patients who consulted a Turkish GP had higher evaluation scores.Conclusion: The evaluation from patients with a Turkish background living in Germany with either Turkish or German GPs showed lower scores than patients in other studies in Europe using EUROPEP. However, our results had higher evaluation scores than those of Turkish patients evaluating GPs in Turkey. Therefore, different explanation models for these findings should be explored in future studies

  19. Gastrointestinal manifestations of hereditary angioedema diagnosed by ultrasound in the emergency department.

    Science.gov (United States)

    Riguzzi, Christine; Losonczy, Lia; Teismann, Nathan; Herring, Andrew A; Nagdev, Arun

    2014-11-01

    Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE). The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis. We describe two cases of abdominal angioedema in patients with known HAE that were diagnosed in the emergency department by point-of-care (POC) ultrasound. In each case, the patient presented with isolated abdominal complaints and no signs of oropharyngeal edema. Findings on POC ultrasound included intraperitoneal free fluid and bowel wall edema. Both patients recovered uneventfully after receiving treatment. Because it can be performed rapidly, requires no ionizing radiation, and can rule out alternative diagnoses, POC ultrasound holds promise as a valuable tool in the evaluation and management of patients with HAE.

  20. Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa.

    Science.gov (United States)

    Chang, Wei; Chamie, Gabriel; Mwai, Daniel; Clark, Tamara D; Thirumurthy, Harsha; Charlebois, Edwin D; Petersen, Maya; Kabami, Jane; Ssemmondo, Emmanuel; Kadede, Kevin; Kwarisiima, Dalsone; Sang, Norton; Bukusi, Elizabeth A; Cohen, Craig R; Kamya, Moses; Havlir, Diane V; Kahn, James G

    2016-11-01

    In 2013-2014, we achieved 89% adult HIV testing coverage using a hybrid testing approach in 32 communities in Uganda and Kenya (SEARCH: NCT01864603). To inform scalability, we sought to determine: (1) overall cost and efficiency of this approach; and (2) costs associated with point-of-care (POC) CD4 testing, multidisease services, and community mobilization. We applied microcosting methods to estimate costs of population-wide HIV testing in 12 SEARCH trial communities. Main intervention components of the hybrid approach are census, multidisease community health campaigns (CHC), and home-based testing for CHC nonattendees. POC CD4 tests were provided for all HIV-infected participants. Data were extracted from expenditure records, activity registers, staff interviews, and time and motion logs. The mean cost per adult tested for HIV was $20.5 (range: $17.1-$32.1) (2014 US$), including a POC CD4 test at $16 per HIV+ person identified. Cost per adult tested for HIV was $13.8 at CHC vs. $31.7 by home-based testing. The cost per HIV+ adult identified was $231 ($87-$1245), with variability due mainly to HIV prevalence among persons tested (ie, HIV positivity rate). The marginal costs of multidisease testing at CHCs were $1.16/person for hypertension and diabetes, and $0.90 for malaria. Community mobilization constituted 15.3% of total costs. The hybrid testing approach achieved very high HIV testing coverage, with POC CD4, at costs similar to previously reported mobile, home-based, or venue-based HIV testing approaches in sub-Saharan Africa. By leveraging HIV infrastructure, multidisease services were offered at low marginal costs.

  1. Introducing Pharmaceutical Care to Primary Care in Iceland—An Action Research Study

    Directory of Open Access Journals (Sweden)

    Anna Bryndis Blondal

    2017-04-01

    Full Text Available Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient’s medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher’s notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125 before and between general practitioners’ interviews. The study setting was a primary care clinic in the Reykjavik area and the patients’ homes. Results showed that the GPs’ knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space

  2. Risk Factors Associated with Increased Morbidity in Living Liver Donation

    Directory of Open Access Journals (Sweden)

    Helry L. Candido

    2015-01-01

    Full Text Available Living donor liver donation (LDLD is an alternative to cadaveric liver donation. We aimed at identifying risk factors and developing a score for prediction of postoperative complications (POCs after LDLD in donors. This is a retrospective cohort study in 688 donors between June 1995 and February 2014 at Hospital Sírio-Libanês and A.C. Camargo Cancer Center, in São Paulo, Brazil. Primary outcome was POC graded ≥III according to the Clavien-Dindo classification. Left lateral segment (LLS, left lobe (LL, and right lobe resections (RL were conducted in 492 (71.4%, 109 (15.8%, and 87 (12.6% donors, respectively. In total, 43 (6.2% developed POCs, which were more common after RL than LLS and LL (14/87 (16.1% versus 23/492 (4.5% and 6/109 (5.5%, resp., p<0.001. Multivariate analysis showed that RL resection (OR: 2.81, 95% CI: 1.32 to 3.01; p=0.008, smoking status (OR: 3.2, 95% CI: 1.35 to 7.56; p=0.012, and blood transfusion (OR: 3.15, 95% CI: 1.45 to 6.84; p=0.004 were independently associated with POCs. RL resection, intraoperative blood transfusion, and smoking were associated with increased risk for POCs in donors.

  3. Workflow standardization of a novel team care model to improve chronic care: a quasi-experimental study.

    Science.gov (United States)

    Panattoni, Laura; Hurlimann, Lily; Wilson, Caroline; Durbin, Meg; Tai-Seale, Ming

    2017-04-19

    Team-based chronic care models have not been widely adopted in community settings, partly due to their varying effectiveness in randomized control trials, implementation challenges, and concerns about physician acceptance. The Palo Alto Medical Foundation designed and implemented "Champion," a novel team-based model that includes new standard work (e.g. proactive patient outreach, pre-visit schedule grooming, depression screening, care planning, health coaching) to support patients' self-management of hypertension and diabetes. We investigated whether Champion improved clinical outcomes. We conducted a quasi-experimental study comparing the Champion clinic-level intervention (n = 38 physicians) with a usual care clinic (n = 37 physicians) in Northern California. The primary outcomes, blood pressure and glycohemoglobin (A1c), were analyzed using a piecewise linear growth curve model for patients exposed to a Champion physician visit (n = 3156) or usual care visit (n = 8034) in the two years prior and one year post implementation. Secondary outcomes were provider experience, compared at baseline and 12 months in both the intervention and usual care clinics using multi-level ordered logistic modeling, and electronic health record based fidelity measures. Compared to usual care, in the first 6 months after a Champion physician visit, diabetes patients aged 18-75 experienced an additional -1.13 mm Hg (95% CI: -2.23 to -0.04) decline in diastolic blood pressure and -0.47 (95% CI: -0.61 to -0.33) decline in A1c. There were no additional improvements in blood pressure or A1c 6 to 12 months post physician visit. At 12 months, Champion physicians reported improved experience with managing chronic care patients in 6 of 7 survey items (p work was uneven; depression screening was the most commonly documented element (85% of patients), while care plans were the least (30.8% of patients). Champion standard work improved glycemic control over the first 6

  4. The limitations of point of care testing for pandemic influenza: what clinicians and public health professionals need to know.

    Science.gov (United States)

    Hatchette, Todd F; Bastien, Nathalie; Berry, Jody; Booth, Tim F; Chernesky, Max; Couillard, Michel; Drews, Steven; Ebsworth, Anthony; Fearon, Margaret; Fonseca, Kevin; Fox, Julie; Gagnon, Jean-Nicolas; Guercio, Steven; Horsman, Greg; Jorowski, Cathy; Kuschak, Theodore; Li, Yan; Majury, Anna; Petric, Martin; Ratnam, Sam; Smieja, Marek; Van Caeseele, Paul

    2009-01-01

    As the world prepares for the next influenza pandemic, governments have made significant funding commitments to vaccine development and antiviral stockpiling. While these are essential components to pandemic response, rapid and accurate diagnostic testing remains an often neglected cornerstone of pandemic influenza preparedness. Clinicians and Public Health Practitioners need to understand the benefits and drawbacks of different influenza tests in both seasonal and pandemic settings. Culture has been the traditional gold standard for influenza diagnosis but requires from 1-10 days to generate a positive result, compared to nucleic acid detection methods such as real time reverse transcriptase polymerase chain reaction (RT-PCR). Although the currently available rapid antigen detection kits can generate results in less than 30 minutes, their sensitivity is suboptimal and they are not recommended for the detection of novel influenza viruses. Until point-of-care (POC) tests are improved, PILPN recommends that the best option for pandemic influenza preparation is the enhancement of nucleic acid-based testing capabilities across Canada.

  5. European neonatal intensive care nursing research priorities: an e-Delphi study.

    Science.gov (United States)

    Wielenga, Joke M; Tume, Lyvonne N; Latour, Jos M; van den Hoogen, Agnes

    2015-01-01

    This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and research statements were generated to be ranged on importance on a scale of 1-6 (not important to most important). Neonatal intensive care units (NICUs) in 17 European countries. NICU clinical nurses, managers, educators and researchers (n=75). None. A list of 43 research statements in eight domains. The six highest ranking statements (≥5.0 mean score) were related to prevention and reduction of pain (mean 5.49; SD 1.07), medication errors (mean 5.20; SD 1.13), end-of-life care (mean 5.05; SD 1.18), needs of parents and family (mean 5.04; SD 1.23), implementing evidence into nursing practice (mean 5.02; SD 1.03), and pain assessment (mean 5.02; SD 1.11). The research domains were prioritised and ranked: (1) pain and stress; (2) family centred care; (3) clinical nursing care practices; (4) quality and safety; (5) ethics; (6) respiratory and ventilation; (7) infection and inflammation; and (8) professional issues in neonatal intensive care nursing. The results of this study might support developing a nursing research strategy for the nursing section of the European Society of Paediatric and Neonatal Intensive Care. In addition, this may promote more European researcher collaboratives for neonatal nursing research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Web Site Policies Important Links Linking Policies Small Business POC Subscribe PTSD Awareness PTSD Consultation More Health Care Veterans Health Administration Health Benefits Health Benefits Home Apply for VA Care Apply Online Application Process Veteran Eligibility Active Duty Families of ...

  7. Point-of-Care Determination of Acetaminophen Levels with Multi-Hydrogen Bond Manipulated Single-Molecule Recognition (eMuHSiR).

    Science.gov (United States)

    Zhang, Yan; Huang, Zhongyuan; Wang, Letao; Wang, Chunming; Zhang, Changde; Wiese, Tomas; Wang, Guangdi; Riley, Kevin; Wang, Zhe

    2018-04-03

    This work aims to face the challenge of monitoring small molecule drugs accurately and rapidly for point-of-care (POC) diagnosis in current clinical settings. Overdose of acetaminophen (AP), a commonly used over the counter (OTC) analgesic drug, has been determined to be a major cause of acute liver failure in the US and the UK. However, there is no rapid and accurate detection method available for this drug in the emergency room. The present study examined an AP sensing strategy that relies on a previously unexplored strong interaction between AP and the arginine (Arg) molecule. It was found that as many as 4 hydrogen bonds can be formed between one Arg molecule and one AP molecule. By taking advantages of this structural selectivity and high tenability of hydrogen bonds, Arg, immobilized on a graphene surface via electrostatic interactions, was utilized to structurally capture AP. Interestingly, bonded AP still remained the perfect electrochemical activities. The extent of Arg-AP bonds was quantified using a newly designed electrochemical (EC) sensor. To verify the feasibility of this novel assay, based on multihydrogen bond manipulated single-molecule recognition (eMuHSiR), both pharmaceutical and serum sample were examined. In commercial tablet measurement, no significant difference was seen between the results of eMuHSiR and other standard methods. For measuring AP concentration in the mice blood, the substances in serum, such as sugars and fats, would not bring any interference to the eMuHSiR in a wide concentration range. This eMuHSiR method opens the way for future development of small molecule detection for the POC testing.

  8. 78 FR 73553 - Prospective Grant of Exclusive License: Development of Cripto-1 Point of Care (POC) Tests and...

    Science.gov (United States)

    2013-12-06

    ... contemplated exclusive license should be directed to: Eggerton Campbell, Ph.D. Licensing and Patenting Manager... colon, pancreas, stomach, gallbladder, breast, lung, endometrium and cervix. Current methodologies of...

  9. Change in Care Dependency of Stroke Patients: A Longitudinal and Multicenter Study.

    Science.gov (United States)

    Nursiswati, Nursiswati; Halfens, Ruud J G; Lohrmann, Christa

    2017-06-01

    The study was conducted to investigate the change of care dependency in stroke patients from inpatient wards and outpatient units in Indonesia. This study is longitudinal and multicentered. One hundred and nine patients were included from four hospitals on the island of Java. Care dependency was assessed using the Indonesian version of the 15-item Care Dependency Scale (CDS) at five points in time: at inpatient wards for admission and discharge and at outpatient units after discharge in the 1st week, the 5th week, and the 13th week. Most of the patients were male (65.1%), and diagnosed with ischemic stroke (71.5%). The results showed that care dependency in stroke patients decreased significantly from admission to discharge, as well as from the 5th to the 13th week as measured by the CDS. At admission, 23.0% of the patients were completely dependent on care, and at the 13th week about 1.0% were. Patients' care dependency decreased significantly in all care dependency items of the CDS in the inpatient ward, but five care dependency items of the CDS did not significantly decrease in the outpatient unit. Based on the findings of this study, we recommend that hospital-based and community-based services should include continual care dependence monitoring using this comprehensive instrument. Care dependency is subject to change over time, therefore nurses have to plan and tailor adequate nursing care measures to patient needs in the different stages, especially with respect to the aspect of mobility. Copyright © 2017. Published by Elsevier B.V.

  10. Iranian women and care providers' perceptions of equitable prenatal care: A qualitative study.

    Science.gov (United States)

    Gheibizadeh, Mahin; Abedi, Heidar Ali; Mohammadi, Easa; Abedi, Parvin

    2016-06-01

    Equity as a basic human right builds the foundation of all areas of primary healthcare, especially prenatal care. However, it is unclear how pregnant women and their care providers perceive the equitable prenatal care. This study aimed to explore Iranian women's and care providers' perceptions of equitable prenatal care. In this study, a qualitative approach was used. Individual in-depth unstructured interviews were conducted with a purposeful sample of pregnant women and their care providers. Data were analyzed using inductive content analysis method. A total of 10 pregnant women and 10 prenatal care providers recruited from six urban health centers across Ahvaz, a south western city in Iran, were participated in the study. The study was approved by the Ethics Committee affiliated to Ahvaz Jundishapur University of Medical Sciences. The ethical principles of voluntary participation, confidentiality, and anonymity were considered. Analysis of participants' interviews resulted in seven themes: guideline-based care, time-saving care, nondiscriminatory care, privacy-respecting care, affordable comprehensive care, effective client-provider relationships, and caregivers' competency. The findings explain the broader and less discussed dimensions of equitable care that are valuable information for the realization of equity in care. Understanding and focusing on these dimensions will help health policy-makers in designing more equitable healthcare services for pregnant women. © The Author(s) 2015.

  11. Point-of-care testing in an organ procurement organization donor management setting.

    Science.gov (United States)

    Baier, K A; Markham, L E; Flaigle, S P; Nelson, P W; Shield, C F; Muruve, N A; Aeder, M I; Murillo, D; Bryan, C F

    2003-01-01

    Our organ procurement organization (OPO) evaluated the clinical and financial efficacy of point-of-care testing (POCT) in management of our deceased organ donors. Before we implemented point-of care testing with the i-STAT into routine clinical donor management, we compared the i-STAT result with the result from the respective donor hospital lab (DHL) for certain analytes on 15 consecutive donors in our OPO from 26 March to 14 May 2001. The financial impact was studied by reviewing 77 donors from July 2001 to March 2002. There was a strong correlation for each analyte between the POC and DHL test results with r-values as follows: pH 0.86; PCO2 = 0.96; PO2 = 0.98; sodium = 0.98; potassium = 0.95; chloride = 0.94; BUN = 0.98; glucose = 0.92; haematocrit = 0.87 and creatinine = 0.95. Since our OPO coordinators began using i-STAT in their routine clinical management of organ donors, they can now more quickly maximize oxygenation and fluid management of the donor and make extra-renal placement calls sooner. Finally, since we are no longer being billed for the testing performed on the i-STAT, average financial savings to our OPO are US dollars 733 per case. Point-of-care testing in management of our OPO donors provides a result that is equivalent to that of the donor hospital lab, has quicker turn-around time than the donor hospital laboratory, allowing more immediate clinical management decisions to be made so that extra-renal offers may begin sooner.

  12. Initiating NTD programs targeting schistosomiasis and soil-transmitted helminthiasis in two provinces of the Democratic Republic of the Congo: Establishment of baseline prevalence for mass drug administration.

    Science.gov (United States)

    Kabore, Achille; Ibikounle, Moudachirou; Tougoue, Jean Jacques; Mupoyi, Sylvain; Ndombe, Martin; Shannon, Scott; Ottesen, Eric A; Mukunda, Faustin; Awaca, Naomi

    2017-02-01

    Schistosomiasis (SCH) and soil-transmitted helminthiasis (STH) are widely distributed in the Democratic Republic of the Congo (DRC) and constitute a serious public health problem. As recommended by the World Health Organization (WHO), before launching mass chemotherapy to control these diseases, parasitological surveys were conducted in sentinel sites in six health zones (HZs) in Bandundu and Maniema provinces. Baseline prevalence and intensity of infection for SCH and STH were determined to establish the appropriate treatment plan using Praziquantel (PZQ) and Albendazole (ALB). Parasitological surveys were conducted from April to May 2015 in twenty-six selected sampling units (schools) for baseline mapping in six HZs: Fifty school children (25 females and 25 males) aged 9-15 years were randomly selected per sampling unit. A total of 1300 samples (urine and stool) were examined using haematuria dipsticks, parasite-egg filtration and the point-of-care Circulating Cathodic Antigen (POC-CCA) assay for urine samples and the Kato-Katz technique for stool specimens. Three species of schistosomes (S. mansoni, S. haematobium and S. intercalatum) and three groups of STH (hookworm, Ascaris and Trichuris) were detected at variable prevalence and intensity among the schools, the HZs and the provinces. In Bandundu, no SCH was detected by either Kato-Katz or the POC-CCA technique, despite a high prevalence of STH with 68% and 80% at Kiri and Pendjua HZs, respectively. In Maniema, intestinal schistosomiasis was detected by both Kato-Katz and POC-CCA with an average prevalence by Kato-Katz of 32.8% and by POC-CCA of 42.1%. Comparative studies confirmed the greater sensitivity (and operational feasibility) of the POC-CCA test on urine compared to Kato-Katz examination of stool for diagnosing intestinal schistosomiasis even in areas of comparatively light infections. STH was widely distributed and present in all HZs with a mean prevalence (95% CI) of 59.62% (46.00-65.00%). The

  13. Distribution of particulate organic matter in the Bay of Bengal

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, V.C.; Rao, T.S.S.

    At greater depths (300m), POC concentrations increased and were similar (145 to 542 mu gl-1) to those observed at surface Deep water POC maximum was embedded within the oxygen minimum layer and was also associated with high phosphate-phosphorus The POC...

  14. Paper-based smart microfluidics for education and low-cost diagnostics

    CSIR Research Space (South Africa)

    Smith, S

    2015-11-01

    Full Text Available , point-of-care (PoC) tests, which are performed at or near the site of clinical care, have gained popularity and are actively being developed. Microfluidic systems, in which small volumes of fluids can be processed, provide an ideal platform on which...

  15. Caring for Students with Type 1 Diabetes: School Nurses' Experiences

    Science.gov (United States)

    Wang, Yueh-Ling; Volker, Deborah L.

    2013-01-01

    This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses' lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from…

  16. An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

    Science.gov (United States)

    Valentijn, Pim P.; Hitzert, Marit; Hermus, Marieke A.A.; Franx, Arie; de Vries, Raymond G.; Wiegers, Therese A.; Bruijnzeels, Marc A.

    2017-01-01

    Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept. PMID:28970747

  17. Self-powered Imbibing Microfluidic Pump by Liquid Encapsulation: SIMPLE.

    Science.gov (United States)

    Kokalj, Tadej; Park, Younggeun; Vencelj, Matjaž; Jenko, Monika; Lee, Luke P

    2014-11-21

    Reliable, autonomous, internally self-powered microfluidic pumps are in critical demand for rapid point-of-care (POC) devices, integrated molecular-diagnostic platforms, and drug delivery systems. Here we report on a Self-powered Imbibing Microfluidic Pump by Liquid Encapsulation (SIMPLE), which is disposable, autonomous, easy to use and fabricate, robust, and cost efficient, as a solution for self-powered microfluidic POC devices. The imbibition pump introduces the working liquid which is sucked into a porous material (paper) upon activation. The suction of the working liquid creates a reduced pressure in the analytical channel and induces the sequential sample flow into the microfluidic circuits. It requires no external power or control and can be simply activated by a fingertip press. The flow rate can be programmed by defining the shape of utilized porous material: by using three different paper shapes with circular section angles 20°, 40° and 60°, three different volume flow rates of 0.07 μL s(-1), 0.12 μL s(-1) and 0.17 μL s(-1) are demonstrated at 200 μm × 600 μm channel cross-section. We established the SIMPLE pumping of 17 μL of sample; however, the sample volume can be increased to several hundreds of μL. To demonstrate the design, fabrication, and characterization of SIMPLE, we used a simple, robust and cheap foil-laminating fabrication technique. The SIMPLE can be integrated into hydrophilic or hydrophobic materials-based microfluidic POC devices. Since it is also applicable to large-scale manufacturing processes, we anticipate that a new chapter of a cost effective, disposable, autonomous POC diagnostic chip is addressed with this technical innovation.

  18. A retrospective study of end-of-life care decisions in the critically Ill in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Yi Lin Lee

    2018-01-01

    Full Text Available Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU. The practice of approaching end-of-life (EOL care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU. The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process. Methods: All consecutive patients aged 21 and above admitted to the SICU from July 2011 to March 2012, and who passed away in the ICU or within 7 days of discharge from the ICU (to account for transferred patients out of the ICU after end-of life care decisions were made and subsequently passed away were included in the study. Results: There were 473 SICU admissions during this period, out of which 53 were included with a mean age of 67.2 ± 11.1 years. EOL discussions were held in 81.1% of patients with a median time from admission to first discussion at 1 day (IQR 0–2.75 and a median number of ICU discussion of 1 (IQR 1–2. As most patients lacked decision-making capacity (inability to retain and process information secondary to the underlying disease pathology or sedative use, a surrogate was involved: group decision in 27.9%, child in 25.6% and an unclear family nominated member in 20.9%. 28.3% of patients were managed as for full active with resuscitation, 39.6% nonescalation of care, and 32.1% for withdrawal. The main reasons for conservative management (nonescalation and withdrawal of care were certain death in 52.3%, medical futility with minimal response to maximal care (27.3%, and the presence of underlying malignancy (18.2%. There was no significant difference between race or religion among patients for active or conservative management. Conclusion: 71.7% of patients who passed away in the ICU or

  19. Fabrication of polyimide based microfluidic channels for biosensor devices

    DEFF Research Database (Denmark)

    Zulfiqar, Azeem; Pfreundt, Andrea; Svendsen, Winnie Edith

    2015-01-01

    The ever-increasing complexity of the fabrication process of Point-of-care (POC) devices, due to high demand of functional versatility, compact size and ease-of-use, emphasizes the need of multifunctional materials that can be used to simplify this process. Polymers, currently in use for the fabr...... in uniformity of PI is also compared to the most commonly used SU8 polymer, which is a near UV sensitive epoxy resin. The potential applications of PI processing are POC and biosensor devices integrated with microelectronics....

  20. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

    Science.gov (United States)

    Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

    2018-05-01

    sufficient information (β 0.403 [95%-CI: 0.03-0.77) and adapted treatment and care (β 0.462 [95%-CI: 0.04-0.88]). Furthermore, higher levels of implicit rationing of nursing care were associated with lower levels of patient-centered care, e.g., adapted treatment and care (β -0.912 [95%-CI: -1.50-0.33]). Our study shows a negative association between implicit rationing of nursing care and patient-centered care: i.e.the lower the level of implicit rationing of nursing care, the better patients understood nurses, felt sufficiently informed and recognized that they were receiving highly individualized treatment. To improve patient-centered care, the nurse work environment and the level of implicit rationing of nursing care should be taken into consideration. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. The Swine Flu Triage (SwiFT) study: development and ongoing refinement of a triage tool to provide regular information to guide immediate policy and practice for the use of critical care services during the H1N1 swine influenza pandemic.

    Science.gov (United States)

    Rowan, K M; Harrison, D A; Walsh, T S; McAuley, D F; Perkins, G D; Taylor, B L; Menon, D K

    2010-12-01

    To use, existing critical care and early pandemic, data to inform care during the pandemic influenza A 2009 (H1N1) pandemic (with a possible use for triage - if the demand for critical care seriously exceeded supply). To monitor the impact of the H1N1 pandemic on critical care services, in real time, with regular feedback to critical care clinicians and other relevant jurisdictions to inform ongoing policy and practice. Modelling of data and cohort study. Modelling - 148 adult, general critical care units in England, Wales and Northern Ireland in the Intensive Care National Audit & Research Centre Case Mix Programme. Cohort study - 192 acute hospitals in England, Wales, Northern Ireland, Scotland and the Republic of Ireland. Modelling - 105,397 admissions to adult, general critical care units. Cohort study - 1728 H1N1 pandemic-related admissions referred and assessed as requiring critical care. Modelling - requirement for organ support and acute hospital mortality. Cohort study - survival to the end of critical care. Modelling - cancelled or postponed, elective or scheduled surgery resulted in savings in calendar days of critical, Level 3 and advanced respiratory care of 17, 11 and 10%, respectively. These savings varied across units. Using routine, physiological variables, the best triage models, for all and for acute respiratory admissions, achieved only satisfactory concordance of 0.79 and 0.75, respectively. Application of the best model on all admissions indicated that approximately 12.5% of calendar days of critical care could be saved. Cohort study - research governance approvals were achieved for 192 acute hospitals, for 91 within 1 day of central research and development approval across the five countries. A total of 1725 cases (562 confirmed) were reported. Confirmed cases were young (mean age of 40 years), had low severity of acute illness on presentation [61% CURB-65 (confusion, urea, respiratory rate, blood pressure, age over 65 years) 0-1], but had

  2. [Diagnostic agreement between two glycosylated a1b hemoglobin methods in Primary Care].

    Science.gov (United States)

    Villar-del-Campo, M C; Rodríguez-Caravaca, G; Gil-Yonte, P; Cidoncha-Calderón, E; García-Cruces Méndez, J; Donnay-Pérez, S

    2014-01-01

    Several methods are available for measuring glycosylated A1c hemoglobin (HbA1c), all rapid methods for point of care use in a clinical or laboratory setting. This study attempts to compare the diagnostic agreement between two methods for detection of HbA1c. A descriptive cross-sectional study of diagnostic agreement was carried out in the Los Carmenes Health Centre. Two groups of patients -with and without type 2 diabetes- were consecutively included. A method for point-of-care use in a Primary Care Clinic setting (DCA(TM) Systems Siemens(®)) was compared with a laboratory test (chromatographic analysis). An analysis was made of the mean concentration of HbA1c, the agreement between methods, using the intra-class correlation coefficient (CCLA1) and the Bland-Altman method. A total of 102 patients were included, 62 diabetic (60.8%) and 40 non-diabetic (39.2%). The overall mean HbA1c was 6.46% (SD=0.88) in the analysis using capillary blood in the clinic with the DCA™ system, and 6.44% (SD=0.86) using the laboratory test (P>.05). The degree of agreement between the two tests was 0.975 (95% CI: 0.963-0.983). The mean of the differences between the results of the two assessed tests was 0.024 (SD=0.27). The percentage of points outside the limits of optimal agreement, as defined in the Bland-Altman graph, was 2.5%. Diagnostic agreement between a method for point-of-care use in a Primary Health Care Clinic and a laboratory test was very high. Detection at the point-of-care allows a quick and simple assessment of HbA1c. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  3. Knowledge and practice for pressure injury prevention among care managers in a home care setting: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Kohta M

    2017-08-01

    Full Text Available Masushi Kohta,1 Yuki Kameda,2 Sadako Morita3 1Medical Engineering Laboratory, Alcare Co. Ltd., Sumida-ku, Tokyo, Japan; 2Wound and Ostomy Care Division, Alcare Co. Ltd., Sumida-ku, Tokyo, Japan; 3Sumire Home-visit Nursing Station, Handa-city, Aichi, Japan Purpose: Previous studies on pressure injury prevention using questionnaire surveys have targeted physicians and nurses working in hospitals. However, few have administered surveys to social welfare professionals at home care. Thus, this study aimed to investigate the current level of knowledge and practice regarding pressure injury prevention among Japanese care managers. Patients and methods: A cross-sectional study among care managers working in a Japanese city was performed from June to July 2016. Data were collected using a questionnaire to assess the participants’ knowledge of and practice for pressure injury prevention. The questionnaire included 1 measures of demographic characterization, 2 measures of knowledge, 3 measures of practice, and 4 measures of the difficulties of using pressure injury risk assessment scales. Results: A total of 48 participants were analyzed (response rate: 55%. The overall knowledge and practice scores were 78.6% and 61.8%, respectively. The percentages of participants who knew the risk assessment scales were 38%, 26%, and 13% for the Braden scale, the Ohura–Hotta scale, and the University of Kanazawa scale, respectively. We also observed that 50% of the participants in this study believed that the use of risk assessment scales in daily practice in home care may be difficult. Conclusion: Through the results of this questionnaire survey, we concluded that the current levels of knowledge and practice regarding pressure injury prevention among the care managers participating in our study were “moderate” and “low”, respectively. Low scores were obtained for knowledge with respect to the question, “Using risk assessment scales”. We will develop a

  4. Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors.

    Science.gov (United States)

    van Dongen, Jerôme Jean Jacques; Lenzen, Stephanie Anna; van Bokhoven, Marloes Amantia; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

    2016-05-28

    The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care. A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis. The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT. Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional

  5. Scenario-Based Assessment of User Needs for Point-of-Care Robots.

    Science.gov (United States)

    Lee, Hyeong Suk; Kim, Jeongeun

    2018-01-01

    This study aimed to derive specific user requirements and barriers in a real medical environment to define the essential elements and functions of two types of point-of-care (POC) robot: a telepresence robot as a tool for teleconsultation, and a bedside robot to provide emotional care for patients. An analysis of user requirements was conducted; user needs were gathered and identified, and detailed, realistic scenarios were created. The prototype robots were demonstrated in physical environments for envisioning and evaluation. In all, three nurses and three clinicians participated as evaluators to observe the demonstrations and evaluate the robot systems. The evaluators were given a brief explanation of each scene and the robots' functionality. Four major functions of the teleconsultation robot were defined and tested in the demonstration. In addition, four major functions of the bedside robot were evaluated. Among the desired functions for a teleconsultation robot, medical information delivery and communication had high priority. For a bedside robot, patient support, patient monitoring, and healthcare provider support were the desired functions. The evaluators reported that the teleconsultation robot can increase support from and access to specialists and resources. They mentioned that the bedside robot can improve the quality of hospital life. Problems identified in the demonstration were those of space conflict, communication errors, and safety issues. Incorporating this technology into healthcare services will enhance communication and teamwork skills across distances and thereby facilitate teamwork. However, repeated tests will be needed to evaluate and ensure improved performance.

  6. Core attitudes of professionals in palliative care: a qualitative study.

    Science.gov (United States)

    Simon, Steffen T; Ramsenthaler, Christina; Bausewein, Claudia; Krischke, Norbert; Geiss, Gerlinde

    2009-08-01

    Self-awareness of one's own reactions towards patients and their relatives is of paramount importance for all professionals in palliative care. 'Core attitude' describes the way in which a person perceives himself and the world, and forms the basis for his actions and thoughts. The aim of this study is to explore what core attitude means for palliative care professionals and whether there is a specific core attitude in palliative care. Qualitative study with 10 face-to-face in-depth interviews with experts in palliative care (nurses, physicians, social workers, psychologists, chaplain) in Germany. Core attitude in palliative care can be best described with the following three domains: 1) personal characteristics; 2) experience of care; and 3) competence in care. Authenticity is the most important characteristic of professionals, along with honesty and mindfulness. Core attitude primarily becomes apparent in the relationship with the patient. Perception and listening are key competences. The experts emphasized the universality of the core attitude in the care of ill people. They stressed the importance and relevance of teaching core attitudes in palliative care education. In the field of palliative care, core attitude consists predominately of authenticity, manifests itself in relationships, and requires a high degree of perceptiveness.

  7. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

    Science.gov (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

    2016-07-01

    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  8. Prevalence of delirium in advanced cancer patients in home care and hospice and outcomes after 1 week of palliative care.

    Science.gov (United States)

    Mercadante, Sebastiano; Masedu, Francesco; Balzani, Isabella; De Giovanni, Daniela; Montanari, Luigi; Pittureri, Cristina; Bertè, Raffaella; Russo, Domenico; Ursini, Laura; Marinangeli, Franco; Aielli, Federica

    2018-03-01

    The aim of this study was to assess the prevalence of delirium in advanced cancer patients admitted to different palliative care services in Italy and possible related factors. The secondary outcome was to assess the changes of delirium after 1 week of palliative care. A consecutive sample of patients was screened for delirium in period of 1 year in seven palliative care services. General data, including primary tumor, age, gender, concomitant disease, palliative prognostic score (PaP), and Karnofsky status, were collected. Possible causes or factors associated with delirium were looked for. The Edmonton Symptom Assessment Scale was used to assess physical and psychological symptoms and the Memorial Delirium Assessment Scale (MDAS) to assess the cognitive status of patients, at admission (T0) and 1 week after palliative care (T7). Of 848 patients screened, 263 patients were evaluated. Sixty-six patients had only the initial evaluation. The mean Karnofsky status was 34.1 (SD = 6.69); the mean PaP score at admission was 6.9 (SD = 3.97). The mean duration of palliative care assistance, equivalent to survival, was 38.4 days (SD = 48, range 2-220). The mean MDAS values at admission and after 1 week of palliative care were 6.9 (SD = 6.71) and 8.8 (SD = 8.26), respectively. One hundred ten patients (41.8%) and 167 patients (67.3%) had MDAS values ≥ 7 at admission and after 1 week of palliative care, respectively. Age, dehydration, cachexia, chemotherapy in the last three months, and intensity of drowsiness and dyspnea were independently associated with a MDAS > 7. A worsening of drowsiness, the use of opioids, and the use of corticosteroids were independently associated with changes of MDAS from T0 to T7. Although the prevalence of delirium seems to be similar to that reported in other acute settings, delirium tended to worsen or poorly responded to a palliative care treatment. Some clinical factors were independently associated with delirium. This

  9. Patient-centeredness and quality management in Dutch diabetes care organizations after a 1-year intervention

    Directory of Open Access Journals (Sweden)

    Campmans-Kuijpers MJ

    2016-10-01

    Full Text Available Marjo JE Campmans-Kuijpers,1 Lidwien C Lemmens,2 Caroline A Baan,2 Guy EHM Rutten1 1Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, 2Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment, Bilthoven, Utrecht, the Netherlands Background: More focus on patient-centeredness in care for patients with type 2 diabetes requests increasing attention to diabetes quality management processes on patient-centeredness by managers in primary care groups and outpatient clinics. Although patient-centered care is ultimately determined by the quality of interactions between patients and clinicians at the practice level, it should be facilitated at organizational level too. This nationwide study aimed to assess the state of diabetes quality management on patient-centeredness at organizational level and its possibilities to improve after a tailored intervention.Methods: This before–after study compares the quality management on patient-centeredness within Dutch diabetes care groups and outpatient clinics before and after a 1-year stepwise intervention. At baseline, managers of 51 diabetes primary care groups and 28 outpatient diabetes clinics completed a questionnaire about the organization’s quality management program. Patient-centeredness (0%–100% was operationalized in six subdomains: facilitating self-management support, individualized care plan support, patients’ access to medical files, patient education policy, safeguarding patients’ interests, and formal patient involvement. The intervention consisted of feedback and benchmark and if requested a telephone call and/or a consultancy visit. After 1 year, the managers completed the questionnaire again. The 1-year changes were examined by dependent (non parametric tests.Results: Care groups improved significantly on patient-centeredness (from 47.1% to 53.3%; P=0.002, and on its subdomains “access to

  10. Anthropogenic and climatic influences on carbon fluxes from eastern North America to the Atlantic Ocean: A process-based modeling study

    Science.gov (United States)

    Tian, Hanqin; Yang, Qichun; Najjar, Raymond G.; Ren, Wei; Friedrichs, Marjorie A. M.; Hopkinson, Charles S.; Pan, Shufen

    2015-04-01

    The magnitude, spatiotemporal patterns, and controls of carbon flux from land to the ocean remain uncertain. Here we applied a process-based land model with explicit representation of carbon processes in streams and rivers to examine how changes in climate, land conversion, management practices, atmospheric CO2, and nitrogen deposition affected carbon fluxes from eastern North America to the Atlantic Ocean, specifically the Gulf of Maine (GOM), Middle Atlantic Bight (MAB), and South Atlantic Bight (SAB). Our simulation results indicate that the mean annual fluxes (±1 standard deviation) of dissolved organic carbon (DOC), particulate organic carbon (POC), and dissolved inorganic carbon (DIC) in the past three decades (1980-2008) were 2.37 ± 0.60, 1.06 ± 0.20, and 3.57 ± 0.72 Tg C yr-1, respectively. Carbon export demonstrated substantial spatial and temporal variability. For the region as a whole, the model simulates a significant decrease in riverine DIC fluxes from 1901 to 2008, whereas there were no significant trends in DOC or POC fluxes. In the SAB, however, there were significant declines in the fluxes of all three forms of carbon, and in the MAB subregion, DIC and POC fluxes declined significantly. The only significant trend in the GOM subregion was an increase in DIC flux. Climate variability was the primary cause of interannual variability in carbon export. Land conversion from cropland to forest was the primary factor contributing to decreases in all forms of C export, while nitrogen deposition and fertilizer use, as well as atmospheric CO2 increases, tended to increase DOC, POC, and DIC fluxes.

  11. The BioFlip Microcytometer

    National Research Council Canada - National Science Library

    Padmanabhan, Aravind

    2004-01-01

    This four-year program successfully demonstrated a point-of-care (POC) integrated scattering and fluorescence flow cytometer capable of counting and classifying white blood cells from a whole-blood sample input...

  12. Electron multi-beam technology for mask and wafer writing at 0.1nm address grid

    Science.gov (United States)

    Platzgummer, Elmar; Klein, Christof; Loeschner, Hans

    2013-03-01

    An overview of electron beam tool configurations is provided. The adoption of multi-beam writing is mandatory in order to fulfill industrial needs for 11nm HP nodes and below. IMS Nanofabrication realized a 50keV electron multibeam proof-of-concept (POC) tool confirming writing principles with 0.1nm address grid and lithography performance capability. The new architecture will be introduced for mask writing at first, but has also the potential for 1xmask (master template) and direct wafer writing. The POC system achieves the predicted 5nm 1sigma blur across the 82μm x 82μm array of 512 x 512 (262,144) programmable 20nm beams. 24nm HP has been demonstrated and complex patterns have been written in scanning stripe exposure mode. The first production worthy system for the 11nm HP mask node is scheduled for 2014 (Alpha), 2015 (Beta) and 1st generation HVM mask writer tools in 2016. Implementing a multi-axis column configuration, 50x / 100x productivity enhancements are possible for direct 300mm / 450mm wafer writing.

  13. [A case study on duty of care in professional nursing].

    Science.gov (United States)

    Huang, Hui-Man; Liao, Chi-Chun

    2013-08-01

    Nurses are expected to discharge their duty of care effectively and professionally to prevent medical negligence. Only three articles have previously focused on medical negligence. Duty of care and medical negligence in nursing are topics that have been neglected in Taiwan. (1) Classify the duty of care of professional nurses; (2) Investigate the facts and disputes in the current case; (3) Clarify the legal issues involved with regard to duty-of-care violations in the current case; (4) Explore the causal relationships in a legal context between nurses' duty-of-care violations and patient harm / injury. Literature analysis and a case study are used to analyze Supreme Court Verdict No.5550 (2010). Duty of care for nursing professionals may be classified into seven broad categories. Each category has its distinct correlatives. In nursing practice, every nursing behavior has a corresponding duty. In this case, the case study nurse did not discharge her obstetric professional duty and failed to inform the doctor in a timely manner. Negligence resulted in prenatal death and the case study nurse was found guilty. In order to prevent committing a crime, nurses should gain a better understanding of their duty of care and adequately discharge these duties in daily practice.

  14. Nitrate removal from agricultural drainage ditch sediments with amendments of organic carbon: Potential for an innovative best management practice

    Science.gov (United States)

    Faust, Derek R.; Kröger, Robert; Miranda, Leandro E.; Rush, Scott A.

    2016-01-01

    Agricultural fertilizer applications have resulted in loading of nutrients to agricultural drainage ditches in the Lower Mississippi Alluvial Valley. The purpose of this study was to determine effects of dissolved organic carbon (DOC) and particulate organic carbon (POC) amendments on nitrate-nitrogen (NO3−-N) removal from overlying water, pore water, and sediment of an agricultural drainage ditch. Two experiments were conducted. In experiment 1, control (i.e., no amendment), DOC, and POC treatments were applied in laboratory microcosms for time intervals of 3, 7, 14, and 28 days. In experiment 2, control, DOC, and POC treatments were applied in microcosms at C/N ratios of 5:1, 10:1, 15:1, and 20:1. There were statistically significant effects of organic carbon amendments in experiment 1 (F2,71 = 27.1, P < 0.001) and experiment 2 (F2,53 = 39.1, P < 0.001), time (F1,71 = 14.5, P < 0.001) in experiment 1, and C/N ratio (F1,53 = 36.5, P < 0.001) in experiment 2. NO3−-N removal varied from 60 to 100 % in overlying water among all treatments. The lowest NO3−-N removals in experiment 1 were observed in the control at 14 and 28 days, which were significantly less than in DOC and POC 14- and 28-day treatments. In experiment 2, significantly less NO3−-N was removed in overlying water of the control compared to DOC and POC treatments at all C/N ratios. Amendments of DOC and POC made to drainage ditch sediment: (1) increased NO3−-N removal, especially over longer time intervals (14 to 28 days); (2) increased NO3−-N removal, regardless of C/N ratio; and (3) NO3−-N removal was best at a 5:1 C/N ratio. This study provides support for continued investigation on the use of organic carbon amendments as a best management practice for NO3−-N removal in agricultural drainage ditches.

  15. Patient preferences for future care - how can Advance Care Planning become embedded into dementia care: a study protocol

    Science.gov (United States)

    2010-01-01

    Background People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP). In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. Methods/Design The four phase project comprises a systematic review (Phase 1) and a series of qualitative studies (Phases 2 and 3), with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4). Discussion In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the study will also develop

  16. Patient preferences for future care - how can Advance Care Planning become embedded into dementia care: a study protocol

    Directory of Open Access Journals (Sweden)

    Exley Catherine

    2010-01-01

    Full Text Available Abstract Background People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP. In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. Methods/Design The four phase project comprises a systematic review (Phase 1 and a series of qualitative studies (Phases 2 and 3, with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4. Discussion In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the

  17. Patient preferences for future care--how can Advance Care Planning become embedded into dementia care: a study protocol.

    Science.gov (United States)

    Robinson, Louise; Bamford, Claire; Beyer, Fiona; Clark, Alexa; Dickinson, Claire; Emmet, Charlotte; Exley, Catherine; Hughes, Julian; Robson, Lesley; Rousseau, Nikki

    2010-01-12

    People living with a long term condition may wish to be able to plan ahead, so that if in future they cannot make decisions, their wishes about their care will be known; this process is termed Advance Care Planning (ACP). In dementia, guidance stipulates that ACP discussions should take place whilst the person still has capacity to make decisions. However there is a lack of evidence on the effectiveness of ACP in influencing patient choice and resource use. The aims of this study are to determine the effectiveness of ACP in dementia care, identify the factors which facilitate the process in practice and provide a better understanding of the views and experiences of key stakeholders in order to inform clinical practice. The four phase project comprises a systematic review (Phase 1) and a series of qualitative studies (Phases 2 and 3), with data collection via focus groups and individual interviews with relevant stakeholders including people with dementia and their carers, health and social care professionals and representatives from voluntary organisations and the legal profession. The conduct of the systematic review will follow current best practice guidance. In phases 2 and 3, focus groups will be employed to seek the perspectives of the professionals; individual interviews will be carried out with people with dementia and their carers. Data from Phases 1, 2 and 3 will be synthesised in a series of team workshops to develop draft guidance and educational tools for implementing ACP in practice (Phase 4). In the UK, there is little published research on the effectiveness of ACP, despite its introduction into policy. This study was designed to explore in greater depth how ACP can best be carried out in routine practice. It affords the opportunity to develop both a theoretical and practical understanding of an area which both patients and professionals may find emotionally challenging. Importantly the study will also develop practical tools, which are grounded in

  18. Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family-centered care.

    Science.gov (United States)

    Katz, Michelle L; Laffel, Lori M; Perrin, James M; Kuhlthau, Karen

    2012-05-01

    To examine whether the medical home, care coordination, or family-centered care was associated with less impact of type 1 diabetes mellitus (T1D) on families' work, finances, time, and school attendance. With the 2005 to 2006 National Survey of Children with Special Health Care Needs, we compared impact in children with T1D (n = 583) with that in children with other special health care needs (n = 39 944) and children without special health care needs (n = 4945). We modeled the associations of the medical home, care coordination, and family-centered care with family impact in T1D. Seventy-five percent of families of children with T1D reported a major impact compared with 45% of families of children with special health care needs (P families of children without special health care needs (P families of children with T1D, 35% reported restricting work, 38% reported financial impact, 41% reported medical expenses >$1000/year, 24% reported spending ≥11 hours/week caring or coordination care, and 20% reported ≥11 school absences/year. The medical home, care coordination, and family-centered care were associated with less work and financial impact. In childhood T1D, most families experience major impact. Better systems of health care delivery may help families reduce some of this impact. Copyright © 2012 Mosby, Inc. All rights reserved.

  19. Effects of particulate oxidation catalyst on unregulated pollutant emission and toxicity characteristics from heavy-duty diesel engine.

    Science.gov (United States)

    Feng, Xiangyu; Ge, Yunshan; Ma, Chaochen; Tan, Jianwei

    2015-01-01

    To evaluate the effects of particulate oxidation catalyst (POC) on unregulated pollutant emission and toxicity characteristics, polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), soot, soluble organic fractions (SOF) and sulphate emissions emitted from a heavy-duty diesel engine retrofitted with a POC were investigated on a diesel bench. The particulate matter (PM) in the exhaust was collected by Teflon membrane, and the PAHs and VOCs were analysed by a gas chromatography/mass spectrometer (GC/MS). The results indicate that the POC exhibits good performance on the emission control of VOCs, PAHs and PM. The POC and the diesel particulate filters (DPF) both show a good performance on reducing the VOCs emission. Though the brake-specific emission (BSE) reductions of the total PAHs by the POC were lower than those by the DPF, the POC still removed almost more than 50% of the total PAHs emission. After the engine was retrofitted with the POC, the reductions of the PM mass, SOF and soot emissions were 45.2-89.0%, 7.8-97.7% and 41.7-93.3%, respectively. The sulphate emissions decreased at low and medium loads, whereas at high load, the results were contrary. The PAHs emissions were decreased by 32.4-69.1%, and the contributions of the PAH compounds were affected by the POC, as well as by load level. The benzo[a]pyrene equivalent (BaPeq) of PAHs emissions were reduced by 35.9-97.6% with the POC. The VOCs emissions were reduced by 21.8-94.1% with the POC, and the reduction was more evident under high load.

  20. The Effect of Hurricane Lili on the Distribution of Organic Matter in the Inner Louisiana Shelf (Gulf of Mexico, USA)

    Science.gov (United States)

    Clinton, R.; Goni, M. A.; Gisewhite, R.; Monacci, N.; Gordon, E.; Allison, M.; Kineke, G.

    2004-12-01

    Suspended particles and surface sediments were collected from the inner shelf of the Louisiana central coast following the passage of Hurricane Lili. The elemental and stable isotopic data of these samples were compared to those determined prior to the hurricane. A week after the storm passage, turbidity levels and total suspended sediment concentrations were not that different from pre-storm values, suggesting most of the suspended sediments must have settled soon after the storm passage. Particulate organic carbon (POC) concentrations ranged from 0.1 mg/L to over 2.0 mg/L, with the highest concentrations measured near the seabed and in the inshore portions of the study area. In these locations, suspended particles displayed high POC/Chlorophyll ratios (POC/Chl of 400 to 4,000) and relatively elevated POC/particulate nitrogen ratios (POC/PN of 10 to 14) that indicated their source was locally resuspended seabed sediments. Relatively low POC/Chl (~200) and POC:PN (~7) ratios consistent with significant contributions from phytoplankton were measured only in the surface waters of the most offshore locations. Post hurricane sediment deposition resulted in a storm layer that ranged from 0.5 to 19 cm in thickness. The storm layer was generally composed of silty clays with a coarser, somewhat sandy 1-2 cm basal layer. These storm deposits were characterized by relatively high SA and OC contents. Similarities in the characteristics of the organic matter before and after reinforce the hypothesis that the source of the storm deposits was the finer fraction of locally resuspended seabed sediments, with little evidence for allochthonous land-derived inputs.

  1. Influence of the late winter bloom on migrant zooplankton metabolism and its implications on export fluxes

    Science.gov (United States)

    Putzeys, S.; Yebra, L.; Almeida, C.; Bécognée, P.; Hernández-León, S.

    2011-12-01

    Studies on carbon active fluxes due to diel migrants are scarce and critical for carbon flux models and biogeochemical estimates. We studied the temporal variability and vertical distribution of biomass, indices of feeding and respiration of the zooplanktonic community north off the Canary Islands during the end of the late winter bloom, in order to assess vertical carbon fluxes in this area. Biomass distribution during the day presented two dense layers of organisms at 0-200 m and around 500 m, whereas at night, most of the biomass concentrated in the epipelagic layer. The gut pigment flux (0.05-0.18 mgC·m - 2 ·d - 1 ) represented 0.22% of the estimated passive export flux (POC flux) while potential ingestion represented 3.91% of the POC (1.24-3.40 mgC·m - 2 ·d - 1 ). The active respiratory flux (0.50-1.36 mgC·m - 2 ·d - 1 ) was only 1.57% of the POC flux. The total carbon flux mediated by diel migrants (respiration plus potential ingestion) ranged between 3.37 and 9.22% of the POC flux; which is three-fold higher than calculating ingestion fluxes from gut pigments. Our results suggest that the fluxes by diel migrants play a small role in the downward flux of carbon in the open ocean during the post-bloom period.

  2. Disease patterns and clinical outcomes of patients admitted in intensive care units of tertiary referral hospitals of Tanzania.

    Science.gov (United States)

    Sawe, Hendry R; Mfinanga, Juma A; Lidenge, Salum J; Mpondo, Boniventura C T; Msangi, Silas; Lugazia, Edwin; Mwafongo, Victor; Runyon, Michael S; Reynolds, Teri A

    2014-09-23

    In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania. This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC). MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009-2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%. The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care

  3. An integrated tiered service delivery model (ITSDM based on local CD4 testing demands can improve turn-around times and save costs whilst ensuring accessible and scalable CD4 services across a national programme.

    Directory of Open Access Journals (Sweden)

    Deborah K Glencross

    Full Text Available The South African National Health Laboratory Service (NHLS responded to HIV treatment initiatives with two-tiered CD4 laboratory services in 2004. Increasing programmatic burden, as more patients access anti-retroviral therapy (ART, has demanded extending CD4 services to meet increasing clinical needs. The aim of this study was to review existing services and develop a service-model that integrated laboratory-based and point-of-care testing (POCT, to extend national coverage, improve local turn-around/(TAT and contain programmatic costs.NHLS Corporate Data Warehouse CD4 data, from 60-70 laboratories and 4756 referring health facilities was reviewed for referral laboratory workload, respective referring facility volumes and related TAT, from 2009-2012.An integrated tiered service delivery model (ITSDM is proposed. Tier-1/POCT delivers CD4 testing at single health-clinics providing ART in hard-to-reach areas (350-1500 tests/day, serving ≥ 200 health-clinics. Tier-6 provides national support for standardisation, harmonization and quality across the organization.The ITSDM offers improved local TAT by extending CD4 services into rural/remote areas with new Tier-3 or Tier-2/POC-Hub services installed in existing community laboratories, most with developed infrastructure. The advantage of lower laboratory CD4 costs and use of existing infrastructure enables subsidization of delivery of more expensive POC services, into hard-to-reach districts without reasonable access to a local CD4 laboratory. Full ITSDM implementation across 5 service tiers (as opposed to widespread implementation of POC testing to extend service can facilitate sustainable 'full service coverage' across South Africa, and save>than R125 million in HIV/AIDS programmatic costs. ITSDM hierarchical parental-support also assures laboratory/POC management, equipment maintenance, quality control and on-going training between tiers.

  4. Factors associated with adherence to diabetes care recommendations among children and adolescents with type 1 diabetes: a facility-based study in two urban diabetes clinics in Uganda

    Directory of Open Access Journals (Sweden)

    Kyokunzire C

    2018-03-01

    Full Text Available Catherine Kyokunzire,1 Nicholas Matovu2,3 1Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda; 2Department of Community Health, Division of Noncommunicable Diseases, Ministry of Health – Uganda, Kampala, Uganda; 3Global Health Corps Fellowship Program 2017/2018, New York, NY, USA Purpose: The purpose of this study was to determine the level of adherence and the factors associated with adherence to diabetes care recommendations among type 1 diabetic children and adolescents at two urban diabetes clinics in Kampala, Uganda.Research design and methods: A facility-based cross-sectional study was carried out among 200 children and adolescents with type 1 diabetes at two major diabetes clinics in Kampala. Caretakers of the children and adolescents were interviewed using pretested questionnaires to provide information on sociodemographic characteristics, diabetes care, knowledge, attitudes, and adherence to diabetes care recommendations in type 1 diabetes. Prevalence rate ratios (PRRs at the 95% confidence interval (CI were used to establish the factors associated with adherence using modified Poisson regression, with robust standard errors. The data were analyzed by using STATA Version 13.0.Results: The overall prevalence of adherence to diabetes care recommendations was at 37%. However, evaluating adherence to specific treatment parameters showed that 52%, 76.5%, and 29.5% of the children and adolescents adhered to insulin, blood glucose monitoring, and dietary recommendations, respectively. In the final adjusted model, active diet monitoring (adjusted PRR [APRR]: 1.95; 95% CI: 1.01, 3.78, being under care of a sibling (APRR: 1.66; 95% CI: 1.61, 1.71, being under care of a married caretaker (APRR: 1.10; 95% CI: 1.05, 1.14 and a separated or divorced caretaker (APRR: 1.60; 95% CI: 1.12, 2.27, taking three or less tests of blood glucose per day (APRR: 0

  5. Gastrointestinal Manifestations of Hereditary Angioedema Diagnosed by Ultrasound in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Christine Riguzzi

    2014-11-01

    Full Text Available Abdominal angioedema is a less recognized type of angioedema, which can occur in patients with hereditary angioedema (HAE. The clinical signs may range from subtle, diffuse abdominal pain and nausea, to overt peritonitis. We describe two cases of abdominal angioedema in patients with known HAE that were diagnosed in the emergency department by point-of-care (POC ultrasound. In each case, the patient presented with isolated abdominal complaints and no signs of oropharyngeal edema. Findings on POC ultrasound included intraperitoneal free fluid and bowel wall edema. Both patients recovered uneventfully after receiving treatment. Because it can be performed rapidly, requires no ionizing radiation,and can rule out alternative diagnoses, POC ultrasound holds promise as a valuable tool in the evaluation and management of patients with HAE. [West J Emerg Med. 2014;15(7:-0.

  6. Multi-centred mixed-methods PEPFAR HIV care & support public health evaluation: study protocol

    Directory of Open Access Journals (Sweden)

    Fayers Peter

    2010-09-01

    Full Text Available Abstract Background A public health response is essential to meet the multidimensional needs of patients and families affected by HIV disease in sub-Saharan Africa. In order to appraise curret provision of HIV care and support in East Africa, and to provide evidence-based direction to future care programming, and Public Health Evaluation was commissioned by the PEPFAR programme of the US Government. Methods/Design This paper described the 2-Phase international mixed methods study protocol utilising longitudinal outcome measurement, surveys, patient and family qualitative interviews and focus groups, staff qualitative interviews, health economics and document analysis. Aim 1 To describe the nature and scope of HIV care and support in two African countries, including the types of facilities available, clients seen, and availability of specific components of care [Study Phase 1]. Aim 2 To determine patient health outcomes over time and principle cost drivers [Study Phase 2]. The study objectives are as follows. 1 To undertake a cross-sectional survey of service configuration and activity by sampling 10% of the facilities being funded by PEPFAR to provide HIV care and support in Kenya and Uganda (Phase 1 in order to describe care currently provided, including pharmacy drug reviews to determine availability and supply of essential drugs in HIV management. 2 To conduct patient focus group discussions at each of these (Phase 1 to determine care received. 3 To undertake a longitudinal prospective study of 1200 patients who are newly diagnosed with HIV or patients with HIV who present with a new problem attending PEPFAR care and support services. Data collection includes self-reported quality of life, core palliative outcomes and components of care received (Phase 2. 4 To conduct qualitative interviews with staff, patients and carers in order to explore and understand service issues and care provision in more depth (Phase 2. 5 To undertake document

  7. Telephone Care Management of Fall Risk:: A Feasibility Study.

    Science.gov (United States)

    Phelan, Elizabeth A; Pence, Maureen; Williams, Barbara; MacCornack, Frederick A

    2017-03-01

    Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients. Patients aged ≥65 years treated for a fall in an emergency department or their primary care provider's office were contacted via telephone by a care manager within 48 hours of their fall-related visit and invited to participate in a telephone-administered interview to identify modifiable fall risk factors and receive recommendations and follow-up to address identified risk factors. Data from care manager records, patient medical records, and healthcare claims for the first 6 months (November 2009-April 2010) of program implementation were analyzed in 2011. The feasibility of screening and management of fall risk factors over the telephone and the effect on medically attended falls were assessed. Twenty-two patients eligible for fall care management were reached and administered the protocol. Administration took 15-20 minutes and integrated easily with the care manager's other responsibilities. Follow-through on recommendations varied, from 45% for those for whom exercise participation was recommended to 100% for other recommendations. No medically attended falls occurred over 6 months of follow-up. Telephone care management of fall risk appears feasible and may reduce falls requiring medical attention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  8. Pushing boundaries-culture-sensitive care in oncology and palliative care: a qualitative study.

    Science.gov (United States)

    Schrank, Beate; Rumpold, Tamara; Amering, Michaela; Masel, Eva Katharina; Watzke, Herbert; Schur, Sophie

    2017-06-01

    In increasingly globalized societies, patient-centered cancer care requires culture-sensitive approaches in order to ensure patients well-being. While migrant patients' needs are frequently reported in the literature, staff members' perception of work with migrant patients, associated challenges, or individual work approaches are largely unknown. This study addresses this research gap through qualitative exploration of experiences of multicultural health care professionals in supportive oncology and palliative care, working with patients from different cultural backgrounds. This study aims to understand staff experience of the impact of culture on cancer care. This study was conducted at the Medical University of Vienna, including staff from different settings of oncology and palliative care, in different professional positions, and with a range of individual migration backgrounds. Semistructured interviews were conducted with 21 staff members working with patients from different cultural backgrounds. Interviews explored views on the impact of culture on care were audio-taped, transcribed, and analyzed using a rigorous method of thematic analysis, enhanced with grounded theory techniques. Interviews revealed 4 key topics: culture-specific differences, assumed reasons for differences, consequences of multicultural care, and tools for culture-sensitive care. Strategies to better deal with migrant patients and their families were suggested to improve work satisfaction amongst staff. This study identifies relevant staff challenges in work with migrant patients. Concrete suggestions for improvement include measures on an organizational level, team level, and personal tools. The suggested measures are applicable to improve work satisfaction and culture-sensitive care not only in cancer care but also in other areas of medicine. Copyright © 2016 John Wiley & Sons, Ltd.

  9. A randomized controlled trial of comprehensive early intervention care in patients with first-episode psychosis in Japan: 1.5-year outcomes from the J-CAP study.

    Science.gov (United States)

    Nishida, Atsushi; Ando, Shuntaro; Yamasaki, Syudo; Koike, Shinsuke; Ichihashi, Kayo; Miyakoshi, Yuji; Maekawa, Sanae; Nakamura, Tomohisa; Natsubori, Tatsunobu; Ichikawa, Eriko; Ishigami, Hiroki; Sato, Kojiro; Matsunaga, Asami; Smith, Jo; French, Paul; Harima, Hirohiko; Kishi, Yoshiki; Fujita, Izumi; Kasai, Kiyoto; Okazaki, Yuji

    2018-04-08

    The first episode of psychosis represents a critical period wherein comprehensive early intervention in psychosis (EIP) may alter the course of illness. However, evidence from randomized controlled trials that have examined the impact of comprehensive EIP care on clinical and functional recovery assessed by independent blinded raters is limited. The objective of this study was to conduct a single-blinded multicenter trial comparing comprehensive EIP care and standard care in young patients with first-episode psychosis (FEP) in Japan (J-CAP Study). A total of 77 participants with FEP (aged 15-35 years) were randomized to receive standard care or specialized comprehensive EIP care and were followed up for 1.5 years (trial no.: UMIN000005092). Function (measured with the Global Assessment of Functioning) and clinical remission (defined by internationally standardized criteria proposed by the Remission in Schizophrenia Working Group) were evaluated by independent raters who were blinded to group assignment. Dropout rate and other secondary outcomes were also examined. The specialized EIP care group had a higher clinical remission rate (odds ratio, 6.3; 95% confidence interval, 1.0-37.9) and lower treatment dropout rate (odds ratio, 0.038; 95% confidence interval, 0.002-0.923) than the standard care group, even after adjusting for baseline characteristics. Functional improvement in the specialized EIP care group was slightly higher than that in the standard care group, but this difference was not statistically significant (p = 0.195). From the results, we conclude that comprehensive EIP care may provide advantages over standard care in patients with FEP. Copyright © 2018. Published by Elsevier Ltd.

  10. Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities.

    Science.gov (United States)

    Backhaus, Ramona; van Rossum, Erik; Verbeek, Hilde; Halfens, Ruud J G; Tan, Frans E S; Capezuti, Elizabeth; Hamers, Jan P H

    2017-01-19

    Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was

  11. Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study.

    Science.gov (United States)

    Schüssler, Sandra; Dassen, Theo; Lohrmann, Christa

    2016-10-01

    Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.

  12. Variation in Point-of-Care Testing of HbA1c in Diabetes Care in General Practice.

    Science.gov (United States)

    Kristensen, Troels; Waldorff, Frans Boch; Nexøe, Jørgen; Skovsgaard, Christian Volmar; Olsen, Kim Rose

    2017-11-09

    Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes, and enhanced clinical efficiency with fewer patient visits and subsequent reductions in costs. In 2008, the Danish regulators created a framework agreement regarding a new fee-for-service fee for the remuneration of POCT of HbA1c in general practice. According to secondary research, only the Capital Region of Denmark has allowed GPs to use this new incentive for POCT. The aim of this study is to use patient data to characterize patients with diabetes who have received POCT of HbA1c and analyze the variation in the use of POCT of HbA1c among patients with diabetes in Danish general practice. Methods: We use register data from the Danish Drug Register, the Danish Health Service Register and the National Patient Register from the year 2011 to define a population of 44,981 patients with diabetes (type 1 and type 2 but not patients with gestational diabetes) from the Capital Region. The POCT fee is used to measure the amount of POCT of HbA1c among patients with diabetes. Next, we apply descriptive statistics and multilevel logistic regression to analyze variation in the prevalence of POCT at the patient and clinic level. We include patient characteristics such as gender, age, socioeconomic markers, health care utilization, case mix markers, and municipality classifications. Results: The proportion of patients who received POCT was 14.1% and the proportion of clinics which were "POCT clinics" was 26.9%. There were variations in the use of POCT across clinics and patients. A part of the described variation can be explained by patient characteristics. Male gender, age differences (older age), short education, and other ethnicity imply significantly higher odds for POCT. High patient costs in general practice and other parts of primary care also imply higher odds for POCT. In contrast, high patient costs for drugs and/or morbidity in terms of the Charlson

  13. Caring from Afar: Asian H1B Migrant Workers and Aging Parents.

    Science.gov (United States)

    Lee, Yeon-Shim; Chaudhuri, Anoshua; Yoo, Grace J

    2015-09-01

    With the growth in engineering/technology industries, the United States has seen an increase in the arrival of highly skilled temporary migrant workers on H1B visas from various Asian countries. Limited research exists on how these groups maintain family ties from afar including caring for aging parents. This study explores the experiences and challenges that Asian H1B workers face when providing care from a distance. A total of 21 Chinese/Taiwanese, Korean, and Indian H1B workers participated in in-depth qualitative interviews. Key findings indicate that despite distance, caring relationships still continue through regular communications, financial remittances, and return visits, at the same time creating emotional, psychological, and financial challenges for the workers. Findings highlight the need for further research in understanding how the decline of aging parent's health impacts the migrants' adjustment and health in the United States.

  14. Underweight and malnutrition in home care: A multicenter study.

    Science.gov (United States)

    Lahmann, Nils A; Tannen, Antje; Suhr, Ralf

    2016-10-01

    This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  15. Comparison of a gel column blood typing method and a point-of-care cartridge for dog erythrocyte antigen 1.1.

    Science.gov (United States)

    Blois, Shauna L; Richardson, Danielle M; Abrams-Ogg, Anthony C G

    2013-01-01

    Blood typing for the presence of Dog Erythrocyte Antigen (DEA) 1.1 is recommended in all donor and recipient dogs prior to transfusion of blood products. The objective of this study was to determine if a point-of-care DEA 1.1 blood typing cartridge could be used in place of the gel column typing method. Detection of DEA 1.1 was performed using a laboratory-based gel column method and a point-of-care cartridge. A convenience sample of 30 healthy blood donors, 13 dogs with immune-mediated hemolytic anemia (IMHA) (3 of which had concurrent immune-mediated thrombocytopenia [IMT]), and 44 dogs with other diseases was included in the study. Agreement was observed between the tests for normal dogs and dogs with nonimmune-mediated disease in 74/74 cases. Two dogs in the IMHA group had indeterminate gel column blood typing results; 1 dog in this group had a negative gel column test result but a positive cartridge test result. There was good agreement between the 2 methods for normal dogs and dogs with nonimmune-mediated disease. Blood typing methods in dogs with IMHA should be further investigated. © Veterinary Emergency and Critical Care Society 2013.

  16. Chronic care coordination by integrating care through a team-based, population-driven approach: a case study.

    Science.gov (United States)

    van Eeghen, Constance O; Littenberg, Benjamin; Kessler, Rodger

    2018-05-23

    Patients with chronic conditions frequently experience behavioral comorbidities to which primary care cannot easily respond. This study observed a Vermont family medicine practice with integrated medical and behavioral health services that use a structured approach to implement a chronic care management system with Lean. The practice chose to pilot a population-based approach to improve outcomes for patients with poorly controlled Type 2 diabetes using a stepped-care model with an interprofessional team including a community health nurse. This case study observed the team's use of Lean, with which it designed and piloted a clinical algorithm composed of patient self-assessment, endorsement of behavioral goals, shared documentation of goals and plans, and follow-up. The team redesigned workflows and measured reach (patients who engaged to the end of the pilot), outcomes (HbA1c results), and process (days between HbA1c tests). The researchers evaluated practice member self-reports about the use of Lean and facilitators and barriers to move from pilot to larger scale applications. Of 20 eligible patients recruited over 3 months, 10 agreed to participate and 9 engaged fully (45%); 106 patients were controls. Relative to controls, outcomes and process measures improved but lacked significance. Practice members identified barriers that prevented implementation of all changes needed but were in agreement that the pilot produced useful outcomes. A systematized, population-based, chronic care management service is feasible in a busy primary care practice. To test at scale, practice leadership will need to allocate staffing, invest in shared documentation, and standardize workflows to streamline office practice responsibilities.

  17. Bioavailable dissolved and particulate organic carbon flux from coastal temperate rainforest watersheds

    Science.gov (United States)

    Fellman, J.; Hood, E. W.; D'Amore, D. V.; Moll, A.

    2017-12-01

    Coastal temperate rainforest (CTR) watersheds of southeast Alaska have dense soil carbon stocks ( 300 Mg C ha-1) and high specific discharge (1.5-7 m yr-1) driven by frontal storms from the Gulf of Alaska. As a result, dissolved organic carbon (DOC) fluxes from Alaskan CTR watersheds are estimated to exceed 2 Tg yr-1; however, little is known about the export of particulate organic carbon (POC). The magnitude and bioavailability of this land-to-ocean flux of terrigenous organic matter ultimately determines how much metabolic energy is translocated to downstream and coastal marine ecosystems in this region. We sampled streamwater weekly from May through October from four watersheds of varying landcover (gradient of wetland to glacial coverage) to investigate changes in the concentration and flux of DOC and POC exported to the coastal ocean. We also used headspace analysis of CO2 following 14 day laboratory incubations to determine the flux of bioavailable DOC and POC exported from CTR watersheds. Across all sites, bioavailable DOC concentrations ranged from 0.2 to 1.9 mg L-1 but were on average 0.6 mg L-1. For POC, bioavailable concentrations ranged from below detection to 0.3 mg L-1 but were on average 0.1 mg L-1. The concentration, flux and bioavailability of DOC was higher than for POC highlighting the potential importance of DOC as a metabolic subsidy to downstream and coastal environments. Ratios of DOC to POC decreased during high flow events because the increase in POC concentrations with discharge exceeds that for DOC. Overall, our findings suggest that projected increases in precipitation and storm intensity will drive changes in the speciation, magnitude and bioavailability of the organic carbon flux from CTR watersheds.

  18. Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data.

    Science.gov (United States)

    Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Warland, Andrew; Westbrook, Johanna

    2018-02-01

    To examine home care service-related and person-based factors associated with time to entry into permanent residential aged care. Longitudinal cohort study using routinely collected client management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. A total of 1116 people aged 60 years and older who commenced home care services for higher-level needs between July 1, 2015 and June 30, 2016. Survival analysis methods were used to examine service-related and person-based factors that were associated with time between first home care service and entry into permanent residential aged care. Predictors included service hours per week, combination of service types, demographics, needs, hospital leave, and change in care level. Cluster analysis was used to determine patterns of types of services used. By December 31, 2016, 21.1% of people using home care services had entered into permanent residential care (n = 235). After adjusting for significant factors such as age and care needs, each hour of service received per week was associated with a 6% lower risk of entry into residential care (hazard ratio = 0.94, 95% confidence interval 0.90-0.98). People who were predominant users of social support services, those with an identified carer, and those born in a non-main English-speaking country also remained in their own homes for longer. Greater volume of home care services was associated with significantly delayed entry into permanent residential care. This study provides much-needed evidence about service outcomes that could be used to inform older adults' care choices. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  19. Do parents who smoke underutilize health care services for their children? A cross sectional study within the longitudinal PIAMA study.

    Science.gov (United States)

    Jacobs-van der Bruggen, Monique A M; Wijga, Alet H; Brunekreef, Bert; de Jongste, Johan C; Baan, Caroline A; Kerkhof, Marjan; Smit, Henriette A

    2007-06-12

    A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected. From previous studies however, it appears that parents who smoke may underutilize health services for their children, especially with respect to respiratory care. This study explores the validity and generalizability of the previous assumption. Data were obtained from a Dutch birth-cohort study; the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) project. Information regarding parental smoking, the child's respiratory symptoms and health care use and potential confounders were obtained by postal questionnaires. Multivariate logistic models were used to relate parental smoking to the child's respiratory symptoms and health care use. The study comprised 3,564, 4-year old children. In the crude analysis, respiratory symptoms were more frequent among children with a parent who smoked, while health care utilization for respiratory symptoms was not significantly different between children with or without a parent who smoked. In the multivariate analyses, maternal smoking had a larger impact on the child's respiratory symptoms and health care use as compared to paternal smoking. Maternal smoking was positively associated with mild respiratory symptoms of the child, adjusted odds ratio [AOR] 1.50 (1.19-1.91), but not with severe respiratory symptoms AOR 1.03 (0.75-1.40). Among children with mild respiratory symptoms, children with a mother who smoked were less likely to be taken to the general practitioner (GP) for respiratory symptoms, than children with mothers who did not smoke, AOR 0.58 (0.33-1.01). This finding was less pronounced among children with severe respiratory symptoms AOR 0.86 (0.49-1.52). Neither GP visits for non-respiratory symptoms nor specialized care for respiratory disease were significantly associated with parental smoking. Mothers who smoke appear to underutilize health care for their

  20. Do parents who smoke underutilize health care services for their children? A cross sectional study within the longitudinal PIAMA study

    Directory of Open Access Journals (Sweden)

    Baan Caroline A

    2007-06-01

    Full Text Available Abstract Background A higher prevalence of respiratory symptoms and an associated increase in health care utilization among children with parents who smoke is to be expected. From previous studies however, it appears that parents who smoke may underutilize health services for their children, especially with respect to respiratory care. This study explores the validity and generalizability of the previous assumption. Methods Data were obtained from a Dutch birth-cohort study; the Prevention and Incidence of Asthma and Mite Allergy (PIAMA project. Information regarding parental smoking, the child's respiratory symptoms and health care use and potential confounders were obtained by postal questionnaires. Multivariate logistic models were used to relate parental smoking to the child's respiratory symptoms and health care use. Results The study comprised 3,564, 4-year old children. In the crude analysis, respiratory symptoms were more frequent among children with a parent who smoked, while health care utilization for respiratory symptoms was not significantly different between children with or without a parent who smoked. In the multivariate analyses, maternal smoking had a larger impact on the child's respiratory symptoms and health care use as compared to paternal smoking. Maternal smoking was positively associated with mild respiratory symptoms of the child, adjusted odds ratio [AOR] 1.50 (1.19–1.91, but not with severe respiratory symptoms AOR 1.03 (0.75–1.40. Among children with mild respiratory symptoms, children with a mother who smoked were less likely to be taken to the general practitioner (GP for respiratory symptoms, than children with mothers who did not smoke, AOR 0.58 (0.33–1.01. This finding was less pronounced among children with severe respiratory symptoms AOR 0.86 (0.49–1.52. Neither GP visits for non-respiratory symptoms nor specialized care for respiratory disease were significantly associated with parental smoking

  1. Meanings and expressions of care and caring for elders in urban Namibian families: a transcultural nursing study.

    Science.gov (United States)

    Leuning, C J; Small, L F; van Dyk, A

    2000-09-01

    Since Namibia's Independence in 1990, the population of elders--persons 65 years old and older--in urban communities is growing steadily. As such, requests for home health care, health counselling, respite care and residential care for aging members of society are overwhelming nurses and the health care system. This study expands transcultural nursing knowledge by increasing understanding of generic (home-based) patterns of elder care that are practised and lived by urban Namibian families. Guided by Madeleine Leininger's theory of culture care diversity and universality and the ethnonursing research method, emic (insider) meanings and expressions of care and caring for elders in selected urban households have been transposed into five substantive themes. The themes, which depict what carring for elders means to urban families, include: 1 nurturing the health of the family, 2 trusting in the benevolence of life as lived, 3 honouring one's elders, 4 sustaining security and purpose for life amid uncertainty, and 5 living with rapidly changing cultural and social structures. These findings add a voice from the developing world to the evolving body of transcultural nursing knowledge. Synthesis of findings with professional care practices facilitates the creation of community-focussed models for provisioning culturally congruent nursing care to elders and their families in urban Namibia.

  2. Differences between early and late involvement of palliative home care in oncology care: A focus group study with palliative home care teams.

    Science.gov (United States)

    Dhollander, Naomi; Deliens, Luc; Van Belle, Simon; De Vleminck, Aline; Pardon, Koen

    2018-05-01

    To date, no randomised controlled trials on the integration of specialised palliative home care into oncology care have been identified. Information on whether existing models of integrated care are applicable to the home care system and how working procedures and skills of the palliative care teams might require adaptation is missing. To gain insight into differences between early and late involvement and the effect on existing working procedures and skills as perceived by palliative home care teams. Qualitative study - focus group interviews. Six palliative home care teams in Flanders, Belgium. Participants included physicians, nurses and psychologists. Differences were found concerning (1) reasons for initiation, (2) planning of care process, (3) focus on future goals versus problems, (4) opportunity to provide holistic care, (5) empowerment of patients and (6) empowerment of professional caregivers. A shift from a medical approach to a more holistic approach is the most noticeable. Being involved earlier also results in a more structured follow-up and in empowering the patient to be part of the decision-making process. Early involvement creates the need for transmural collaboration, which leads to the teams taking on more supporting and coordinating tasks. Being involved earlier leads to different tasks and working procedures and to the need for transmural collaboration. Future research might focus on the development of an intervention model for the early integration of palliative home care into oncology care. To develop this model, components of existing models might need to be adapted or extended.

  3. Health care utilization in patients with gout: a prospective multicenter cohort study.

    Science.gov (United States)

    Singh, Jasvinder A; Bharat, Aseem; Khanna, Dinesh; Aquino-Beaton, Cleopatra; Persselin, Jay E; Duffy, Erin; Elashoff, David; Khanna, Puja P

    2017-05-31

    All published studies of health care utilization in gout have been cross-sectional to date, and most used a patient-reported diagnosis of gout. Our objective was to assess health care utilization and its predictors in patients with physician-confirmed gout in a prospective cohort study. In a multi-center prospective cohort study of U.S. veterans with rheumatologist-confirmed gout (N = 186; two centers), we assessed patient self-reported overall and gout-specific health care utilization with the Gout Assessment Questionnaire (GAQ) every 3-months for a 9-month period. Comparisons were made using the student's t test or the chi-square, Wilcoxon rank sum test or Fisher exact test, as appropriate. Mixed effects Poisson regression was used to assess potential correlates of gout-related health care utilization. Mean age was 64.6 years, 98% were men, 13% Hispanic or Latino, 32% were African-American, 6% did not graduate high school, mean serum urate was 8.3 and mean Deyo-Charlson score was 3.1. During the past year, mean gout-related visits were as follows: rheumatologist, 1.5; primary care physician, 2 visits; ≥1 inpatient visits, 7%; ≥1 ER visits, 26%; and urgent care/walk-in visit, 33%. In longitudinal analyses, African-American race and gout flares in the last 3 months were associated with significantly higher rate ratio of gout-related outpatient visits. African-American race and lack of college education were associated with significantly higher rate ratio for gout-related urgent visits and overnight stays. African-American race and recent gout flares were associated with higher outpatient utilization and African-American race and no college education with higher urgent or inpatient utilization. Future studies should examine whether modifiable predictors of utilization can be targeted to reduce healthcare utilization in patients with gout.

  4. Neuroimaging studies of GABA in schizophrenia: a systematic review with meta-analysis.

    Science.gov (United States)

    Egerton, A; Modinos, G; Ferrera, D; McGuire, P

    2017-06-06

    Data from animal models and from postmortem studies suggest that schizophrenia is associated with brain GABAergic dysfunction. The extent to which this is reflected in data from in vivo studies of GABA function in schizophrenia is unclear. The Medline database was searched to identify articles published until 21 October 2016. The search terms included GABA, proton magnetic resonance spectroscopy ( 1 H-MRS), positron emission tomography (PET), single photon emission computed tomography (SPECT), schizophrenia and psychosis. Sixteen GABA 1 H-MRS studies (538 controls, 526 patients) and seven PET/SPECT studies of GABA A /benzodiazepine receptor (GABA A /BZR) availability (118 controls, 113 patients) were identified. Meta-analyses of 1 H-MRS GABA in the medial prefrontal cortex (mPFC), parietal/occipital cortex (POC) and striatum did not show significant group differences (mFC: g=-0.3, 409 patients, 495 controls, 95% confidence interval (CI): -0.6 to 0.1; POC: g=-0.3, 139 patients, 111 controls, 95% CI: -0.9 to 0.3; striatum: g=-0.004, 123 patients, 95 controls, 95% CI: -0.7 to 0.7). Heterogeneity across studies was high (I 2 >50%), and this was not explained by subsequent moderator or meta-regression analyses. There were insufficient PET/SPECT receptor availability studies for meta-analyses, but a systematic review did not suggest replicable group differences in regional GABA A /BZR availability. The current literature does not reveal consistent alterations in in vivo GABA neuroimaging measures in schizophrenia, as might be hypothesized from animal models and postmortem data. The analysis highlights the need for further GABA neuroimaging studies with improved methodology and addressing potential sources of heterogeneity.

  5. Women's and care providers' perspectives of quality prenatal care: a qualitative descriptive study

    Science.gov (United States)

    2012-01-01

    Background Much attention has been given to the adequacy of prenatal care use in promoting healthy outcomes for women and their infants. Adequacy of use takes into account the timing of initiation of prenatal care and the number of visits. However, there is emerging evidence that the quality of prenatal care may be more important than adequacy of use. The purpose of our study was to explore women's and care providers' perspectives of quality prenatal care to inform the development of items for a new instrument, the Quality of Prenatal Care Questionnaire. We report on the derivation of themes resulting from this first step of questionnaire development. Methods A qualitative descriptive approach was used. Semi-structured interviews were conducted with 40 pregnant women and 40 prenatal care providers recruited from five urban centres across Canada. Data were analyzed using inductive open and then pattern coding. The final step of analysis used a deductive approach to assign the emergent themes to broader categories reflective of the study's conceptual framework. Results The three main categories informed by Donabedian's model of quality health care were structure of care, clinical care processes, and interpersonal care processes. Structure of care themes included access, physical setting, and staff and care provider characteristics. Themes under clinical care processes were health promotion and illness prevention, screening and assessment, information sharing, continuity of care, non-medicalization of pregnancy, and women-centredness. Interpersonal care processes themes were respectful attitude, emotional support, approachable interaction style, and taking time. A recurrent theme woven throughout the data reflected the importance of a meaningful relationship between a woman and her prenatal care provider that was characterized by trust. Conclusions While certain aspects of structure of care were identified as being key dimensions of quality prenatal care, clinical and

  6. Initiating Antiretroviral Therapy for HIV at a Patient's First Clinic Visit: The RapIT Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Sydney Rosen

    2016-05-01

    Full Text Available High rates of patient attrition from care between HIV testing and antiretroviral therapy (ART initiation have been documented in sub-Saharan Africa, contributing to persistently low CD4 cell counts at treatment initiation. One reason for this is that starting ART in many countries is a lengthy and burdensome process, imposing long waits and multiple clinic visits on patients. We estimated the effect on uptake of ART and viral suppression of an accelerated initiation algorithm that allowed treatment-eligible patients to be dispensed their first supply of antiretroviral medications on the day of their first HIV-related clinic visit.RapIT (Rapid Initiation of Treatment was an unblinded randomized controlled trial of single-visit ART initiation in two public sector clinics in South Africa, a primary health clinic (PHC and a hospital-based HIV clinic. Adult (≥18 y old, non-pregnant patients receiving a positive HIV test or first treatment-eligible CD4 count were randomized to standard or rapid initiation. Patients in the rapid-initiation arm of the study ("rapid arm" received a point-of-care (POC CD4 count if needed; those who were ART-eligible received a POC tuberculosis (TB test if symptomatic, POC blood tests, physical exam, education, counseling, and antiretroviral (ARV dispensing. Patients in the standard-initiation arm of the study ("standard arm" followed standard clinic procedures (three to five additional clinic visits over 2-4 wk prior to ARV dispensing. Follow up was by record review only. The primary outcome was viral suppression, defined as initiated, retained in care, and suppressed (≤400 copies/ml within 10 mo of study enrollment. Secondary outcomes included initiation of ART ≤90 d of study enrollment, retention in care, time to ART initiation, patient-level predictors of primary outcomes, prevalence of TB symptoms, and the feasibility and acceptability of the intervention. A survival analysis was conducted comparing attrition

  7. Primary care providers' experiences caring for complex patients in primary care: a qualitative study.

    Science.gov (United States)

    Loeb, Danielle F; Bayliss, Elizabeth A; Candrian, Carey; deGruy, Frank V; Binswanger, Ingrid A

    2016-03-22

    Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs' experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs' experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP's expressed concepts of

  8. Effect of Coating Palm Oil Clinker Aggregate on the Engineering Properties of Normal Grade Concrete

    Directory of Open Access Journals (Sweden)

    Fuad Abutaha

    2017-10-01

    Full Text Available Palm oil clinker (POC is a waste material generated in large quantities from the palm oil industry. POC, when crushed, possesses the potential to serve as an aggregate for concrete production. Experimental investigation on the engineering properties of concrete incorporating POC as aggregate and filler material was carried out in this study. POC was partially and fully used to replace natural coarse aggregate. The volumetric replacements used were 0%, 20%, 40%, 60%, 80%, and 100%. POC, being highly porous, negatively affected the fresh and hardened concrete properties. Therefore, the particle-packing (PP method was adopted to measure the surface and inner voids of POC coarse aggregate in the mixtures at different substitution levels. In order to enhance the engineering properties of the POC concrete, palm oil clinker powder (POCP was used as a filler material to fill up and coat the surface voids of POC coarse, while the rest of the mix constituents were left as the same. Fresh and hardened properties of the POC concrete with and without coating were determined, and the results were compared with the control concrete. The results revealed that coating the surface voids of POC coarse with POCP significantly improved the engineering properties as well as the durability performance of the POC concrete. Furthermore, using POC as an aggregate and filler material may reduce the continuous exploitation of aggregates from primary sources. Also, this approach offers an environmental friendly solution to the ongoing waste problems associated with palm oil waste material.

  9. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.

    Science.gov (United States)

    van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D

    2015-01-01

    Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.

  10. Primary health-care costs associated with special health care needs up to age 7 years: Australian population-based study.

    Science.gov (United States)

    Quach, Jon; Oberklaid, Frank; Gold, Lisa; Lucas, Nina; Mensah, Fiona K; Wake, Melissa

    2014-10-01

    We studied infants and children with and without special health care needs (SHCN) during the first 8 years of life to compare the (i) types and costs to the government's Medicare system of non-hospital health-care services and prescription medication in each year and (ii) cumulative costs according to persistence of SHCN. Data from the first two biennial waves of the nationally representative Longitudinal Study of Australian Children, comprising two independent cohorts recruited in 2004, at ages 0-1 (n = 5107) and 4-5 (n = 4983) years. Exposure condition: parent-reported Children with Special Health Care Needs Screener at both waves, spanning ages 0-7 years. Federal Government Medicare expenditure, via data linkage to the Medicare database, on non-hospital health-care attendances and prescriptions from birth to 8 years. At both waves and in both cohorts, >92% of children had complete SHCN and Medicare data. The proportion of children with SHCN increased from 6.1% at age 0-1 years to 15.0% at age 6-7 years. Their additional Medicare costs ranged from $491 per child at 6-7 years to $1202 at 0-1 year. This equates to an additional $161.8 million annual cost or 0.8% of federal funding for non-hospital-based health care. In both cohorts, costs were highest for children with persistent SHCNs. SHCNs incur substantial non-hospital costs to Medicare, and no doubt other sources of care, from early childhood. This suggests that economic evaluations of early prevention and intervention services for SHCNs should consider impacts on not only the child and family but also the health-care system. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  11. Quality in the provision of headache care. 1

    DEFF Research Database (Denmark)

    Peters, Michele; Perera, Suraj; Loder, Elizabeth

    2012-01-01

    and improvement of headache services in other settings. Some studies had evaluated the use of existing disability and quality of life instruments, but their findings had not been incorporated into quality indicators. Existing headache care quality indicators are incomplete and inadequate for purpose......Widely accepted quality indicators for headache care would provide a basis not only for assessment of care but also, and more importantly, for its improvement. The objective of the study was to identify and summarize existing information on such indicators: specifically, did indicators exist, how...... had they been developed, what aspects of headache care did they relate to and how and with what utility were they being used? A systematic review of the medical literature was performed. A total of 32 articles met criteria for inclusion. We identified 55 existing headache quality indicators of which...

  12. Measuring client experiences in long-term care in the Netherlands: a pilot study with the Consumer Quality Index Long-term Care

    Directory of Open Access Journals (Sweden)

    Kool Rudolf B

    2010-04-01

    Full Text Available Abstract Background This study aims to describe the development, testing and optimization of a new standard instrument, the Consumer Quality Index (CQ-index® Long-term Care, for measuring client experiences with long-term care in the Netherlands. Methods Three versions of the CQ-index questionnaires and protocols for study sampling and data collection were developed, designed for interviews with residents of nursing or residential care homes and postal surveys among representatives of psychogeriatric residents and homecare clients. From July to November 2006 a pilot study was conducted among 2,697 clients of 68 nursing or residential care homes, 2,164 representatives of clients in 57 psychogeriatric care institutions, and 1,462 clients of 19 homecare organizations. We performed psychometric analyses and descriptive analyses, and evaluated the pilot study. Results The pilot study showed the feasibility and usability of the instruments, supported the multidimensionality of the questionnaires and showed first findings on client experiences and possibilities for quality improvement. Nine scales applied to all care settings: shared decision making, attitude and courtesy, information, body care, competence and safety of care, activities, autonomy, mental well-being, and availability of personnel. The pilot resulted in three optimized questionnaires and recommendations for nationwide implementation. Conclusions The CQ-index® Long-term Care provides a good basis to investigate the quality of nursing homes, residential care homes and homecare from the clients' perspective. This standardized instrument enables a nationwide comparison of the quality of long-term care for the purpose of transparency and quality assurance.

  13. A region-based palliative care intervention trial using the mixed-method approach: Japan OPTIM study

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    Morita Tatsuya

    2012-01-01

    Full Text Available Abstract Background Disseminating palliative care is a critical task throughout the world. Several outcome studies explored the effects of regional palliative care programs on a variety of end-points, and some qualitative studies investigated the process of developing community palliative care networks. These studies provide important insights into the potential benefits of regional palliative care programs, but the clinical implications are still limited, because: 1 many interventions included fundamental changes in the structure of the health care system, and, thus, the results would not be applicable for many regions where structural changes are difficult or unfeasible; 2 patient-oriented outcomes were not measured or explored only in a small number of populations, and interpretation of the results from a patient's view is difficult; and 3 no studies adopted a mixed-method approach using both quantitative and qualitative methodologies to interpret the complex phenomenon from multidimensional perspectives. Methods/designs This is a mixed-method regional intervention trial, consisting of a pre-post outcome study and qualitative process studies. The primary aim of the pre-post outcome study is to evaluate the change in the number of home deaths, use of specialized palliative care services, patient-reported quality of palliative care, and family-reported quality of palliative care after regional palliative care intervention. The secondary aim is to explore the changes in a variety of outcomes, including patients' quality of life, pain intensity, family care burden, and physicians' and nurses' knowledge, difficulties, and self-perceived practice. Outcome measurements used in this study include the Care Evaluation Scale, Good Death Inventory, Brief pain Inventory, Caregiving Consequence Inventory, Sense of Security Scale, Palliative Care Knowledge test, Palliative Care Difficulties Scale, and Palliative Care Self-reported Practice Scale. Study

  14. Drug utilization study in a burn care unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Santoshkumar R Jeevangi

    2011-03-01

    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  15. Associations of family-centered care with health care outcomes for children with special health care needs.

    Science.gov (United States)

    Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

    2011-08-01

    The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

  16. Skin care practice in German nursing homes: a German-wide cross-sectional study.

    Science.gov (United States)

    Kottner, Jan; Rahn, Yasmin; Blume-Peytavi, Ulrike; Lahmann, Nils

    2013-04-01

    Due to anatomical and physiological changes in the course of aging and due to increased vulnerability, there are special skin care needs in elderly and care-dependent persons. Little is known about skin care practice in German long-term care facilities. The aim of the study was to gather epidemiological data about skin care practice in German nursing homes. In spring 2012 a German-wide cross sectional study was conducted in 47 nursing homes. Based on standardized data collection sheets. demographics and variables about methods and frequencies of skin cleansing and application of skin care products for 3 552 nursing home residents were collected and analyzed. The variables age, gender and level of care dependency was representative for the group of all German nursing home residents. More than 90% of investigated nursing home residents required skin care assistance. Washing body parts or the whole body were conducted most frequently (89.1%, 95% CI 88.0- 90.1). Skin care leave-on products were used in 91.7% (95% CI 90.7-92.6), whereas there were large variations between individuals. In total, more than 100 brands were used. Skin care practice in multimorbid care dependent persons shows large variations. How skin care products meet the special requirements of aged skin and whether they enhance the skin barrier function and prevent cuteneous skin damage is unknown. © The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.

  17. Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

    Directory of Open Access Journals (Sweden)

    Annemarije L Kruis

    Full Text Available BACKGROUND: Guideline recommendations for chronic obstructive pulmonary disease (COPD are based on the results of large pharmaceutically-sponsored COPD studies (LPCS. There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care. OBJECTIVE: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials. METHODS: Baseline data of seven primary care databases (n=3508 from Europe were compared to baseline data of the LPCS. In addition, we examined the proportion of primary care patients eligible to participate in the LPCS, based on inclusion criteria. RESULTS: Overall, patients included in the LPCS were younger (mean difference (MD-2.4; p=0.03, predominantly male (MD 12.4; p=0.1 with worse lung function (FEV1% MD -16.4; p<0.01 and worse quality of life scores (SGRQ MD 15.8; p=0.01. There were large differences in GOLD stage distribution compared to primary care patients. Mean exacerbation rates were higher in LPCS, with an overrepresentation of patients with ≥ 1 and ≥ 2 exacerbations, although results were not statistically significant. Our findings add to the literature, as we revealed hitherto unknown GOLD I exacerbation characteristics, showing 34% of mild patients had ≥ 1 exacerbations per year and 12% had ≥ 2 exacerbations per year. The proportion of primary care patients eligible for inclusion in LPCS ranged from 17% (TRISTAN to 42% (ECLIPSE, UPLIFT. CONCLUSION: Primary care COPD patients stand out from patients enrolled in LPCS in terms of gender, lung function, quality of life and exacerbations. More research is needed to determine the effect of pharmacological treatment in mild to moderate patients. We encourage future guideline makers to involve primary care

  18. Primary care and communication in shared cancer care: A Qualitative Study

    Science.gov (United States)

    Sada, Yvonne; Street, Richard L.; Singh, Hardeep; Shada, Rachel; Naik, Aanand D.

    2013-01-01

    Objective To explore perceptions of primary care physicians’ (PCPs) and oncologists’ roles, responsibilities, and patterns of communication related to shared cancer care in three integrated health systems that used electronic health records (EHRs). Study design Qualitative study. Methods We conducted semi-structured interviews with ten early stage colorectal cancer patients and fourteen oncologists and PCPs. Sample sizes were determined by thematic saturation. Dominant themes and codes were identified and subsequently applied to all transcripts. Results Physicians reported that EHRs improved communication within integrated systems, but communication with physicians outside their system was still difficult. PCPs expressed uncertainty about their role during cancer care, even though medical oncologists emphasized the importance of co-morbidity control during cancer treatment. Both patients and physicians described additional roles for PCPs, including psychological distress support and behavior modification. Conclusions Integrated systems that use EHRs likely facilitate shared cancer care through improved PCP-oncologist communication. However, strategies to facilitate a more active role for PCPs in managing co-morbidities, psychological distress and behavior modification, as well as to overcome communication challenges between physicians not practicing within the same integrated system, are still needed to improve shared cancer care. PMID:21615196

  19. Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

    Science.gov (United States)

    Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

    2017-11-01

    The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

  20. Improving predicted protein loop structure ranking using a Pareto-optimality consensus method.

    Science.gov (United States)

    Li, Yaohang; Rata, Ionel; Chiu, See-wing; Jakobsson, Eric

    2010-07-20

    Accurate protein loop structure models are important to understand functions of many proteins. Identifying the native or near-native models by distinguishing them from the misfolded ones is a critical step in protein loop structure prediction. We have developed a Pareto Optimal Consensus (POC) method, which is a consensus model ranking approach to integrate multiple knowledge- or physics-based scoring functions. The procedure of identifying the models of best quality in a model set includes: 1) identifying the models at the Pareto optimal front with respect to a set of scoring functions, and 2) ranking them based on the fuzzy dominance relationship to the rest of the models. We apply the POC method to a large number of decoy sets for loops of 4- to 12-residue in length using a functional space composed of several carefully-selected scoring functions: Rosetta, DOPE, DDFIRE, OPLS-AA, and a triplet backbone dihedral potential developed in our lab. Our computational results show that the sets of Pareto-optimal decoys, which are typically composed of approximately 20% or less of the overall decoys in a set, have a good coverage of the best or near-best decoys in more than 99% of the loop targets. Compared to the individual scoring function yielding best selection accuracy in the decoy sets, the POC method yields 23%, 37%, and 64% less false positives in distinguishing the native conformation, indentifying a near-native model (RMSD Pareto optimality and fuzzy dominance, the POC method is effective in distinguishing the best loop models from the other ones within a loop model set.

  1. Parents' experiences with neonatal home care following initial care in the neonatal intensive care unit: a phenomenological hermeneutical interview study.

    Science.gov (United States)

    Dellenmark-Blom, Michaela; Wigert, Helena

    2014-03-01

    A descriptive study of parents' experiences with neonatal home care following initial care in the neonatal intensive care unit. As survival rates improve among premature and critically ill infants with an increased risk of morbidity, parents' responsibilities for neonatal care grow in scope and degree under the banner of family-centred care. Concurrent with medical advances, new questions arise about the role of parents and the experience of being provided neonatal care at home. An interview study with a phenomenological hermeneutic approach. Parents from a Swedish neonatal (n = 22) home care setting were extensively interviewed within one year of discharge. Data were collected during 2011-2012. The main theme of the findings is that parents experience neonatal home care as an inner emotional journey, from having a child to being a parent. This finding derives from three themes: the parents' experience of leaving the hospital milieu in favour of establishing independent parenthood, maturing as a parent and processing experiences during the period of neonatal intensive care. This study suggests that neonatal home care is experienced as a care structure adjusted to incorporate parents' needs following discharge from a neonatal intensive care unit. Neonatal home care appears to bridge the gap between hospital and home, supporting the family's adaptation to life in the home setting. Parents become empowered to be primary caregivers, having nurse consultants serving the needs of the whole family. Neonatal home care may therefore be understood as the implementation of family-centred care during the transition from NICU to home. © 2013 John Wiley & Sons Ltd.

  2. Psychometric properties of the Persian version of the Intensive and Critical Care Nursing Competence Scale version-1 (ICCN-CS-1).

    Science.gov (United States)

    Shouryabi, Ali Asghar; Ghahrisarabi, Alireza; Anboohi, Sima Zohari; Nasiri, Malihe; Rassouli, Maryam

    2017-11-01

    Nursing competence is highly related to patient outcomes and patient safety issues, especially in intensive care units. Competence assessment tools are needed specifically for intensive care nursing. This study was performed to determine psychometric properties of the Intensive and Critical Care Nursing Competence Scale version-1 between Iranian Nurses. The present study was a methodological research in which 289 nurses of Intensive Care Units from nine hospitals in Shahid Beheshti University of Medical Sciences in Tehran were selected between 2015 and 2016. The original version of the scale was translated into Persian and back-translated into English, and the comments of the developer were applied. The validity of the scale was the determined quality (content validity and face validity) and quantity (confirmatory factor analysis). Reliability of the scale was reported by Cronbach's alpha coefficient and Intra class Correlation Coefficient. SPSS-PC (v.21) and LISREL (v.8.5) were used to analyze the data. The intensive and critical care nursing competence scale version-1 is a self-assessment test that consists of 144 items and four domains which are the knowledge base, the skill base, the attitudes and values base and the experience base, which are divided into clinical competence and professional competence. Content and face validity was confirmed by 10 experts and 10 practitioner nurses in the intensive care units. In confirmatory factor analysis, all fitness indexes, except goodness of fit index (0.64), confirmed the four-factor structure of the ICCN-CS-1. The results of the factor analysis, load factor between 0.304 and 0.727 items was estimated; only 4 items out of 144 items, that were loaded were less than 0.3 due to high Cronbach's alpha coefficient (0.984-0.986), all items were preserved, no item was removed and 4 subscales of the original scale were confirmed. The results of this study indicated that the Persian version of "The Intensive and Critical Care

  3. Using of thorium isotopes to study marine particles in the Southern Ocean, the Barents and the the Mediterranean sea

    International Nuclear Information System (INIS)

    Coppola, Laurent

    2002-01-01

    This work is based on thorium (Th) isotopes to quantify the particles fluxes and exchange between dissolved and particulate phase in three distinct environments. In the shelf region of the Barents Sea, the 234 Th fluxes in the water column suggest that the sediment traps have a good catchment efficiency. To estimate the export of Particulate Organic Carbon (POC), we need to use a POC/ 234 Th ratio. It is 10 times lower in the large trapped particles than in the suspended particles. This is due to a preferential remineralisation of POC vs 234 Th and also to a large quantity of fecal pellets in traps. These results show us the importance of the large particles in the vertical fluxes and suggest that data estimated in previous studies based on the composition of suspended particles in other Arctic regions have been overestimated. In the Indian sector of the Southern Ocean, the export of POC is higher in the Polar Front Zone (PFZ). The 230 Th profiles in the water column indicate a rapid renewal rate of deep water (1-15 y) by the North Atlantic Deep Water (NADW) and the Antarctic Bottom Water (AABW) in the site of study. From 234 Th- 230 Th coupling, we are able to constrain the dynamic processes of marine particles in the upper layer. The results suggest that the settling speed of the filtered large particles are lower in the north of the Agulhas Front (AF). Moreover, we note that the desorption and the disaggregation are higher. This could be explained by the presence of detrital organic matter and/or an efficient microbial loop limiting the export of organic matter to the deep layers. In the Mediterranean studies, we have used 232 Th and 230 Th to estimate the degradation of large marine particles during in vitro experiments. This results suggests that the aggregation of filtered large particles requires to take into account in the particles dynamic models. 230 Th- 232 Th budget of the western Mediterranean Sea indicates that the refractory elements fluxes are

  4. Programmatic implications of implementing the relational algebraic capacitated location (RACL algorithm outcomes on the allocation of laboratory sites, test volumes, platform distribution and space requirements

    Directory of Open Access Journals (Sweden)

    Naseem Cassim

    2017-02-01

    Full Text Available Introduction: CD4 testing in South Africa is based on an integrated tiered service delivery model that matches testing demand with capacity. The National Health Laboratory Service has predominantly implemented laboratory-based CD4 testing. Coverage gaps, over-/under-capacitation and optimal placement of point-of-care (POC testing sites need investigation. Objectives: We assessed the impact of relational algebraic capacitated location (RACL algorithm outcomes on the allocation of laboratory and POC testing sites. Methods: The RACL algorithm was developed to allocate laboratories and POC sites to ensure coverage using a set coverage approach for a defined travel time (T. The algorithm was repeated for three scenarios (A: T = 4; B: T = 3; C: T = 2 hours. Drive times for a representative sample of health facility clusters were used to approximate T. Outcomes included allocation of testing sites, Euclidian distances and test volumes. Additional analysis included platform distribution and space requirement assessment. Scenarios were reported as fusion table maps. Results: Scenario A would offer a fully-centralised approach with 15 CD4 laboratories without any POC testing. A significant increase in volumes would result in a four-fold increase at busier laboratories. CD4 laboratories would increase to 41 in scenario B and 61 in scenario C. POC testing would be offered at two sites in scenario B and 20 sites in scenario C. Conclusion: The RACL algorithm provides an objective methodology to address coverage gaps through the allocation of CD4 laboratories and POC sites for a given T. The algorithm outcomes need to be assessed in the context of local conditions.

  5. Dynamic temperature and humidity environmental profiles: impact for future emergency and disaster preparedness and response.

    Science.gov (United States)

    Ferguson, William J; Louie, Richard F; Tang, Chloe S; Paw U, Kyaw Tha; Kost, Gerald J

    2014-02-01

    During disasters and complex emergencies, environmental conditions can adversely affect the performance of point-of-care (POC) testing. Knowledge of these conditions can help device developers and operators understand the significance of temperature and humidity limits necessary for use of POC devices. First responders will benefit from improved performance for on-site decision making. To create dynamic temperature and humidity profiles that can be used to assess the environmental robustness of POC devices, reagents, and other resources (eg, drugs), and thereby, to improve preparedness. Surface temperature and humidity data from the National Climatic Data Center (Asheville, North Carolina USA) was obtained, median hourly temperature and humidity were calculated, and then mathematically stretched profiles were created to include extreme highs and lows. Profiles were created for: (1) Banda Aceh, Indonesia at the time of the 2004 Tsunami; (2) New Orleans, Louisiana USA just before and after Hurricane Katrina made landfall in 2005; (3) Springfield, Massachusetts USA for an ambulance call during the month of January 2009; (4) Port-au-Prince, Haiti following the 2010 earthquake; (5) Sendai, Japan for the March 2011 earthquake and tsunami with comparison to the colder month of January 2011; (6) New York, New York USA after Hurricane Sandy made landfall in 2012; and (7) a 24-hour rescue from Hawaii USA to the Marshall Islands. Profiles were validated by randomly selecting 10 days and determining if (1) temperature and humidity points fell inside and (2) daily variations were encompassed. Mean kinetic temperatures (MKT) were also assessed for each profile. Profiles accurately modeled conditions during emergency and disaster events and enclosed 100% of maximum and minimum temperature and humidity points. Daily variations also were represented well with 88.6% (62/70) of temperature readings and 71.1% (54/70) of relative humidity readings falling within diurnal patterns. Days

  6. Stimulation of Diesel Fuel Biodegradation by Indigenous Nitrogen Fixing Bacterial Consortia.

    Science.gov (United States)

    Piehler; Swistak; Pinckney; Paerl

    1999-07-01

    > Abstract Successful stimulation of N2 fixation and petroleum hydrocarbon degradation in indigenous microbial consortia may decrease exogenous N requirements and reduce environmental impacts of bioremediation following petroleum pollution. This study explored the biodegradation of petroleum pollution by indigenous N2 fixing marine microbial consortia. Particulate organic carbon (POC) in the form of ground, sterile corn-slash (post-harvest leaves and stems) was added to diesel fuel amended coastal water samples to stimulate biodegradation of petroleum hydrocarbons by native microorganisms capable of supplying a portion of their own N. It was hypothesized that addition of POC to petroleum amended water samples from N-limited coastal waters would promote the growth of N2 fixing consortia and enhance biodegradation of petroleum. Manipulative experiments were conducted using samples from coastal waters (marinas and less polluted control site) to determine the effects of POC amendment on biodegradation of petroleum pollution by native microbial consortia. Structure and function of the microbial consortia were determined by measurement of N2 fixation (acetylene reduction), hydrocarbon biodegradation (14C hexadecane mineralization), bacterial biomass (AODC), number of hydrocarbon degrading bacteria (MPN), and bacterial productivity (3H-thymidine incorporation). Throughout this study there was a consistent enhancement of petroleum hydrocarbon degradation in response to the addition of POC. Stimulation of diesel fuel biodegradation following the addition of POC was likely attributable to increases in bacterial N2 fixation, diesel fuel bioavailability, bacterial biomass, and metabolic activity. Toxicity of the bulk phase water did not appear to be a factor affecting biodegradation of diesel fuel following POC addition. These results indicate that the addition of POC to diesel-fuel-polluted systems stimulated indigenous N2 fixing microbial consortia to degrade petroleum

  7. Comparison of pulsed versus continuous oxygen delivery using realistic adult nasal airway replicas

    Directory of Open Access Journals (Sweden)

    Chen JZ

    2017-08-01

    Full Text Available John Z Chen,1 Ira M Katz,2 Marine Pichelin,2 Kaixian Zhu,3 Georges Caillibotte,2 Michelle L Noga,4 Warren H Finlay,1 Andrew R Martin1 1Department of Mechanical Engineering, University of Alberta, Edmonton, AB, Canada; 2Medical R&D, Air Liquide Santé International, Centre de Recherche Paris-Saclay, Les Loges-en-Josas, 3Centre Explor!, Air Liquide Healthcare, Gentilly, France; 4Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada Background: Portable oxygen concentrators (POCs typically include pulse flow (PF modes to conserve oxygen. The primary aims of this study were to develop a predictive in vitro model for inhaled oxygen delivery using a set of realistic airway replicas, and to compare PF for a commercial POC with steady flow (SF from a compressed oxygen cylinder. Methods: Experiments were carried out using a stationary compressed oxygen cylinder, a POC, and 15 adult nasal airway replicas based on airway geometries derived from medical images. Oxygen delivery via nasal cannula was tested at PF settings of 2.0 and 6.0, and SF rates of 2.0 and 6.0 L/min. A test lung simulated three breathing patterns representative of a chronic obstructive pulmonary disease patient at rest, during exercise, and while asleep. Volume-averaged fraction of inhaled oxygen (FiO2 was calculated by analyzing oxygen concentrations sampled at the exit of each replica and inhalation flow rates over time. POC pulse volumes were also measured using a commercial O2 conserver test system to attempt to predict FiO2 for PF. Results: Relative volume-averaged FiO2 using PF ranged from 68% to 94% of SF values, increasing with breathing frequency and tidal volume. Three of 15 replicas failed to trigger the POC when used with the sleep breathing pattern at the 2.0 setting, and four of 15 replicas failed to trigger at the 6.0 setting. FiO2 values estimated from POC pulse characteristics followed similar trends but were lower than those derived from

  8. Health Care Transition for Young Adults With Type 1 Diabetes: Stakeholder Engagement for Defining Optimal Outcomes.

    Science.gov (United States)

    Pierce, Jessica S; Aroian, Karen; Schifano, Elizabeth; Milkes, Amy; Schwindt, Tiani; Gannon, Anthony; Wysocki, Tim

    2017-10-01

    Research on the transition to adult care for young adults with type 1 diabetes (T1D) emphasizes transition readiness, with less emphasis on transition outcomes. The relatively few studies that focus on outcomes use a wide variety of measures with little reliance on stakeholder engagement for measure selection. This study engaged multiple stakeholders (i.e., young adults with T1D, parents, pediatric and adult health care providers, and experts) in qualitative interviews to identify the content domain for developing a multidimensional measure of health care transition (HCT) outcomes. The following constructs were identified for a planned measure of HCT outcomes: biomedical markers of T1D control; T1D knowledge/skills; navigation of a new health care system; integration of T1D into emerging adult roles; balance of parental involvement with autonomy; and "ownership" of T1D self-management. The results can guide creation of an initial item pool for a multidimensional profile of HCT outcomes. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  9. 26 CFR 1.188-1 - Amortization of certain expenditures for qualified on-the-job training and child care facilities.

    Science.gov (United States)

    2010-04-01

    ... qualified on-the-job training and child care facilities. 1.188-1 Section 1.188-1 Internal Revenue INTERNAL... qualified on-the-job training and child care facilities. (a) Allowance of deduction—(1) In general. Under... operation of a qualified on-the-job training or child care facility or are integrally related facilities...

  10. Taiwanese women's experiences of hospital midwifery care: a phenomenological study.

    Science.gov (United States)

    Kuo, Su-Chen; Wu, Cheng Jing; Mu, Pei-Fan

    2010-08-01

    to explore women's experiences in interaction with their midwives during their antenatal checks and during labour. a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. All interviews were transcribed verbatim. Data were analysed using Colaizzi's method for data analysis. the homes of the study participants in the district of a Taipei (Taiwan) teaching hospital. a purposive sample of 11 Taiwanese women, one primipara, and 10 multiparae, who were one to three months post-childbirth at the time of interview. five major themes revealed the essence of women's experiences of their interaction with a midwife during pregnancy and childbirth: (1) being respected, (2) being accompanied, (3) trust, (4) being satisfied, and (5) professional competence. the women recognised the service model of the midwife; they treasured their mutual relationships and the benefits that women derived from midwifery care during childbirth. In Taiwan, the government is mandated to offer midwifery models of care in hospitals, and to allow women to choose different types of care provider. an awareness of women's experiences will help identify the caring behaviours as recognised by the women and may help health-care professionals provide better support and care for women during the pregnancy and childbirth periods. These findings can serve as references for future midwifery practice models and improvements in quality of care. Crown Copyright 2008. Published by Elsevier Ltd. All rights reserved.

  11. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Kit Logos and Badges Materials for Printing PTSD Awareness About the Website Site Map Content Inventory Accessibility ... Links Linking Policies Small Business POC Subscribe PTSD Awareness PTSD Consultation More Health Care Veterans Health Administration ...

  12. Linking patient satisfaction with nursing care: the case of care rationing - a correlational study

    Science.gov (United States)

    2014-01-01

    Background Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing measures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nurses’ perceptions of their professional environment, negative patient outcomes, and placing patient safety at risk. The aims of the study were: a) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nurses’ perceptions of their practice environment while adjusting for patient and nurse characteristics. b) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across rationing levels. Methods A descriptive, correlational design was employed. Participants in this study included 352 patients and 318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were used: the BERNCA scale for rationing of care, the RPPE scale to explore nurses’ perceptions of their work environment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The statistical analysis included the use of Kendall’s correlation coefficient to explore a possible relationship between the variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together with organizational characteristics on patient satisfaction. Results The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0–3), the overall mean of RPPE was 2.76 (SD = 0.32, range = 1.28 – 3.69) and the two scales were significantly correlated (τ = −0.234, p patient satisfaction, even after controlling for nurse and patient characteristics. The results from the adjusted regression models showed that even at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction. Conclusions The results support the relationships between

  13. Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

    Science.gov (United States)

    Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

    2017-12-01

    Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  14. The Study of Frequency Self Care Strategies against Auditory Hallucinations

    Directory of Open Access Journals (Sweden)

    Mahin Nadem

    2012-03-01

    Full Text Available Background: In schizophrenic clients, self-care strategies against auditory hallucinations can decrease disturbances results in hallucination. This study was aimed to assess frequency of self-care strategies against auditory hallucinations in paranoid schizophrenic patients, hospitalized in Shafa Hospital.Materials and Method: This was a descriptive study on 201 patients with paranoid schizophrenia hospitalized in psychiatry unit with convenience sampling in Rasht. The gathered data consists of two parts, first unit demographic characteristic and the second part, self- report questionnaire include 38 items about self-care strategies.Results: There were statistically significant relationship between demographic variables and knowledg effect and self-care strategies against auditory hallucinaions. Sex with phisical domain p0.07, marriage status with cognitive domain (p>0.07 and life status with behavioural domain (p>0.01. 53.2% of reported type of our auditory hallucinations were command hallucinations, furtheremore the most effective self-care strategies against auditory hallucinations were from physical domain and substance abuse (82.1% was the most effective strategies in this domain.Conclusion: The client with paranoid schizophrenia used more than physical domain strategies against auditory hallucinaions and this result highlight need those to approprait nursing intervention. Instruction and leading about selection the effective self-care strategies against auditory ha

  15. A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital.

    Science.gov (United States)

    Smith, Thomas J

    2012-01-01

    This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

  16. Carbon Composition of Particulate Organic Carbon in the Gulf of Mexico

    Science.gov (United States)

    Rogers, K.; Montoya, J. P.; Weber, S.; Bosman, S.; Chanton, J.

    2016-02-01

    The Deepwater Horizon blowout released 5.0x1011 g C from gaseous hydrocarbons and up to 6.0x1011g C from oil into the water column. Another carbon source, adding daily to the water column, leaks from the natural hydrocarbon seeps that pepper the seafloor of the Gulf of Mexico. How much of this carbon from the DWH and natural seeps is assimilated into particulate organic carbon (POC) in the water column? We filtered seawater collected in 2010, 2012, and 2013 from seep and non-seep sites, collecting POC on 0.7µm glass microfiber filters and analyzing the POC for stable and radiocarbon isotopes. Mixing models based on carbon isotopic endmembers of methane, oil, and modern production were used to estimate the percentage of hydrocarbon incorporated into POC. Significant differences were seen between POC from shallow and deep waters and between POC collected from seep, non-seep, and blowout sites; however yearly differences were not as evident suggesting the GOM has a consistent supply of depleted carbon. Stable carbon isotopes signatures of POC in the Gulf averaged -23.7±2.5‰ for shallow samples and -26.65±2.9‰ for deep POC samples, while radiocarbon signatures averaged -100.4±146.1‰ for shallow and -394.6±197‰ for deep samples. POC in the northern Gulf are composed of 23-91% modern carbon, 2-21% methane, and 0-71% oil. Oil plays a major role in the POC composition of the GOM, especially at the natural seep GC600.

  17. Optimization of the protein concentration process from residual peanut oil-cake

    Directory of Open Access Journals (Sweden)

    Gayol, M. F.

    2013-12-01

    Full Text Available The objective of this study was to find the best process conditions for preparing protein concentrate from residual peanut oil-cake (POC. The study was carried out on POC from industrial peanut oil extraction. Different protein extraction and precipitation conditions were used: water/ flour ratio (10:1, 20:1 and 30:1, pH (8, 9 and 10, NaCl concentration (0 and 0.5 M, extraction time (30, 60 and 120 min, temperature (25, 40 and 60 °C, extraction stages (1, 2 and 3, and precipitation pH (4, 4.5 and 5. The extraction and precipitation conditions which showed the highest protein yield were 10:1 water/flour ratio, extraction at pH 9, no NaCl, 2 extraction stages of 30 min at 40 °C and precipitation at pH 4.5. Under these conditions, the peanut protein concentrate (PC contained 86.22% protein, while the initial POC had 38.04% . POC is an alternative source of protein that can be used for human consumption or animal nutrition. Therefore, it adds value to an industry residue.El objetivo de este trabajo fue encontrar las mejores condiciones para obtener un concentrado de proteínas a partir de la torta residual de maní (POC. El estudio se llevó a cabo en POC provenientes de la extracción industrial de aceite de maní. Se utilizaron distintas condiciones para la extracción y precipitación de proteínas: relación agua / harina (10:1, 20:1 y 30:1, pH de extracción (8, 9 y 10, concentración de NaCl (0 y 0,5 M, tiempo de extracción (30, 60 y 120 min, temperatura (25, 40 y 60 °C, número de etapas de extracción (1, 2 y 3, y el pH de precipitación (4, 4,5 y 5. Las condiciones de extracción y de precipitación que mostraron mayor rendimiento de proteína fueron: relación de 10:1 en agua / harina, pH de extracción de 9, en ausencia de NaCl, 2 etapas de extracción de 30 min cada una a 40 °C y el pH de precipitación de 4,5. En estas condiciones, el concentrado de proteína de maní (PC fue de 86,22%, mientras que el porcentaje de proteínas de

  18. [Modifications of vital signs during hygiene care in intensive care patients: an explorative study].

    Science.gov (United States)

    Lucchini, Alberto; Giacovelli, Matteo; Elli, Stefano; Gariboldi, Roberto; Pelucchi, Giulia; Bondi, Herman; Brambilla, Daniela

    2009-01-01

    Hygiene care in critical patients may alter vital signs. Aim of this paper is to measure vital signs and their modifications in critical patients during hygiene care and measure differences with pre and post hygiene values. Vital signs of 6 patients two hours before, during and 90 minutes after hygienic care were measured. During and 2 hours after the end of hygiene a modification of vital signs was observed compared to basic values (mean values during/90 min after, compared to baseline): heart rate +11.20%/ +1.48; systolic blood pressure +22.68%/+1.56; arterial capillary saturimetry -4.31/+0.27, Respiratory frequency +8.10/+2.66, tidal volume +4,04/-7,51, CO2 min/vol +5,34/- 22.33, bladder temperature -0.85/-0.60. Hygiene care in critical care patients may significantly alter vital signs. Therefore a strict haemodinamic and respiratory monitoring is warranted as well as protocols for the management of sedation and of vasoactive support.

  19. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    Science.gov (United States)

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. [Comparative study of burnout in Intensive Care and Emergency Care nursing staff].

    Science.gov (United States)

    Ríos Risquez, M I; Godoy Fernández, C; Peñalver Hernández, F; Alonso Tovar, A R; López Alcaraz, F; López Romera, A; Garnés González, S; Salmerón Saura, E; López Real, M D; Ruiz Sánchez, R; Simón Domingo, P; Manzanera Nicolás, J L; Menchón Almagro, M A; Liébanas Bellón, R

    2008-01-01

    To assess and compare the burnout level between Intensive Care Unit and Emergency Unit, and study its association with the sociodemographic and work characteristics of the professionals surveyed. Cross-sectional, descriptive study. Emplacement. Intensive Care Unit of the university hospital Morales Meseguer, Murcia-Spain. STUDIED SAMPLE: 97 nursing professionals: 55 professionals belong to the Emergency Department, and 42 professionals belong to the Intensive Care Department. Two evaluation tools were used: a sociodemographic and work survey, and the Maslach Burnout Inventory, 1986. Quantitative variables expressed as mean +/- SD compared with the Student's T test and qualitative variables compared with the chi2 test. SPSS 12.0(c). The comparative analysis of the burnout dimensions shows that emotional exhaustion level is significantly higher in the intensive care service than in the emergency one (25.45 +/- 11.15 vs 22.09 +/- 10.99) p burnout dimensions do not show significant differences between both departments. The masculine gender obtains a higher score in the depersonalization dimension of burnout (10.12 +/- 5.38) than female one (6.7 +/- 5.21) p burnout levels are moderate to high among the nursing professionals studied. A total of 5.15% of the sample studied achieves a high score in the three dimensions of the burnout syndrome. The intensive care professionals are the most vulnerable to suffering high levels of emotional exhaustion, and the masculine gender is more susceptible to depersonalization attitudes.

  1. Cost-Effectiveness Analysis of 1-Year Treatment with Golimumab/Standard Care and Standard Care Alone for Ulcerative Colitis in Poland.

    Directory of Open Access Journals (Sweden)

    Ewa Stawowczyk

    Full Text Available The objective of this study was to assess the cost-effectiveness of induction and maintenance treatment up to 1 year of ulcerative colitis with golimumab/standard care and standard care alone in Poland.A Markov model was used to estimate the expected costs and effects of golimumab/standard care and a standard care alone. For each treatment option the costs and quality adjusted life years were calculated to estimate the incremental cost-utility ratio. The analysis was performed from the perspective of the Polish public payer and society over a 30-years time horizon. The clinical parameters were derived mainly from the PURSUIT-SC and PURSUIT-M clinical trials. Different direct and indirect costs and utility values were assigned to the various model health states.The treatment of ulcerative colitis patients with golimumab/standard care instead of a standard care alone resulted in 0.122 additional years of life with full health. The treatment with golimumab/standard care was found to be more expensive than treatment with the standard care alone from the public payer perspective and from social perspective. The incremental cost-utility ratio of golimumab/standard care compared to the standard care alone is estimated to be 391,252 PLN/QALY gained (93,155 €/QALYG from public payer perspective and 374,377 PLN/QALY gained (89,137 €/QALYG from social perspective.The biologic treatment of ulcerative colitis patients with golimumab/standard care is more effective but also more costly compared with standard care alone.

  2. Study protocol: cross-national comparative case study of recovery-focused mental health care planning and coordination (COCAPP).

    Science.gov (United States)

    Simpson, Alan; Hannigan, Ben; Coffey, Michael; Jones, Aled; Barlow, Sally; Cohen, Rachel; Všetečková, Jitka; Faulkner, Alison; Haddad, Mark

    2015-07-03

    The collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively. COCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday 'frontline' practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide

  3. Primary medical care and reductions in addiction severity: a prospective cohort study.

    Science.gov (United States)

    Saitz, Richard; Horton, Nicholas J; Larson, Mary Jo; Winter, Michael; Samet, Jeffrey H

    2005-01-01

    To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions. We studied a prospective cohort of adults enrolled in a randomized trial to improve linkage with primary medical care. Subjects at a residential detoxification unit with alcohol, heroin or cocaine as a substance of choice, and no primary medical care were enrolled. Receipt of primary medical care was assessed over 2 years. Outcomes included (1) alcohol severity, (2) drug severity and (3) any substance use. For the 391 subjects, receipt of primary care (> or = 2 visits) was associated with a lower odds of drug use or alcohol intoxication (adjusted odds ratio (AOR) 0.45, 95% confidence interval (CI) 0.29-0.69, 2 d.f. chi(2)P = 0.002). For 248 subjects with alcohol as a substance of choice, alcohol severity was lower in those who received primary care [predicted mean Addiction Severity Index (ASI) alcohol scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.30, 0.26 and 0.34, P = 0.04]. For 300 subjects with heroin or cocaine as a substance of choice, drug severity was lower in those who received primary care (predicted mean ASI drug scores for those reporting > or = 2, 1 and 0 visits, respectively, 0.13, 0.15 and 0.16, P = 0.01). Receipt of primary medical care is associated with improved addiction severity. These results support efforts to link patients with addictions to primary medical care services.

  4. Microbead agglutination based assays

    KAUST Repository

    Kodzius, Rimantas; Castro, David; Foulds, Ian G.; Parameswaran, Ash M.; Sumanpreet, K. Chhina

    2013-01-01

    We report a simple and rapid room temperature assay for point-of-care (POC) testing that is based on specific agglutination. Agglutination tests are based on aggregation of microbeads in the presence of a specific analyte thus enabling

  5. POC-SCALE TESTING OF A DRY TRIBOELECTROSTATIC SEPARATOR FOR FINE COAL CLEANING

    Energy Technology Data Exchange (ETDEWEB)

    R.H. Yoon; G.H. Luttrell; E.S. Yan; A.D. Walters

    2001-04-30

    suffer from low throughput capacities and high maintenance requirements. In general, surface area-based separators (e.g., shaking tables, magnetic drum separator, electrodynamic separator, etc.) have lower throughput capacities than volume-based separators (e.g., flotation cell, dense-medium bath, cyclones, etc.) by an order of magnitude. Furthermore, the electrodes of the laboratory unit need to be cleaned frequently, creating a high maintenance requirement if it is scaled-up to a commercial unit. The bench-scale continuous TES unit developed at NETL, on the other hand, separates positively and negatively charged particles by splitting the gaseous stream containing these particles in an electric field by means of a flow splitter, so that the oppositely charged particles can be directed into different compartments. This device is fundamentally different from the laboratory unit in that the former is a surface area-based separator, while the latter is a volume-based separator. The bench-scale unit is referred to as an entrained flow separator by the in-house researchers at NETL. Thus, the entrained flow TES unit is a significant improvement over the laboratory unit with regard to throughput capacity. In the present work, the entrained flow separator concept will be utilized for developing a proof-of concept (POC) separator that can be scaled-up to commercial size units. To accomplish this, it is necessary to develop a bench-scale separator that can achieve high Btu recoveries while maintaining the high degree of separation efficiencies. It is the objective of the present investigation to develop an efficient separator by studying the mechanisms of triboelectrification and investigating better ways of separating the charged particles. An important criterion for developing efficient separators is that they not only provide high separation efficiencies but also have high throughput capacities, which are essential ingredients for successful commercialization.

  6. The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients

    Directory of Open Access Journals (Sweden)

    Sina Waibel

    2015-07-01

    Full Text Available Background: Integrated health care networks (IHN are promoted in numerous countries as a response to fragmented care delivery by providing a coordinated continuum of services to a defined population. However, evidence on their effectiveness and outcome is scarce, particularly considering continuity across levels of care; that is the patient's experience of connected and coherent care received from professionals of the different care levels over time. The objective was to analyse the chronic obstructive pulmonary disease (COPD patients’ perceptions of continuity of clinical management and information across care levels and continuity of relation in IHN of the public health care system of Catalonia.Methods: A qualitative multiple case study was conducted, where the cases are COPD patients. A theoretical sample was selected in two stages: (1 study contexts: IHN and (2 study cases consisting of COPD patients. Data were collected by means of individual, semi-structured interviews to the patients, their general practitioners and pulmonologists and review of records. A thematic content analysis segmented by IHN and cases with a triangulation of sources and analysists was carried out.Results: COPD patients of all networks perceived that continuity of clinical management was existent due to clear distribution of roles for COPD care across levels, rapid access to care during exacerbations and referrals to secondary care when needed; nevertheless, patients of some networks highlighted too long waiting times to non-urgent secondary care. Physicians generally agreed with patients, however, also indicated unclear distribution of roles, some inadequate referrals and long waiting times to primary care in some networks. Concerning continuity of information, patients across networks considered that their clinical information was transferred across levels via computer and that physicians also used informal communication mechanisms (e-mail, telephone; whereas

  7. A home-based comprehensive care model in patients with Multiple Sclerosis: A study pre-protocol [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Lufei Young

    2015-09-01

    Full Text Available Background Disability is prevalent in individuals with multiple sclerosis (MS, leading to difficulty in care access, significant caregiver burden, immense challenges in self-care and great societal burden.  Without highly coordinated, competent and accessible care, individuals living with progressive MS experience psychological distress, poor quality of life, suffer from life-threatening complications, and have frequent but avoidable healthcare utilizations. Unfortunately, current healthcare delivery models present severe limitations in providing easily accessible, patient-centered, coordinated comprehensive care to those with progressive MS. We propose a home-based comprehensive care model (MAHA to address the unmet needs, challenges, and avoidable complications in individuals with progressive MS with disabling disease. Objective The article aims to describe the study design and methods used to implement and evaluate the proposed intervention.   Method The study will use a randomized controlled design to evaluate the feasibility of providing a 24-month, home-based, patient-centered comprehensive care program to improve quality of life, reduce complications and healthcare utilizations overtime (quarterly for 24 months. A transdisciplinary team led by a MS-Comprehensivist will carry out this project. Fifty MS patients will be randomly assigned to the intervention and usual care program using block randomization procedures. We hypothesize that patients in the intervention group will have fewer complications, higher quality of life, greater satisfaction with care, and reduced healthcare utilization. The proposed project is also expected to be financially sustainable in fee-for-service models but best suited for and gain financial success in valued-based care systems.   Discussion This is the first study to examine the feasibility and effectiveness of a home-based comprehensive care management program in MS patients living with progressive

  8. Validation and Intercomparison of Ocean Color Algorithms for Estimating Particulate Organic Carbon in the Oceans

    Directory of Open Access Journals (Sweden)

    Hayley Evers-King

    2017-08-01

    Full Text Available Particulate Organic Carbon (POC plays a vital role in the ocean carbon cycle. Though relatively small compared with other carbon pools, the POC pool is responsible for large fluxes and is linked to many important ocean biogeochemical processes. The satellite ocean-color signal is influenced by particle composition, size, and concentration and provides a way to observe variability in the POC pool at a range of temporal and spatial scales. To provide accurate estimates of POC concentration from satellite ocean color data requires algorithms that are well validated, with uncertainties characterized. Here, a number of algorithms to derive POC using different optical variables are applied to merged satellite ocean color data provided by the Ocean Color Climate Change Initiative (OC-CCI and validated against the largest database of in situ POC measurements currently available. The results of this validation exercise indicate satisfactory levels of performance from several algorithms (highest performance was observed from the algorithms of Loisel et al., 2002; Stramski et al., 2008 and uncertainties that are within the requirements of the user community. Estimates of the standing stock of the POC can be made by applying these algorithms, and yield an estimated mixed-layer integrated global stock of POC between 0.77 and 1.3 Pg C of carbon. Performance of the algorithms vary regionally, suggesting that blending of region-specific algorithms may provide the best way forward for generating global POC products.

  9. Association between child-care and acute diarrhea: a study in Portuguese children

    Directory of Open Access Journals (Sweden)

    Barros Henrique

    2003-01-01

    Full Text Available OBJECTIVE: To quantify the influence of the type of child-care on the occurrence of acute diarrhea with special emphasis on the effect of children grouping during care. METHODS: From October 1998 to January 1999 292 children, aged 24 to 36 months, recruited using a previously assembled cohort of newborns, were evaluated. Information on the type of care and occurrence of diarrhea in the previous year was obtained from parents by telephone interview. The X² and Kruskal-Wallis tests were used to compare proportions and quantitative variables, respectively. The risk of diarrhea was estimated through the calculation of incident odds ratios (OR and their respective 95% confidence intervals (95% CI, crude and adjusted by unconditional logistic regression. RESULTS: Using as reference category children cared individually at home, the adjusted ORs for diarrhea occurrence were 3.18, 95% CI [1.49, 6.77] for children cared in group at home, 2.28, 95% CI [0.92, 5.67] for children cared in group in day-care homes and 2.54, 95% CI [1.21, 5.33] for children cared in day-care centers. Children that changed from any other type of child-care setting to child-care centers in the year preceding the study showed a risk even higher (OR 7.65, 95% CI [3.25, 18.02]. CONCLUSIONS: Group care increases the risk of acute diarrhea whatsoever the specific setting.

  10. Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.

    Science.gov (United States)

    Burn, Anne-Marie; Fleming, Jane; Brayne, Carol; Fox, Chris; Bunn, Frances

    2018-03-17

    In 2012-2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs' lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care

  11. Feasibility Studies of Palm Oil Mill Waste Aggregates for the Construction Industry

    OpenAIRE

    Kanadasan, Jegathish; Ahmad Fauzi, Auni Filzah; Abdul Razak, Hashim; Selliah, Paramananthan; Subramaniam, Vijaya; Yusoff, Sumiani

    2015-01-01

    The agricultural industry in Malaysia has grown rapidly over the years. Palm oil clinker (POC) is a byproduct obtained from the palm oil industry. Its lightweight properties allows for its utilization as an aggregate, while in powder form as a filler material in concrete. POC specimens obtained throughout each state in Malaysia were investigated to evaluate the physical, chemical, and microstructure characteristics. Variations between each state were determined and their possible contributory...

  12. Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals.

    Science.gov (United States)

    Petersson, Lena; Erlingsdóttir, Gudbjörg

    2018-02-02

    When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work

  13. Effect of the Uganda Newborn Study on care-seeking and care practices: a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Peter Waiswa

    2015-03-01

    Full Text Available Background: Care for women and babies before, during, and after the time of birth is a sensitive measure of the functionality of any health system. Engaging communities in preventing newborn deaths is a promising strategy to achieve further progress in child survival in sub-Saharan Africa. Objective: To assess the effect of a home visit strategy combined with health facility strengthening on uptake of newborn care-seeking, practices and services, and to link the results to national policy and scale-up in Uganda. Design: The Uganda Newborn Study (UNEST was a two-arm cluster-randomised controlled trial in rural eastern Uganda. In intervention villages volunteer community health workers (CHWs were trained to identify pregnant women and make five home visits (two during pregnancy and three in the first week after birth to offer preventive and promotive care and counselling, with extra visits for sick and small newborns to assess and refer. Health facility strengthening was done in all facilities to improve quality of care. Primary outcomes were coverage of key essential newborn care behaviours (breastfeeding, thermal care, and cord care. Analyses were by intention to treat. This study is registered as a clinical trial, number ISRCTN50321130. Results: The intervention significantly improved essential newborn care practices, although many interventions saw major increases in both arms over the study period. Immediate breastfeeding after birth and exclusive breastfeeding were significantly higher in the intervention arm compared to the control arm (72.6% vs. 66.0%; p=0.016 and 81.8% vs. 75.9%, p=0.042, respectively. Skin-to-skin care immediately after birth and cord cutting with a clean instrument were marginally higher in the intervention arm versus the control arm (80.7% vs. 72.2%; p=0.071 and 88.1% vs. 84.4%; p=0.023, respectively. Half (49.6% of the mothers in the intervention arm waited more than 24 hours to bathe the baby, compared to 35.5% in

  14. Radiotherapy in Cancer Care. Chapter 1

    International Nuclear Information System (INIS)

    Rosenblatt, E.; Zubizarreta, E.; Camacho, R.; Vikram, B.

    2017-01-01

    Cancer control, cancer care and cancer treatment are three different concepts, although the terms are often used interchangeably. Cancer control is the reduction in the incidence, morbidity and mortality of cancer, as well as the improvement in the quality of life of cancer patients and their families. As such, cancer control includes actions relating to prevention, early detection and screening, diagnosis, treatment and palliative care. Cancer care includes all actions and interventions aimed at supporting, assisting and treating cancer patients. Cancer care includes cancer treatment, but also other forms of support such as nutrition, symptom relief, speech therapy, physiotherapy, stoma care, nursing care, lymphoedema care and psychosocial care. Cancer treatment includes medical interventions aimed at the cure or palliation of a patient who has been diagnosed with cancer. As such, cancer treatment modalities include surgery, radiotherapy, systemic therapies such as chemotherapy, hormone therapy, immunotherapy, gene therapy and other investigational strategies.

  15. Implementing a stepped-care approach in primary care: results of a qualitative study

    Directory of Open Access Journals (Sweden)

    Franx Gerdien

    2012-01-01

    Full Text Available Abstract Background Since 2004, 'stepped-care models' have been adopted in several international evidence-based clinical guidelines to guide clinicians in the organisation of depression care. To enhance the adoption of this new treatment approach, a Quality Improvement Collaborative (QIC was initiated in the Netherlands. Methods Alongside the QIC, an intervention study using a controlled before-and-after design was performed. Part of the study was a process evaluation, utilizing semi-structured group interviews, to provide insight into the perceptions of the participating clinicians on the implementation of stepped care for depression into their daily routines. Participants were primary care clinicians, specialist clinicians, and other healthcare staff from eight regions in the Netherlands. Analysis was supported by the Normalisation Process Theory (NPT. Results The introduction of a stepped-care model for depression to primary care teams within the context of a depression QIC was generally well received by participating clinicians. All three elements of the proposed stepped-care model (patient differentiation, stepped-care treatment, and outcome monitoring, were translated and introduced locally. Clinicians reported changes in terms of learning how to differentiate between patient groups and different levels of care, changing antidepressant prescribing routines as a consequence of having a broader treatment package to offer to their patients, and better working relationships with patients and colleagues. A complex range of factors influenced the implementation process. Facilitating factors were the stepped-care model itself, the structured team meetings (part of the QIC method, and the positive reaction from patients to stepped care. The differing views of depression and depression care within multidisciplinary health teams, lack of resources, and poor information systems hindered the rapid introduction of the stepped-care model. The NPT

  16. Origin of particulate organic carbon in the marine atmosphere as indicated by it stable carbon isotopic composition

    International Nuclear Information System (INIS)

    Chesselet, R.; Fontugne, M.; Buat-Menard, P.; Ezat, U.; Lambert, C.E.

    1981-01-01

    Organic carbon concentration and isotopic composition were determined in samples of atmospheric particulate matter collected in 1979 at remote marine locations (Enewetak atoll, Sargasso Sea) during the SEAREX (Sea-Air Exchange) program field experiments. Atmospheric Particulate Organic Carbon (POC) concentrations were found to be in the range of 0.3 to 1.2 mg. m -3 , in agreement with previous literature data. The major mass of POC was found on the smallest particles (r 13 C/ 12 C of the small particles is close to the one expected (d 13 C = 26 +- 2 0 //sub infinity/) for atmospheric POC of continental origin. For all the samples analysed so far, it appears that more than 80% of atmospheric POC over remote marine areas is of continental origin. This can be explained either by long-range transport of small sized continental organic aserosols or by the production of POC in the marine atmosphere from a vapor phase organic carbon pool of continental origin. The POC in the large size fraction of marine aerosols ( 13 C = -21 +- 2 0 / 00 ) for POC associated with sea-salt droplets transported to the marine atmosphere

  17. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    Directory of Open Access Journals (Sweden)

    Shima R

    2014-11-01

    Full Text Available Razatul Shima,1,3 Mohd Hairi Farizah,1,2 Hazreen Abdul Majid1,2 1Department of Social and Preventive Medicine; 2Centre for Population Health, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 3Ministry of Health Malaysia, Putrajaya, Malaysia Purpose: The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes in primary health clinic settings. Patients and methods: A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis.Results: There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups.Conclusion: Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their

  18. Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions

    Science.gov (United States)

    Oppong, Raymond; Jit, Mark; Smith, Richard D; Butler, Christopher C; Melbye, Hasse; Mölstad, Sigvard; Coast, Joanna

    2013-01-01

    Background Point-of-care C-reactive protein (POCCRP) is a biomarker of inflammation that offers clinicians a rapid POC test to guide antibiotic prescribing decisions for acute cough and lower respiratory tract infections (LRTI). However, evidence that POCCRP is cost-effective is limited, particularly outside experimental settings. Aim To assess the cost-effectiveness of POCCRP as a diagnostic tool for acute cough and LRTI from the perspective of the health service. Design and setting Observational study of the presentation, management, and outcomes of patients with acute cough and LRTI in primary care settings in Norway and Sweden. Method Using hierarchical regression, data were analysed in terms of the effect on antibiotic use, cost, and patient outcomes (symptom severity after 7 and 14 days, time to recovery, and EQ-5D), while controlling for patient characteristics (self-reported symptom severity, comorbidities, and health-related quality of life) at first attendance. Results POCCRP testing is associated with non-significant positive reductions in antibiotic prescribing (P = 0.078) and increased cost (P = 0.092). Despite the uncertainty, POCCRP testing is also associated with a cost per quality-adjusted life year (QALY) gain of €9391. At a willingness-to-pay threshold of €30 000 per QALY gained, there is a 70% probability of CRP being cost-effective. Conclusion POCCRP testing is likely to provide a cost-effective diagnostic intervention both in terms of reducing antibiotic prescribing and in terms of QALYs gained. PMID:23834883

  19. CAREGIVERS’ NEEDS IN CARING FOR RELATIVES WITH SCHIZOPHRENIA IN MEDAN INDONESIA: A PHENOMENOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    Jenny Marlindawani Purba

    2017-12-01

    Full Text Available Background: A caregiver is a primary nurse and has a major role in providing care for people with schizophrenia. Caring for those with schizophrenia for a long period of time is a challenge for families, especially caregivers. Various needs ought to be studied by nurses to assist caregivers in providing optimal care for family members who experience schizophrenia. Objective: This qualitative study aims to explore the needs of caregivers in treating schizophrenia at home. Methods: The method used in this study is the method of purposive sampling with the number of participants as many as 10 people with criteria: 1 have family members diagnosed with schizophrenia, 2 directly involved in home care patients, 3 caring for schizophrenia for more than one year, 4 willing to be a participant by signing informed consent, 4 being able to identify what is needed in treating schizophrenia. Colaizzi is used to analyze interview data. Results: The results of the study found four themes of caregiver needs in caring for schizophrenia patients at home, namely: 1 seeking information about schizophrenia, 2 sought schizophrenic relatives’ recovery, 3 looking for appropriate rehabilitation for relatives with schizophrenias, and 4 utilizing mental health facilities. Conclusions: It is expected that nurses have the knowledge and skills in identifying and helping families, especially caregivers, to meet unmet needs so they can optimize home care.

  20. Simple Approaches to Minimally-Instrumented, Microfluidic-Based Point-of-Care Nucleic Acid Amplification Tests

    Science.gov (United States)

    Mauk, Michael G.; Song, Jinzhao; Liu, Changchun; Bau, Haim H.

    2018-01-01

    Designs and applications of microfluidics-based devices for molecular diagnostics (Nucleic Acid Amplification Tests, NAATs) in infectious disease testing are reviewed, with emphasis on minimally instrumented, point-of-care (POC) tests for resource-limited settings. Microfluidic cartridges (‘chips’) that combine solid-phase nucleic acid extraction; isothermal enzymatic nucleic acid amplification; pre-stored, paraffin-encapsulated lyophilized reagents; and real-time or endpoint optical detection are described. These chips can be used with a companion module for separating plasma from blood through a combined sedimentation-filtration effect. Three reporter types: Fluorescence, colorimetric dyes, and bioluminescence; and a new paradigm for end-point detection based on a diffusion-reaction column are compared. Multiplexing (parallel amplification and detection of multiple targets) is demonstrated. Low-cost detection and added functionality (data analysis, control, communication) can be realized using a cellphone platform with the chip. Some related and similar-purposed approaches by others are surveyed. PMID:29495424

  1. Simple Approaches to Minimally-Instrumented, Microfluidic-Based Point-of-Care Nucleic Acid Amplification Tests

    Directory of Open Access Journals (Sweden)

    Michael G. Mauk

    2018-02-01

    Full Text Available Designs and applications of microfluidics-based devices for molecular diagnostics (Nucleic Acid Amplification Tests, NAATs in infectious disease testing are reviewed, with emphasis on minimally instrumented, point-of-care (POC tests for resource-limited settings. Microfluidic cartridges (‘chips’ that combine solid-phase nucleic acid extraction; isothermal enzymatic nucleic acid amplification; pre-stored, paraffin-encapsulated lyophilized reagents; and real-time or endpoint optical detection are described. These chips can be used with a companion module for separating plasma from blood through a combined sedimentation-filtration effect. Three reporter types: Fluorescence, colorimetric dyes, and bioluminescence; and a new paradigm for end-point detection based on a diffusion-reaction column are compared. Multiplexing (parallel amplification and detection of multiple targets is demonstrated. Low-cost detection and added functionality (data analysis, control, communication can be realized using a cellphone platform with the chip. Some related and similar-purposed approaches by others are surveyed.

  2. The German MultiCare-study: Patterns of multimorbidity in primary health care – protocol of a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Schäfer Ingmar

    2009-08-01

    Full Text Available Abstract Background Multimorbidity is a highly frequent condition in older people, but well designed longitudinal studies on the impact of multimorbidity on patients and the health care system have been remarkably scarce in numbers until today. Little is known about the long term impact of multimorbidity on the patients' life expectancy, functional status and quality of life as well as health care utilization over time. As a consequence, there is little help for GPs in adjusting care for these patients, even though studies suggest that adhering to present clinical practice guidelines in the care of patients with multimorbidity may have adverse effects. Methods/Design The study is designed as a multicentre prospective, observational cohort study of 3.050 patients aged 65 to 85 at baseline with at least three different diagnoses out of a list of 29 illnesses and syndromes. The patients will be recruited in approx. 120 to 150 GP surgeries in 8 study centres distributed across Germany. Information about the patients' morbidity will be collected mainly in GP interviews and from chart reviews. Functional status, resources/risk factors, health care utilization and additional morbidity data will be assessed in patient interviews, in which a multitude of well established standardized questionnaires and tests will be performed. Discussion The main aim of the cohort study is to monitor the course of the illness process and to analyse for which reasons medical conditions are stable, deteriorating or only temporarily present. First, clusters of combinations of diseases/disorders (multimorbidity patterns with a comparable impact (e.g. on quality of life and/or functional status will be identified. Then the development of these clusters over time will be analysed, especially with regard to prognostic variables and the somatic, psychological and social consequences as well as the utilization of health care resources. The results will allow the development of an

  3. Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.

    Science.gov (United States)

    Divatia, Jigeeshu V; Amin, Pravin R; Ramakrishnan, Nagarajan; Kapadia, Farhad N; Todi, Subhash; Sahu, Samir; Govil, Deepak; Chawla, Rajesh; Kulkarni, Atul P; Samavedam, Srinivas; Jani, Charu K; Rungta, Narendra; Samaddar, Devi Prasad; Mehta, Sujata; Venkataraman, Ramesh; Hegde, Ashit; Bande, B D; Dhanuka, Sanjay; Singh, Virendra; Tewari, Reshma; Zirpe, Kapil; Sathe, Prachee

    2016-04-01

    To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.

  4. Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

    Science.gov (United States)

    Rahmani, Zuhal; Brekke, Mette

    2013-05-06

    Despite attempts from the government to improve ante- and perinatal care, Afghanistan has once again been labeled "the worst country in which to be a mom" in Save the Children's World's Mothers' Report. This study investigated how pregnant women and health care providers experience the existing antenatal and obstetric health care situation in Afghanistan. Data were obtained through one-to-one semi-structured interviews of 27 individuals, including 12 women who were pregnant or had recently given birth, seven doctors, five midwives, and three traditional birth attendants. The interviews were carried out in Kabul and the village of Ramak in Ghazni Province. Interviews were taped, transcribed, and analyzed according to the principles of Giorgi's phenomenological analysis. Antenatal care was reported to be underused, even when available. Several obstacles were identified, including a lack of knowledge regarding the importance of antenatal care among the women and their families, financial difficulties, and transportation problems. The women also reported significant dissatisfaction with the attitudes and behavior of health personnel, which included instances of verbal and physical abuse. According to the health professionals, poor working conditions, low salaries, and high stress levels contributed to this matter. Personal contacts inside the hospital were considered necessary for receiving high quality care, and bribery was customary. Despite these serious concerns, the women expressed gratitude for having even limited access to health care, especially treatment provided by a female doctor. Health professionals were proud of their work and enjoyed the opportunity to help their community. This study identified several obstacles which must be addressed to improve reproductive health in Afghanistan. There was limited understanding of the importance of antenatal care and a lack of family support. Financial and transportation problems led to underuse of available care

  5. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care

    Directory of Open Access Journals (Sweden)

    Monaghan M

    2016-04-01

    Full Text Available Maureen Monaghan,1,2 Katherine Baumann2 1Center for Translational Science, Children's National Health System, 2George Washington University School of Medicine, Washington, DC, USA Abstract: Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented. Keywords: type 1 diabetes

  6. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... Accessibility Privacy and Security Updating of Web Site Web Site Policies Important Links Linking Policies Small Business POC Subscribe PTSD Awareness PTSD Consultation More Health Care Veterans Health Administration Health Benefits Health Benefits Home Apply for VA ...

  7. The Diabetes Care Project: an Australian multicentre, cluster randomised controlled trial [study protocol].

    Science.gov (United States)

    Leach, Matthew J; Segal, Leonie; Esterman, Adrian; Armour, Caroline; McDermott, Robyn; Fountaine, Tim

    2013-12-20

    Diabetes mellitus is an increasingly prevalent metabolic disorder that is associated with substantial disease burden. Australia has an opportunity to improve ways of caring for the growing number of people with diabetes, but this may require changes to the way care is funded, organised and delivered. To inform how best to care for people with diabetes, and to identify the extent of change that is required to achieve this, the Diabetes Care Project (DCP) will evaluate the impact of two different, evidence-based models of care (compared to usual care) on clinical quality, patient and provider experience, and cost. The DCP uses a pragmatic, cluster randomised controlled trial design. Accredited general practices that are situated within any of the seven Australian Medicare Locals/Divisions of General Practice that have agreed to take part in the study were invited to participate. Consenting practices will be randomly assigned to one of three treatment groups for approximately 18 to 22 months: (a) control group (usual care); (b) Intervention 1 (which tests improvements that could be made within the current funding model, facilitated through the use of an online chronic disease management network); or (c) Intervention 2 (which includes the same components as Intervention 1, as well as altered funding to support voluntary patient registration with their practice, incentive payments and a care facilitator). Adult patients who attend the enrolled practices and have established (≥12 month's duration) type 1 diabetes mellitus or newly diagnosed or established type 2 diabetes mellitus are invited to participate. Multiple outcomes will be studied, including changes in glycosylated haemoglobin (primary outcome), changes in other biochemical and clinical metrics, incidence of diabetes-related complications, quality of life, clinical depression, success of tailored care, patient and practitioner satisfaction, and budget sustainability. This project responds to a need for robust

  8. Sources and Reactivity of Terrestrial Organic Carbon to the Colville River Delta, Beaufort Sea, Alaska

    Science.gov (United States)

    Schreiner, K. M.; Bianchi, T. S.; Rosenheim, B. E.

    2014-12-01

    Terrestrial particulate organic carbon (tPOC) delivery to nearshore deltaic regions is an important mechanism of OC storage and burial, and continental margins worldwide account for approximately 90% of the carbon burial in the ocean. Increasing warming in the Arctic is leading to an acceleration of the hydrologic cycle, warming of permafrost, and broad shifts in vegetation. All of these changes are likely to affect the delivery, reactivity, and burial of tPOC in nearshore Arctic regions, making the Arctic an ideal place to study the effects of climate change on tPOC delivery. However, to date, most studies of tPOC delivery from North America to the Arctic Ocean have focused on large Arctic rivers like the Mackenzie and Yukon, and a significant portion of those watersheds lie in sub-Arctic latitudes, meaning that their tPOC delivery is likely not uniquely representative of the high Arctic tundra. Here, we focus on tPOC delivery by the Colville River, the largest North American river with a watershed that does not include sub-Arctic latitudes. Sediment samples from the river delta and nearby Simpson's Lagoon were taken in August of 2010 and subsequently fractionated by density, in order to study the delivery of both discrete and sediment-sorbed tPOC. Samples were analyzed for stable carbon isotopes, bulk radiocarbon, terrestrial biomarkers (including lignin-phenols, and other CuO reaction products), and aquatic biomarkers (algal pigments), and additionally a subset of the samples were analyzed by ramped pyrolysis-14C. Results show that tPOC delivery near the river mouth is sourced from coastal plain tundra, with additional delivery of tPOC from peat released into the lagoon from the seaward limit of the tundra by coastal erosion. Ramped pyrolysis-14C analysis also shows a clear differentiation between tPOC delivered by the river and tPOC delivered by coastal retreat in the lagoon. Additionally, a significant portion of the OC released by the Colville River is

  9. Paramedic-Initiated Home Care Referrals and Use of Home Care and Emergency Medical Services.

    Science.gov (United States)

    Verma, Amol A; Klich, John; Thurston, Adam; Scantlebury, Jordan; Kiss, Alex; Seddon, Gayle; Sinha, Samir K

    2018-01-01

    We examined the association between paramedic-initiated home care referrals and utilization of home care, 9-1-1, and Emergency Department (ED) services. This was a retrospective cohort study of individuals who received a paramedic-initiated home care referral after a 9-1-1 call between January 1, 2011 and December 31, 2012 in Toronto, Ontario, Canada. Home care, 9-1-1, and ED utilization were compared in the 6 months before and after home care referral. Nonparametric longitudinal regression was performed to assess changes in hours of home care service use and zero-inflated Poisson regression was performed to assess changes in the number of 9-1-1 calls and ambulance transports to ED. During the 24-month study period, 2,382 individuals received a paramedic-initiated home care referral. After excluding individuals who died, were hospitalized, or were admitted to a nursing home, the final study cohort was 1,851. The proportion of the study population receiving home care services increased from 18.2% to 42.5% after referral, representing 450 additional people receiving services. In longitudinal regression analysis, there was an increase of 17.4 hours in total services per person in the six months after referral (95% CI: 1.7-33.1, p = 0.03). The mean number of 9-1-1 calls per person was 1.44 (SD 9.58) before home care referral and 1.20 (SD 7.04) after home care referral in the overall study cohort. This represented a 10% reduction in 9-1-1 calls (95% CI: 7-13%, p home care referral and 0.79 (SD 6.27) after home care referral, representing a 7% reduction (95% CI: 3-11%, p home care records were included in the analysis, the reductions in 9-1-1 calls and ambulance transports to ED were attenuated but remained statistically significant. Paramedic-initiated home care referrals in Toronto were associated with improved access to and use of home care services and may have been associated with reduced 9-1-1 calls and ambulance transports to ED.

  10. Impact of depression on health care utilization and costs among multimorbid patients--from the MultiCare Cohort Study.

    Directory of Open Access Journals (Sweden)

    Jens-Oliver Bock

    Full Text Available OBJECTIVE: The objective of this study was to describe and analyze the effects of depression on health care utilization and costs in a sample of multimorbid elderly patients. METHOD: This cross-sectional analysis used data of a prospective cohort study, consisting of 1,050 randomly selected multimorbid primary care patients aged 65 to 85 years. Depression was defined as a score of six points or more on the Geriatric Depression Scale (GDS-15. Subjects passed a geriatric assessment, including a questionnaire for health care utilization. The impact of depression on health care costs was analyzed using multiple linear regression models. A societal perspective was adopted. RESULTS: Prevalence of depression was 10.7%. Mean total costs per six-month period were €8,144 (95% CI: €6,199-€10,090 in patients with depression as compared to €3,137 (95% CI: €2,735-€3,538; p<0.001 in patients without depression. The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity. In particular, multiple regression analyses showed a significant positive association between depression and pharmaceutical costs. CONCLUSION: Among multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs. The effect of depression on costs was even greater than reported by previous studies conducted in less morbid patients.

  11. Seasonal and spatial distribution of particulate organic matter in the Bay of Bengal

    Digital Repository Service at National Institute of Oceanography (India)

    Fernandes, L.; Bhosle, N.B.; Matondkar, S.G.P.; Bhushan, R.

    spatial differences were observed for the offshore stations in SPIM (Table 1). 3.4. POC and % POC In the Bay of Bengal, the surface POC concentrations ranged from 4.3 to 11.1 µMC, 3.1 to 10.9 µMC, and 4.3 to 9.0 µMC in the SWM, FIM, and SPIM.... This is NIO contribution no. 4435. 10 References Bale, A., Morris, A., 1998. Organic carbon in suspended particulate material in the North Sea: effect of mixing resuspended and background particles. Cont. Shelf Res. 18, 1333 –1345. Bates, N. R., Dennis, A...

  12. Polyester composite versus PTFE in laparoscopic ventral hernia repair.

    Science.gov (United States)

    Colon, Modesto J; Telem, Dana A; Chin, Edward; Weber, Kaare; Divino, Celia M; Nguyen, Scott Q

    2011-01-01

    Both polyester composite (POC) and polytetrafluoroethylene (PTFE) mesh are commonly used for laparoscopic ventral hernia repair. However, sparse information exists comparing perioperative and long-term outcome by mesh repair. A prospective database was utilized to identify 116 consecutive patients who underwent laparoscopic ventral hernia repair at The Mount Sinai Hospital from 2004-2009. Patients were grouped by type of mesh used, PTFE versus POC, and retrospectively compared. Follow-up at a mean of 12 months was achieved by telephone interview and office visit. Of the 116 patients, 66 underwent ventral hernia repair with PTFE and 50 with POC mesh. Patients were well matched by patient demographics. No difference in mean body mass index (BMI) was demonstrated between the PTFE and POC group (31.8 vs. 32.5, respectively; P=NS). Operative time was significantly longer in the PTFE group (136 vs.106 minutes, PPTFE group and none in the POC group (P NS). No other major complications occurred in the immediate postoperative period (30 days). At a mean follow-up of 12 months, no significant difference was demonstrated between the PTFE and POC groups in hernia recurrence (3% vs. 2%), wound complications (1% vs. 0%), mesh infection, requiring removal (3% vs. 0%), bowel obstruction (3% vs. 2%), or persistent pain or discomfort (28% vs. 32%), respectively (P=NS). Our study demonstrated no significant association between types of mesh used and postoperative complications. In the 12-month follow-up, no differences were noted in hernia recurrence.

  13. [Effects of grazing disturbance on soil active organic carbon in mountain forest-arid valley ecotone in the upper reaches of Minjiang River].

    Science.gov (United States)

    Liu, Shan-Shan; Zhang, Xing-Hua; Gong, Yuan-Bo; Li, Yuan; Wang, Yan; Yin, Yan-Jie; Ma, Jin-Song; Guo, Ting

    2014-02-01

    Effects of grazing disturbance on the soil carbon contents and active components in the four vegetations, i.e., artificial Robinia pseudoacacia plantation, artificial poplar plantation, Berberis aggregate shrubland and grassland, were studied in the mountain forest-arid valley ecotone in the upper Minjiang River. Soil organic carbon and active component contents in 0-10 cm soil layer were greater than in 10-20 cm soil layer at each level of grazing disturbance. With increasing the grazing intensity, the total organic carbon (TOC), light fraction organic carbon (LFOC), particulate organic carbon (POC) and easily oxidized carbon (LOC) contents in 0-10 cm soil layer decreased gradually in the artificial R. pseudoacacia plantation. The LFOC content decreased, the POC content increased, and the TOC and LOC contents decreased initially and then increased with increasing the grazing intensity in the artificial poplar plantation. The POC content decreased, and the TOC, LFOC and LOC contents decreased initially and then increased with increasing the grazing intensity in the B. aggregate shrubland. The POC and TOC contents decreased, and the LFOC and LOC contents decreased initially and then increased with increasing the grazing intensity in the grassland. The decreasing ranges of LOC, LFOC and POC contents were 0.1-7.9 times more than that of TOC content. There were significant positive relationships between TOC and LOC, LFOC and POC, suggesting that the active organic carbon components could reflect the change of soil total carbon content.

  14. Transforming the blood glucose meter into a general healthcare meter for in vitro diagnostics in mobile health.

    Science.gov (United States)

    Lan, Tian; Zhang, Jingjing; Lu, Yi

    2016-01-01

    Recent advances in mobile network and smartphones have provided an enormous opportunity for transforming in vitro diagnostics (IVD) from central labs to home or other points of care (POC). A major challenge to achieving the goal is a long time and high costs associated with developing POC IVD devices in mobile Health (mHealth). Instead of developing a new POC device for every new IVD target, we and others are taking advantage of decades of research, development, engineering and continuous improvement of the blood glucose meter (BGM), including those already integrated with smartphones, and transforming the BGM into a general healthcare meter for POC IVDs of a wide range of biomarkers, therapeutic drugs and other analytical targets. In this review, we summarize methods to transduce and amplify selective binding of targets by antibodies, DNA/RNA aptamers, DNAzyme/ribozymes and protein enzymes into signals such as glucose or NADH that can be measured by commercially available BGM, making it possible to adapt many clinical assays performed in central labs, such as immunoassays, aptamer/DNAzyme assays, molecular diagnostic assays, and enzymatic activity assays onto BGM platform for quantification of non-glucose targets for a wide variety of IVDs in mHealth. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    Science.gov (United States)

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  16. HOME CARE NURSES’ ROLES IN ENHANCING QUALITY OF NURSING CARE FOR PATIENTS AT HOME: A PHENOMENOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    Titan Ligita

    2017-08-01

    Full Text Available Background: Provision of health care service at home is one of the advanced forms of care for patients being discharged from hospitalization. Little is known about the experience of nurses providing home care services through a nursing home-care model especially in Indonesian context. Objective: This study aims to explore the experience in order to increase understanding on the form of home care provision, and consequently the nurses may understand the form of home care globally. Methods: This study employed a phenomenological design and performed interview in the process of data collection. Data were analysed by using content analysis. Results: The main contexts of home care nurse experiences were generated. There were definition and role of home care nurses, the involvement of family members in the provision of care, the facilitating and hindering factors contributed to home care provision as well as manual on providing home care nursing. Conclusion: The implication from this study is that nursing care should be given to the patients continuously and consequently the need for family involvement is important. Additionally, in providing the home care, a proper manual is needed by home care nurses as the guidance to give best quality of care to patients.

  17. Sleep of 1- and 2-year-old children in intensive care.

    Science.gov (United States)

    Corser, N C

    1996-01-01

    Physiologic and psychologic changes associated with sleep disturbance decrease the ability of a critically ill child to adapt to hospitalization and thus hamper recovery. Research demonstrates that intensive care settings interfere with sleep of adults, but little is known about the impact of these settings on children's sleep. An exploratory field study was conducted to describe the sleep-wake patterns of 1- and 2-year-old children in intensive care, identify intensive care environmental stimuli associated with sleep and waking states, compare the intensive care sleep-wake pattern to the pre-illness sleep-wake pattern, and determine the time required for children to return to their pre-illness sleep-wake pattern. Twelve children aged 13 to 35 months composed the sample for the study. Pre-illness and postdischarge sleep patterns, sleep patterns during a 12-hour night in the pediatric intensive care unit (PICU), and external and internal environmental stimuli were measured. Prior to hospitalization, subjects demonstrated sleep similar to that documented in healthy children. Children in the PICU experienced a significant loss of sleep, frequent awakenings, and a virtual rapid eye movement (REM) sleep deprivation. External environmental stimuli of light, noise, and caregiver activity were negatively correlated with sleep state. Pain and treatment with benzodiazepines were associated with sleep acquisition. Sleep changes persisted after discharge from the PICU and the hospital. Total sleep time recovered more rapidly than nighttime awakening. Parents perceived that their child's sleep remained different longer than total sleep time and night awakening values demonstrated.

  18. Effective factors in providing holistic care: a qualitative study.

    Science.gov (United States)

    Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba

    2015-01-01

    Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software. Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  19. Effective factors in providing holistic care: A qualitative study

    Directory of Open Access Journals (Sweden)

    Vahid Zamanzadeh

    2015-01-01

    Full Text Available Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses′ provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.

  20. Politics and care: a study of Czech Americans within Leininger's theory of culture care diversity and universality.

    Science.gov (United States)

    Miller, J

    1997-01-01

    The domain of inquiry for this study was the influence of the American political environmental context on professional and generic care patterns, expressions, and meanings of Czech American immigrants. The purpose of the research was to document, describe, interpret, and analyze the diversities and universalities of professional and generic care for this cultural group, to provide culturally congruent care to Czech Americans, and to explicate the role of politics as an influence on care patterns, health, and well being. The researcher's former transcultural ethnonursing study in Prague, Czechoslovakia in 1991 served as a stimulus for this in-depth study on politics and care. Twelve key and twenty general informants were interviewed. Five major themes were identified. The researcher discovered that the capitalist economic market structure of the United States influenced informant lifeways in all dimensions of Leininger's Theory of Culture Care Diversity and Universality, as depicted in the Sunrise Model. Specific care patterns discovered included care as choice, care as responsibility, and care as helping each other. Findings related to professional and generic care supported researcher predictions that generic culture care patterns would be important to immigrants. Provisions for culturally congruent nursing care were articulated based on research findings.

  1. Experience with and amount of postpartum maternity care: Comparing women who rated the care they received from the maternity care assistant as 'good' or 'less than good care'.

    Science.gov (United States)

    Baas, C I; Wiegers, T A; de Cock, T P; Erwich, J J H M; Spelten, E R; Hutton, E K

    2017-12-01

    The postpartum period is an important time in the lives of new mothers, their children and their families. The aim of postpartum care is 'to detect health problems of mother and/or baby at an early stage, to encourage breastfeeding and to give families a good start' (Wiegers, 2006). The Netherlands maternity care system aims to enable every new family to receive postpartum care in their home by a maternity care assistant (MCA). In order to better understand this approach, in this study we focus on women who experienced the postpartum care by the MCA as 'less than good' care. Our research questions are; among postpartum women in the Netherlands, what is the uptake of MCA care and what factors are significantly associated with women's rating of care provided by the MCA. Design and setting This study uses data from the 'DELIVER study', a dynamic cohort study, which was set up to investigate the organization, accessibility and quality of primary midwifery care in the Netherlands. Participants In the DELIVER population 95.6% of the women indicated that they had received postpartum maternity care by an MCA in their home. We included the responses of 3170 women. To assess the factors that were significantly associated with reporting 'less than good (postpartum) care' by the MCA, a full cases backward logistic regression model was built using the multilevel approach in Generalized Linear Mixed Models. The mean rating of the postpartum care by the MCA was 8.8 (on a scale from 1-10), and 444 women (14%) rated the postpartum maternity care by the MCA as 'less than good care'. In the full cases multivariable analysis model, odds of reporting 'less than good care' by the MCA were significantly higher for women who were younger (women 25-35 years had an OR 1.32, CI 0.96-1.81 and women 35 years), multiparous (OR 1.27, CI 1.01-1.60) and had a higher level of education (women with a middle level had an OR 1.84,CI 1.22-2.79, and women with a high level of education had an OR 2

  2. Prevalence of comorbidity in primary care patients with type 2 diabetes and its association with elevated HbA1c: A cross-sectional study in Croatia.

    Science.gov (United States)

    Bralić Lang, Valerija; Bergman Marković, Biserka

    2016-01-01

    To the authors' knowledge, there are few valid data that describe the prevalence of comorbidity in type 2 diabetes mellitus (T2DM) patients seen in family practice. This study aimed to investigate the prevalence of comorbidities and their association with elevated (≥ 7.0%) haemoglobin A1c (HbA1c) using a large sample of T2DM patients from primary care practices. A cross-sectional study in which multivariate logistic regression was applied to explore the association of comorbidities with elevated HbA1c. Primary care practices in Croatia. Altogether, 10 264 patients with diabetes in 449 practices. Comorbidities and elevated HbA1c. In total 7979 (77.7%) participants had comorbidity. The mean number of comorbidities was 1.6 (SD 1.28). Diseases of the circulatory system were the most common (7157, 69.7%), followed by endocrine and metabolic diseases (3093, 30.1%), and diseases of the musculoskeletal system and connective tissue (1437, 14.0%). After adjustment for age and sex, the number of comorbidities was significantly associated with HbA1c. The higher the number of comorbidities, the lower the HbA1c. The prevalence of physicians' inertia was statistically significantly and negatively associated with the number of comorbidities (Mann-Whitney U test, Z = -12.34; p < 0.001; r = -0.12). There is a high prevalence of comorbidity among T2DM patients in primary care. A negative association of number of comorbidities and HbA1c is probably moderated by physicians' inertia in treatment of T2DM strictly according to guidelines. There is a high prevalence of comorbidity among T2DM patients in primary care. Patients with breast cancer, obese patients, and those with dyslipidaemia and ischaemic heart disease were more likely to have increased HbA1c. The higher the number of comorbidities, the lower the HbA1c.

  3. Understanding delayed access to antenatal care: a qualitative interview study

    Science.gov (United States)

    2014-01-01

    Background Delayed access to antenatal care ('late booking’) has been linked to increased maternal and fetal mortality and morbidity. The aim of this qualitative study was to understand why some women are late to access antenatal care. Methods 27 women presenting after 19 completed weeks gestation for their first hospital booking appointment were interviewed, using a semi-structured format, in community and maternity hospital settings in South Yorkshire, United Kingdom. Interviews were transcribed verbatim and entered onto NVivo 8 software. An interdisciplinary, iterative, thematic analysis was undertaken. Results The late booking women were diverse in terms of: age (15–37 years); parity (0–4); socioeconomic status; educational attainment and ethnicity. Three key themes relating to late booking were identified from our data: 1) 'not knowing’: realisation (absence of classic symptoms, misinterpretation); belief (age, subfertility, using contraception, lay hindrance); 2) 'knowing’: avoidance (ambivalence, fear, self-care); postponement (fear, location, not valuing care, self-care); and 3) 'delayed’ (professional and system failures, knowledge/empowerment issues). Conclusions Whilst vulnerable groups are strongly represented in this study, women do not always fit a socio-cultural stereotype of a 'late booker’. We report a new taxonomy of more complex reasons for late antenatal booking than the prevalent concepts of denial, concealment and disadvantage. Explanatory sub-themes are also discussed, which relate to psychological, empowerment and socio-cultural factors. These include poor reproductive health knowledge and delayed recognition of pregnancy, the influence of a pregnancy 'mindset’ and previous pregnancy experience, and the perceived value of antenatal care. The study also highlights deficiencies in early pregnancy diagnosis and service organisation. These issues should be considered by practitioners and service commissioners in order to promote

  4. Older Persons’ Transitions in Care (OPTIC: a study protocol

    Directory of Open Access Journals (Sweden)

    Cummings Greta G

    2012-12-01

    Full Text Available Abstract Background Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH residents and necessitate transitions between NHs and Emergency Departments (EDs. During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS, and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH – ED transitions. Methods/Design This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT approach. It uses data from multiple levels (facility, care unit, individual and sources (healthcare providers, residents, health records, and administrative databases. Discussion Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and

  5. Competencies of specialised wound care nurses: a European Delphi study.

    Science.gov (United States)

    Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester

    2014-12-01

    Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  6. Avoidant coping moderates the relationship between paternal involvement in the child's type 1 diabetes (T1D) care and parenting stress.

    Science.gov (United States)

    Teasdale, Ashley; Limbers, Christine

    2018-01-01

    Fathers may experience greater parenting stress and anxiety when they are more involved in their child's type 1 diabetes (T1D) care. The present study evaluated whether seeking social support and avoidant coping strategies moderate the relationship between paternal involvement in the child's T1D care and parenting stress in an international sample. Two hundred forty-nine fathers of young children with T1D completed the Parenting Stress Index (PSI), Pediatric Inventory for Parents (PIP), Dads' Active Disease Support scale (DADS), COPE Inventory, Self-Care Inventory (SCI-R), and a demographic questionnaire online. Pearson's product moment correlations were computed, and multiple linear regression analysis was conducted with three separate models in which the PSI Child Domain, PIP Frequency, and PIP Difficulty scores represented different parenting stress outcomes. The interaction between use of denial coping and DADS Involvement was significantly correlated with general parenting stress ( p diabetes treatment regimen ( p management.

  7. "Invisible During My Own Crisis": Responses of LGBT People of Color to the Orlando Shooting.

    Science.gov (United States)

    Ramirez, Johanna L; Gonzalez, Kirsten A; Galupo, M Paz

    2018-01-01

    On June 12, 2016, the Pulse nightclub in Orlando, Florida was the target of one of the country's deadliest mass shootings. Pulse, a gay nightclub, was hosting a Latin Pride Night the evening of the tragedy, which resulted in the death of 49 victims and 53 casualties, over 90% of whom were lesbian, gay, bisexual, and transgender (LGBT) Latinx people, specifically. The present research investigates the narrative responses from LGBT people of color (LGBT-POC) following the tragedy. Results included an analysis of 94 participant narrative responses. Results were collected online from a sample of LGBT-POC with varying sexual, gender, and racial identities. Thematic analysis revealed four major themes: (1) Violence is Not New for LGBT-POC; (2) Personal Identification with Victims; (3) Lack of Intersectionality in Others' Responses to Orlando; and (4) Acknowledgment of Intersectionality across LGBT-POC. Discussion focuses on describing the ways in which LGBT-POC responded to the shooting regarding their multiple minority identities. Implications of this research reinforce the need for continued intersectional research with LGBT-POC.

  8. Mental health care use in medically unexplained and explained physical symptoms: findings from a general population study

    Directory of Open Access Journals (Sweden)

    van Eck van der Sluijs JF

    2016-08-01

    Full Text Available Jonna F van Eck van der Sluijs,1,2 Margreet ten Have,3 Cees A Rijnders,4 Harm WJ van Marwijk,5,6 Ron de Graaf,3 Christina M van der Feltz-Cornelis1,2 1Clinical Centre of Excellence for Body, Mind and Health, GGz Breburg, 2Tranzo Department, Tilburg University, Tilburg, 3Netherlands Institute of Mental Health and Addiction, Utrecht, 4Department of Residency training, GGz Breburg, Tilburg, the Netherlands; 5Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK; 6Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands Objective: The aim of this study was to explore mental health care utilization patterns in primary and specialized mental health care of people with unexplained or explained physical symptoms. Methods: Data were derived from the first wave of the Netherlands Mental Health Survey and Incidence Study-2, a nationally representative face-to-face cohort study among the general population aged 18–64 years. We selected subjects with medically unexplained symptoms (MUS only (MUSonly; n=177, explained physical symptoms only (PHYonly, n=1,952, combined MUS and explained physical symptoms (MUS + PHY, n=209, and controls without physical symptoms (NONE, n=4,168. We studied entry into mental health care and the number of treatment contacts for mental problems, in both primary care and specialized mental health care. Analyses were adjusted for sociodemographic characteristics and presence of any 12-month mental disorder assessed with the Composite International Diagnostic Interview 3.0. Results: At the primary care level, all three groups of subjects with physical symptoms showed entry into care for mental health problems significantly more often than controls. The adjusted odds ratios were 2.29 (1.33, 3.95 for MUSonly, 1.55 (1.13, 2.12 for PHYonly, and 2.25 (1.41, 3.57 for MUS + PHY. At the

  9. Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

    Science.gov (United States)

    Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

    2018-02-01

    The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

  10. Paperfuge: An ultralow-cost, hand-powered paper-centrifuge inspired by the mechanics of a whirligig toy

    Science.gov (United States)

    Bhamla, M. Saad; Benson, Brandon; Chai, Chew; Katsikis, Georgios; Johri, Aanchal; Prakash, Manu

    From a global-health context, commercial centrifuges are expensive, bulky and electricity-powered, and thus constitute a critical bottleneck in the development of decentralized, battery-free-point-of-care (POC) diagnostic devices. Here, we report an ultralow-cost (20 cents), lightweight (2 g), human-powered paper centrifuge (which we name 'paperfuge') designed on the basis of a theoretical model inspired by the fundamental mechanics of an ancient whirligig (or buzzer toy; 3300 B.C.E). The paperfuge achieves speeds of 125,000 rpm (and equivalent centrifugal forces of 30,000 g), with theoretical limits predicting one million rpm. We demonstrate that the paperfuge can separate pure plasma from whole blood in less than 1.5 minutes, and isolate malaria parasites in 15 minutes. We also show that paperfuge-like centrifugal microfluidic devices can be made of polymethylsiloxane, plastic and 3D-printed polymeric materials. Ultracheap, power-free centrifuges should open up opportunities for POC diagnostics in resource-poor settings.

  11. Effect of Education of Self-care Behaviors on HbA1C level in Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Ahmadi Zakieh

    2016-06-01

    Full Text Available Background and Objective: The successful glycemic control in diabetic patients is very important. Since the poor self-care is reported as the most important causes of mortality and complications, therefore these patients require self-care knowledge. This study aimed to determine the effect of education of self-care behaviors on HbA1C level in diabetic patients. Materials and Method: In this clinical trial, 80 diabetic patients referred to the diabetes clinic in Bandar Abbas were selected through random sampling and then were randomly allocated into two groups of intervention and control based on stratified random sampling. Designed educational program was implemented in 9 sessions (60 minutes, once a week for 12 weeks for patients in the intervention group. Patients in the control group were received usual care of clinic. Data were collected through using demographic information form and HbA1c test. Data were collected at the beginning of the study and 12 weeks after the intervention. Data were analyzed by SPSS software (version 18 using independent T- test, paired T-test, Mann-Whitney U and chi-square. Results: Before the intervention, the HbA1c average in the intervention and control groups was 8.18 ± 1.66 and 8.41 ± 2.10, respectively and after the intervention these values were changed to 7.78 ± 1.48 and 8.82 ± 2.11 in the intervention and control groups respectively (p = 0.01. Conclusion: Implementation of educational program of self-care behaviors was effective in reducing HbA1C and it can be used as an appropriate educational method by nurses and other health care team in controlling of diabetes in patients.

  12. Prenatal care and pregnancy outcomes: A cross-sectional study in Luanda, Angola.

    Science.gov (United States)

    Nimi, Tazi; Fraga, Sílvia; Costa, Diogo; Campos, Paulo; Barros, Henrique

    2016-11-01

    To describe prenatal care in Angolan women delivered at a large tertiary care unit, and to explore the association between prenatal care and selected perinatal outcomes. We conducted a cross-sectional study between December 2012 and February 2013, involving 995 women aged 13-46years, delivered at Lucrécia Paím Maternity, Luanda. Trained interviewers collected information on timing, frequency, place, and satisfaction with prenatal care; sociodemographic and clinical characteristics; birth weight; and gestational age. Logistic regression models were fitted, and odds ratios with 95% confidence intervals (OR, 95%CI) estimated. Quantitatively inadequate prenatal care (<4 visits) was more common in younger, less educated, poorer women, followed in public institutions, and those who felt more dissatisfied with care. More visits, both in primiparas and multiparas, were independently associated with more cesarean deliveries. After adjustment, having fewer than four visits was significantly associated with low birth weight (OR 2.00; 95% CI, 1.15-3.50) and preterm delivery (OR 2.74; 95% CI, 1.69-4.44 for 2-4 visits); similar associations were found regarding late entrance into care. Early entrance into prenatal care and the recommended number of visits are major determinants of mode of delivery and pregnancy outcomes, constituting targets to improve perinatal health. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  13. Maternal care in rural China: a case study from Anhui province

    Directory of Open Access Journals (Sweden)

    Li Xiaohong

    2008-03-01

    Full Text Available Abstract Background Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. Methods A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10 and county level hospitals (n = 2 were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used. Results The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87% gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Conclusion Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave

  14. 42 CFR 456.143 - Content of medical care evaluation studies.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143 Section 456.143 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care...

  15. Innovations In Diabetes Care Around the World: Case Studies Of Care Transformation Through Accountable Care Reforms.

    Science.gov (United States)

    Thoumi, Andrea; Udayakumar, Krishna; Drobnick, Elizabeth; Taylor, Andrea; McClellan, Mark

    2015-09-01

    The rising prevalence, health burden, and cost of chronic diseases such as diabetes have accelerated global interest in innovative care models that use approaches such as community-based care and information technology to improve or transform disease prevention, diagnosis, and treatment. Although evidence on the effectiveness of innovative care models is emerging, scaling up or extending these models beyond their original setting has been difficult. We developed a framework to highlight policy barriers-institutional, regulatory, and financial-to the diffusion of transformative innovations in diabetes care. The framework builds on accountable care principles that support higher-value care, or better patient-level outcomes at lower cost. We applied this framework to three case studies from the United States, Mexico, and India to describe how innovators and policy leaders have addressed barriers, with a focus on important financing barriers to provider and consumer payment. The lessons have implications for policy reform to promote innovation through new funding approaches, institutional reforms, and performance measures with the goal of addressing the growing burdens of diabetes and other chronic diseases. Project HOPE—The People-to-People Health Foundation, Inc.

  16. Predictors of activity involvement in dementia care homes: a cross-sectional study.

    Science.gov (United States)

    Smit, Dieneke; de Lange, Jacomine; Willemse, Bernadette; Pot, Anne Margriet

    2017-08-04

    Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement. Data were derived from the second measurement (2011) of the Living Arrangements for people with Dementia study. One thousand two hundred eighteen people residing in 139 dementia care homes were involved. Forty predictors of higher involvement were studied. Multilevel backward regression analyses were performed. The most important predictors of higher involvement were: absence of agitation, less ADL dependency, and a higher cognitive status of the residents, higher staff educational level, lower experienced job demands by care staff and a smaller number of residents living in the dementia care wards of a facility. More social supervisor support as perceived by staff was found to predict less activity involvement. To increase the activity involvement of care home residents with dementia it seems vital to: 1) reduce staff's experienced job demands; 2) elevate their overall educational level; 3) train staff to provide suitable activities, taking account of the behavior and preserved capabilities of residents; and 4) foster transition towards small-scale care. In order to achieve these aims, care organizations might need to evaluate the use of their financial means.

  17. Multiple sources driving the organic matter dynamics in two contrasting tropical mangroves

    International Nuclear Information System (INIS)

    Ray, R.; Shahraki, M.

    2016-01-01

    In this study, we have selected two different mangroves based on their geological, hydrological and climatological variations to investigate the origin (terrestrial, phytobenthos derived, and phytoplankton derived) of dissolved organic carbon (DOC), particulate organic carbon (POC) in the water column and the sedimentary OC using elemental ratios and stable isotopes. Qeshm Island, representing the Iranian mangroves received no attention before this study in terms of DOC, POC biogeochemistry and their sources unlike the Sundarbans (Indian side), the world's largest mangrove system. Slightly higher DOC concentrations in the Iranian mangroves were recorded in our field campaigns between 2011 and 2014, compared to the Sundarbans (315 ± 25 μM vs. 278 ± 42 μM), owing to the longer water residence times, while 9–10 times greater POC concentration (303 ± 37 μM, n = 82) was linked to both suspended load (345 ± 104 mg L"− "1) and high algal production. Yearlong phytoplankton bloom in the mangrove-lined Persian Gulf was reported to be the perennial source of both POC and DOC contributing 80–86% to the DOC and 90–98% to the POC pool. Whereas in the Sundarbans, riverine input contributed 50–58% to the DOC pool and POC composition was regulated by the seasonal litter fall, river discharge and phytoplankton production. Algal derived organic matter (microphytobenthos) represented the maximum contribution (70–76%) to the sedimentary OC at Qeshm Island, while mangrove leaf litters dominated the OC pool in the Indian Sundarbans. Finally, hydrographical settings (i.e. riverine transport) appeared to be the determinant factor in differentiating OM sources in the water column between the dry and wet mangroves. - Highlights: • Sources of OC have been identified and compared between two contrasting mangroves. • Phytoplankton dominated the DOC and POC pool in the Iranian mangroves. • River input contributed half of the total DOC and part of POC in the Indian

  18. Multiple sources driving the organic matter dynamics in two contrasting tropical mangroves

    Energy Technology Data Exchange (ETDEWEB)

    Ray, R., E-mail: raghab.ray@gmail.com [Institut Universitaire Européen de la Mer, UBO, UMR 6539 LEMAR, rue Dumont dUrville, 29280 Plouzane (France); Leibniz Center for Tropical Marine Ecology, Fahrenheitstr. 6, 28359 Bremen (Germany); Shahraki, M. [Leibniz Center for Tropical Marine Ecology, Fahrenheitstr. 6, 28359 Bremen (Germany); Alfred Wegener Institute, Helmholtz Centre for Polar and Marine Research, Am Handelshafen 12, 27570 Bremerhaven (Germany)

    2016-11-15

    In this study, we have selected two different mangroves based on their geological, hydrological and climatological variations to investigate the origin (terrestrial, phytobenthos derived, and phytoplankton derived) of dissolved organic carbon (DOC), particulate organic carbon (POC) in the water column and the sedimentary OC using elemental ratios and stable isotopes. Qeshm Island, representing the Iranian mangroves received no attention before this study in terms of DOC, POC biogeochemistry and their sources unlike the Sundarbans (Indian side), the world's largest mangrove system. Slightly higher DOC concentrations in the Iranian mangroves were recorded in our field campaigns between 2011 and 2014, compared to the Sundarbans (315 ± 25 μM vs. 278 ± 42 μM), owing to the longer water residence times, while 9–10 times greater POC concentration (303 ± 37 μM, n = 82) was linked to both suspended load (345 ± 104 mg L{sup −} {sup 1}) and high algal production. Yearlong phytoplankton bloom in the mangrove-lined Persian Gulf was reported to be the perennial source of both POC and DOC contributing 80–86% to the DOC and 90–98% to the POC pool. Whereas in the Sundarbans, riverine input contributed 50–58% to the DOC pool and POC composition was regulated by the seasonal litter fall, river discharge and phytoplankton production. Algal derived organic matter (microphytobenthos) represented the maximum contribution (70–76%) to the sedimentary OC at Qeshm Island, while mangrove leaf litters dominated the OC pool in the Indian Sundarbans. Finally, hydrographical settings (i.e. riverine transport) appeared to be the determinant factor in differentiating OM sources in the water column between the dry and wet mangroves. - Highlights: • Sources of OC have been identified and compared between two contrasting mangroves. • Phytoplankton dominated the DOC and POC pool in the Iranian mangroves. • River input contributed half of the total DOC and part of POC in

  19. Associations between perceptions of care and women's childbirth experience: a population-based cross-sectional study in Rwanda.

    Science.gov (United States)

    Mukamurigo, Judith U; Berg, Marie; Ntaganira, Joseph; Nyirazinyoye, Laetitia; Dencker, Anna

    2017-06-09

    In recent years Rwanda has achieved remarkable improvement in quality of maternity care services but there is evidence of deficiencies in care quality in terms of disrespectful care. Women's overall childbirth experience is an important outcome of childbirth and a factor in assessing quality of care. The aim of this study was to investigate how women's overall childbirth experience in Rwanda was related to their perceptions of childbirth care. A cross-sectional household study of women who had given birth 1-13 months earlier (n = 921) was performed in the Northern Province and in the capital city. Data was collected via structured interviews following a questionnaire. Significant variables measuring perceptions of care were included in a stepwise forward selection logistic regression model with overall childbirth experience as a dichotomised target variable to find independent predictors of a good childbirth experience. The majority of women (77.5%) reported a good overall childbirth experience. In a logistic regression model five factors of perceived care were significant independent predictors of a good experience: confidence in staff (Adjusted OR 1.73, 95% CI 1.20-2.49), receiving enough information (AOR 1.44, 95% CI 1.03-2.00), being treated with respect (AOR 1.69, 95% CI 1.18-2.43), getting support from staff (AOR 1.75, 95% CI 1.20-2.56), and having the baby skin-to-skin after birth (AOR 2.21, 95% CI 1.52-3.19). To further improve childbirth care in Rwanda and care for women according to their preferences, it is important to make sure that the childbirth care includes the following quality aspects in national and clinical guidelines: build confidence, provide good information, treat women and families with respect, provide good professional support during childbirth and put the newborn baby skin-to-skin with its mother early after birth.

  20. Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study

    Science.gov (United States)

    Mack, Jennifer W.; Cronin, Angel; Keating, Nancy L.; Taback, Nathan; Huskamp, Haiden A.; Malin, Jennifer L.; Earle, Craig C.; Weeks, Jane C.

    2012-01-01

    Purpose National guidelines recommend that discussions about end-of-life (EOL) care planning happen early for patients with incurable cancer. We do not know whether earlier EOL discussions lead to less aggressive care near death. We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death. Patients and Methods We studied 1,231 patients with stage IV lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system–based prospective cohort study, who died during the 15-month study period but survived at least 1 month. Our main outcome measure was the aggressiveness of EOL care received. Results Nearly half of patients received at least one marker of aggressive EOL care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%). Patients who had EOL discussions with their physicians before the last 30 days of life were less likely to receive aggressive measures at EOL, including chemotherapy (P = .003), acute care (P EOL discussions are prospectively associated with less aggressive care and greater use of hospice at EOL. PMID:23150700

  1. Self-care among healthcare social workers: An exploratory study.

    Science.gov (United States)

    Miller, J Jay; Lianekhammy, Joann; Pope, Natalie; Lee, Jacquelyn; Grise-Owens, Erlene

    2017-01-01

    Despite growing interest in self-care, few studies have explicitly examined the self-care practices of healthcare social workers. This exploratory study investigated self-care among practitioners (N = 138) in one southeastern state. Overall, data suggest that healthcare social workers only moderately engaged in self-care. Additionally, analyses revealed significant differences in self-care practices by financial stability, overall health, and licensure status, respectively. Interestingly, perceived health status and current financial situation were significant predictors for overall self-care practices. After a brief review of the literature, this narrative will explicate findings, elucidate discussion points, identify salient implications, and conclude with areas for future research.

  2. Application of HER2 CISH pharmDX for DNA Ploidy Determination.

    Science.gov (United States)

    He, Mai; Pasquariello, Terese; Steinhoff, Margaret

    2016-08-01

    Products of conception (POC) are encountered daily in general pathology practice. The molar workup is an important part of POC examination. Ploidy analysis, expressed as DNA index (DI), is part of the pathologic workup of molar pregnancy. For the past decade, chromogenic in situ hybridization (CISH) has become a popular way to detect HER2 gene amplification. Current study aims to determine whether HER2 CISH dual-color assay can be used to determine DI in POCs. Twenty-two POC cases were chosen from the departmental archives, including 6 complete hydatidiform mole (CM), 10 partial mole (PM), and 6 hydropic POC (HP). CISH assay was performed using the HER2 CISH PharmDx Kit (SK109; Dako). This kit generates red (HER2) and blue (CEN-17) chromogenic signals on the same tissue section. In the 10 triploid PM cases, CISH generated HER2 signal value of 2.925±0.19. Nine cases (90%) had values within this range, except 1 case (2.5). In diploid cases, CISH generated HER2 signal value of 2.063±0.19. Results from 11 (91.7%) cases fell within this range, except 1 HP case (2.35). Sensitivity is 90%, specificity 91.6%, and overall accuracy 90.9%. The current study is the first one that demonstrates HER2/CEN-17 dual-color CISH can be used for microscopic analysis of cell ploidy. This technique provides a relatively easy and straight way to access DI using regular bright-field microscope. Concurrent CEN-17 signal and ploidy in both placental and maternal tissue can be used as internal control. This assay can be performed in any laboratory that can perform immunohistochemistry.

  3. The Chinese family-centered care survey for adult intensive care unit: A psychometric study.

    Science.gov (United States)

    Wang, Wen-Ling; Feng, Jui-Ying; Wang, Chi-Jen; Chen, Jing-Huei

    2016-02-01

    This study aimed to develop a family-centered care survey for Chinese adult intensive care units and to establish the survey's psychometric properties. Family-centered care (FCC) is widely recognized as an ideal model of care. Few studies have explored FCC perceptions among family members of adult critical care patients in Asian countries, and no Chinese FCC measurement has been developed. An English version of the 3-factor family-centered care survey for adult intensive care units (FCCS-AICU) was translated into Chinese using a modified back translation procedure. Based on the literature review, two additional concepts, information and empowerment, were added to the Chinese FCCS-AICU. The psychometric properties of the Chinese FCCS-AICU were determined with 249 family members from a medical center in Taiwan and were tested for construct and convergent validity, and internal consistency. Both the monolingual and bilingual equivalence tests of the English and Chinese versions of the 3-factor FCCS-AICU were supported. Exploratory factor analysis supported the 5-factor structure of the Chinese FCCS-AICU with a total explained variance of 58.34%. The Chinese FCCS-AICU was correlated with the Chinese Critical Care Family Needs Inventory. Internal consistency, determined by Cronbach's α, for the overall scale was .94. The Chinese FCCS-AICU is a valid and reliable tool for measuring perceptions of FCC by family members of adult intensive care patients within Chinese-speaking communities. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Multicentre randomised study of the effect and experience of an early inhome programme (PreHomeCare) for preterm infants using video consultation and smartphone applications compared with inhospital consultations: protocol of the PreHomeCare study.

    Science.gov (United States)

    Hägi-Pedersen, Mai-Britt; Norlyk, Annelise; Dessau, Ram; Stanchev, Hristo; Kronborg, Hanne

    2017-03-09

    Although premature infants and their parents are discharged earlier to inhomecare programmes, how to optimally support parents during this transition remains unknown. The aim of this study is to compare the effects of early inhomecare (PreHomeCare) including video consultations and mobile applications with those of inhospital consultations regarding breast feeding, parental confidence and parent-infant interactions. A randomised controlled intervention study will be conducted in four neonatal departments offering PreHomeCare (ie, premature infant inhomecare) in Denmark. Parents of hospitalised premature infants who fulfil the inclusion criteria for PreHomeCare will be randomised during hospitalisation to either the intervention (n=80) or control group (n=80) using 1:1 block randomisation. During PreHomeCare, the intervention group will receive a smartphone application with a video system and an infant scale, and the control group will receive usual care (ie, hospital consultations). Additionally, both groups will have planned nurse consultations two to three times a week: the intervention group through video consultations and the control group through inhospital consultations. Data collection will occur at inclusion/baseline, at the end of PreHomeCare and 1 month after discharge using questionnaires and hospital records. The primary outcome is the proportion of exclusively breastfed infants 1 month after discharge/end of PreHomeCare, the secondary outcomes are parent-infant interactions measured by the Mother and baby interaction scale and family confidence in caring for infants measured by the Karitane Parenting Confidence Scale. The process evaluation will consist of two qualitative studies: a field study and an interview study. Data collection will initially involve field observations of three scheduled video consultations with six families from the intervention group. These families will also be interviewed 1 month after PreHomeCare has ended. The project

  5. Primary care nurses' performance in motivational interviewing: a quantitative descriptive study.

    Science.gov (United States)

    Östlund, Ann-Sofi; Kristofferzon, Marja-Leena; Häggström, Elisabeth; Wadensten, Barbro

    2015-07-25

    Motivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing. The study was based on twelve primary care nurses' audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1. None of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in "percent open questions" was the summary score that fewest achieved. Primary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.

  6. Caring Teaching as a Moral Practice: An Exploratory Study on Perceived Dimensions of Caring Teaching

    Directory of Open Access Journals (Sweden)

    Khalil Gholami

    2012-01-01

    Full Text Available Caring teaching is a conceptual framework used to gain an insight into the moral aspect of teaching. Using a quantitative research approach, we studied 556 teachers in order to explore their perceived dimensions of caring teaching. Drawing on existing literature, we found that caring teaching has been elaborated in line with two broad concepts: personal care and academic care. Considering these concepts, we developed the Caring Teaching Scale with which we identified four dimensions of caring teaching: the nurturing of a student's character, didactical bias, awareness, and respectful didactics. A meta-analysis reflection suggests that the nurturing of students' characters and awareness represent personal care while didactical bias and respectful didactics call for academic care. Further analysis showed that these teachers attached more pedagogical value to personal care. Controlling for two demographic variables, we found statistically significant differences with regard to gender and caring teaching.

  7. Volunteers in Palliative Care - A Comparison of Seven European Countries: A Descriptive Study.

    Science.gov (United States)

    Woitha, Kathrin; Hasselaar, Jeroen; van Beek, Karen; Radbruch, Lukas; Jaspers, Birgit; Engels, Yvonne; Vissers, Kris

    2015-07-01

    In Europe, volunteers have an important role in the delivery of palliative care. As part of the EU co-funded Europall project, 4 aspects of volunteering in palliative care were studied for 7 European countries (Belgium, England, France, Germany, the Netherlands, Poland, and Spain). These included (1) involvement of volunteers in palliative care, (2) organization of palliative care volunteering, (3) legal regulations concerning volunteering, and (4) education and training of palliative care volunteering. A literature search combined with an interview study. Information from the scientific literature, and country-specific policy documents were obtained and completed, along with data of consecutive semi-structured interviews with experts in the field of palliative care in the participating countries. In all countries, volunteers appeared to be involved in palliative care, yet their involvement across health care settings differed per country. England, for example, has the highest number of volunteers whereas Spain has the lowest number. Volunteering is embedded in law and regulations in all participating countries except for England and the Netherlands. In all participating countries, training programs are available and volunteers are organized, both on a national and a regional level. This study provides a descriptive overview of volunteer work in palliative care in 7 European countries, with a focus on the organizational aspects. Further research should concentrate on the roles and responsibilities of volunteers in the care for the terminally ill in different European health systems. © 2014 World Institute of Pain.

  8. Predictors of intensive care unit refusal in French intensive care units: a multiple-center study.

    Science.gov (United States)

    Garrouste-Orgeas, Maité; Montuclard, Luc; Timsit, Jean-François; Reignier, Jean; Desmettre, Thibault; Karoubi, Philippe; Moreau, Delphine; Montesino, Laurent; Duguet, Alexandre; Boussat, Sandrine; Ede, Christophe; Monseau, Yannick; Paule, Thierry; Misset, Benoit; Carlet, Jean

    2005-04-01

    To identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. Observational, prospective, multiple-center study. Four university hospitals and seven primary-care hospitals in France. None. Age, underlying diseases (McCabe score and Knaus class), dependency, hospital mortality, and ICU characteristics were recorded. The crude ICU refusal rate was 23.8% (137/574), with variations from 7.1% to 63.1%. The reasons for refusal were too well to benefit (76/137, 55.4%), too sick to benefit (51/137, 37.2%), unit too busy (9/137, 6.5%), and refusal by the family (1/137). In logistic regression analyses, two patient-related factors were associated with ICU refusal: dependency (odds ratio [OR], 14.20; 95% confidence interval [CI], 5.27-38.25; p refused patients, and 1.03 (95% CI, 0.28-1.75) for later-admitted patients. ICU refusal rates varied greatly across ICUs and were dependent on both patient and organizational factors. Efforts to define ethically optimal ICU admission policies might lead to greater homogeneity in refusal rates, although case-mix variations would be expected to leave an irreducible amount of variation across ICUs.

  9. Meaning of caring in pediatric intensive care unit from the perspective of parents: A qualitative study.

    Science.gov (United States)

    Mattsson, Janet Yvonne; Arman, Maria; Castren, Maaret; Forsner, Maria

    2014-12-01

    When children are critically ill, parents still strive to be present and participate in the care of their child. Pediatric intensive care differs from other realms of pediatric care as the nature of care is technically advanced and rather obstructing than encouraging parental involvement or closeness, either physically or emotionally, with the critically ill child. The aim of this study was to elucidate the meaning of caring in the pediatric intensive care unit from the perspective of parents. The design of this study followed Benner's interpretive phenomenological method. Eleven parents of seven children participated in observations and interviews. The following aspects of caring were illustrated in the themes arising from the findings: being a bridge to the child on the edge, building a sheltered atmosphere, meeting the child's needs, and adapting the environment for family life. The overall impression is that the phenomenon of caring is experienced exclusively when it is directed toward the exposed child. The conclusion drawn is that caring is present when providing expert physical care combined with fulfilling emotional needs and supporting continuing daily parental care for the child in an inviting environment. © The Author(s) 2013.

  10. 45,X product of conception after preimplantation genetic diagnosis and euploid embryo transfer: evidence of a spontaneous conception confirmed by DNA fingerprinting.

    Science.gov (United States)

    Bettio, Daniela; Capalbo, Antonio; Albani, Elena; Rienzi, Laura; Achille, Valentina; Venci, Anna; Ubaldi, Filippo Maria; Levi Setti, Paolo Emanuele

    2016-09-06

    Preimplantation genetic screening (PGS) provides an opportunity to eliminate a potential implantation failure due to aneuploidy in infertile couples. Some studies clearly show that twins following single embryo transfer (SET) can be the result of a concurrent natural conception and an incidence as high as 1 in 5 twins has been reported. In our case PGS was performed on trophectoderm (TE) biopsies by quantitative polymerase chain reaction (qPCR). The product of conception (POC) was cytogenetically investigated after selection of the placental villi by means of the direct method. Molecular cytogenetic characterization of the POC was performed by fluorescence in situ hybridization (FISH) and array-comparative genomic hybridization (a-CGH) analyses. To investigate the possibility of a spontaneous conception, a panel of 40 single nucleotide polymorphisms (SNPs) was used to compare genetic similarity between the DNA of the POC and the DNA leftover of the TE biopsy. We describe a 36-year old infertile woman undergoing PGS who had a spontaneous abortion after a single euploid embryo transfer on a spontaneous cycle. The POC showed a 45,X karyotype confirmed by FISH and a-CGH. DNA fingerprinting demonstrated a genetic similarity of 75 % between the DNA of the POC and TE biopsy, consistent with a sibling status. All supernumerary euploid embryos were also tested showing a non-self relationship with the POC, excluding a mix-up event at the time of fetal embryo transfer. DNA fingerprinting of the transferred blastocyst and POC, confirmed the occurrence of a spontaneous conception. This case challenges the assumption that a pregnancy after assisted reproductive technology (ART) is always a result of ART, and strengthens the importance to avoid intercourses during PGS and natural transfer cycles. Moreover, cytogenetic analysis of the POCs is strongly recommended along with fingerprinting children born after PGS to see what the concordance is between the embryo transferred and

  11. Flocculation of organic carbon from headwaters to estuary - the impact of soil erosion, water quality and land use on carbon transformation processes in eight streams draining Exmoor, UK

    Science.gov (United States)

    Snoalv, J.; Groeneveld, M.; Quine, T. A.; Tranvik, L.

    2017-12-01

    Flocculation of dissolved organic carbon (DOC) in streams and rivers is a process that contributes to the pool of particulate organic carbon (POC) in the aquatic system. In low-energy waters the increased sedimentation rates of this higher-density fraction of organic carbon (OC) makes POC important in allocating organic carbon into limnic storage, which subsequently influences emissions of greenhouse gases from the continental environment to the atmosphere. Allochthonous OC, derived from the terrestrial environment by soil erosion and litterfall, import both mineral aggregate-bound and free OC into freshwaters, which comprise carbon species of different quality and recalcitrance than autochthonous in-stream produced OC, such as from biofilms, aquatic plants and algae. Increased soil erosion due to land use change (e.g. agriculture, deforestation etc.) influences the input of allochthonous OC, which can lead to increased POC formation and sedimentation of terrestrial OC at flocculation boundaries in the landscape, i.e. where coagulation and flocculation processes are prone to occur in the water column. This study investigates the seasonal variation in POC content and flocculation capacity with respect to water quality (elemental composition) in eight river systems (four agricultural and four wooded streams) with headwaters in Exmoor, UK, that drain managed and non-managed land into Bristol Channel. Through flocculation experiments the samples were allowed to flocculate by treatments with added clay and salt standards that simulate the flocculation processes by 1) increased input of sediment into streams, and 2) saline mixing at the estuarine boundary, in order to quantify floc production and investigate POC quality by each process respectively. The results show how floc production, carbon quality and incorporation (e.g. complexation) of metals and rare earth elements (REE) in produced POC and remaining DOC in solution vary in water samples over the season and how

  12. Implementation of integrated care for diabetes mellitus type 2 by two Dutch care groups: a case study.

    Science.gov (United States)

    Busetto, Loraine; Luijkx, Katrien; Huizing, Anna; Vrijhoef, Bert

    2015-08-21

    Even though previous research has demonstrated improved outcomes of integrated care initiatives, it is not clear why and when integrated care works. This study aims to contribute to filling this knowledge gap by examining the implementation of integrated care for type 2 diabetes by two Dutch care groups. An embedded single case study was conducted including 26 interviews with management staff, care purchasers and health professionals. The Context + Mechanism = Outcome Model was used to study the relationship between context factors, mechanisms and outcomes. Dutch integrated care involves care groups, bundled payments, patient involvement, health professional cooperation and task substitution, evidence-based care protocols and a shared clinical information system. Community involvement is not (yet) part of Dutch integrated care. Barriers to the implementation of integrated care included insufficient integration between the patient databases, decreased earnings for some health professionals, patients' insufficient medical and policy-making expertise, resistance by general practitioner assistants due to perceived competition, too much care provided by practice nurses instead of general practitioners and the funding system incentivising the provision of care exactly as described in the care protocols. Facilitators included performance monitoring via the care chain information system, increased earnings for some health professionals, increased focus on self-management, innovators in primary and secondary care, diabetes nurses acting as integrators and financial incentives for guideline adherence. Economic and political context and health IT-related barriers were discussed as the most problematic areas of integrated care implementation. The implementation of integrated care led to improved communication and cooperation but also to insufficient and unnecessary care provision and deteriorated preconditions for person-centred care. Dutch integrated diabetes care is still a

  13. The view of pulmonologists on palliative care for patients with COPD: a survey study

    Directory of Open Access Journals (Sweden)

    Duenk RG

    2017-01-01

    Full Text Available RG Duenk,1 C Verhagen,1 PNR Dekhuijzen,2 KCP Vissers,1 Y Engels,1,* Y Heijdra2,* 1Department of Anesthesiology, Pain and Palliative Medicine, 2Department of Lung Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands *These authors contributed equally to this work Introduction: Early palliative care is not a common practice for patients with COPD. Important barriers are the identification of patients for palliative care and the organization of such care in this patient group. Objective: Pulmonologists have a central role in providing good quality palliative care for patients with COPD. To guide future research and develop services, their view on palliative care for these patients was explored. Methods: A survey study was performed by the members of the Netherlands Association of Physicians for Lung Diseases and Tuberculosis. Results: The 256 respondents (31.8% covered 85.9% of the hospital organizations in the Netherlands. Most pulmonologists (92.2% indicated to distinguish a palliative phase in the COPD trajectory, but there was no consensus about the different criteria used for its identification. Aspects of palliative care in COPD considered important were advance care planning conversation (82%, communication between pulmonologist and general practitioner (77%, and identification of the palliative phase (75.8%, while the latter was considered the most important aspect for improvement (67.6%. Pulmonologists indicated to prefer organizing palliative care for hospitalized patients with COPD themselves (55.5%, while 30.9% indicated to prefer cooperation with a specialized palliative care team (SPCT. In the ambulatory setting, a multidisciplinary cooperation between pulmonologist, general practitioner, and a respiratory nurse specialist was preferred (71.1%. Conclusion: To encourage pulmonologists to timely initiate palliative care in COPD, we recommend to conduct further research into more specific identification

  14. The concept of care complexity: a qualitative study

    Directory of Open Access Journals (Sweden)

    Milena Guarinoni

    2015-12-01

    Full Text Available Background: Hospital organisations based on the level of care intensity have clearly revealed a concept, that of care complexity, which has been widely used for decades in the healthcare field. Despite its wide use, this concept is still poorly defined and it is often confused with and replaced by similar concepts such as care intensity or workload. This study aims to describe the meaning of care complexity as perceived by nurses in their day-to-day experience of hospital clinical care, rehabilitation, home care, and organisation. Design and methods: Fifteen interviews were conducted with nurses belonging to clinical-care areas and to heterogeneous organisational areas. The interview was of an unstructured type. The participants were selected using a propositional methodology. Colaizzi’s descriptive phenomenological method was chosen for the analysis of the interviews. Results: The nurses who were interviewed predominantly perceive the definition of care complexity as coinciding with that of workload. Nevertheless, the managerial perspective does not appear to be exclusive, as from the in-depth interviews three fundamental themes emerge that are associated with the concept of care complexity: the patient, the nurse and the organisation. Conclusions: The study highlights that care complexity consists of both quantitative and qualitative aspects that do not refer only to the organisational dimension. The use of the terminology employed today should be reconsidered: it appears to be inappropriate to talk of measurement of care complexity, as this concept also consists of qualitative – thus not entirely quantifiable – aspects referring to the person being cared for. In this sense, reference should instead be made to the evaluation of care complexity, which would also constitute a better and more complete basis for defining the nursing skills required in professional nursing practice.

  15. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes

    DEFF Research Database (Denmark)

    Murphy, Helen R.; Roland, Jonathan M.; Skinner, Timothy C.

    2010-01-01

    of 680 pregnancies in women with type 1 and type 2 diabetes was performed. Primary outcomes were adverse pregnancy outcome (congenital malformation, stillbirth, or neonatal death), congenital malformation, and indicators of pregnancy preparation (5 mg folic acid, gestational age, and A1C). Comparisons...... with improved pregnancy preparation and reduced risk of adverse pregnancy outcome in type 1 and type 2 diabetes. Prepregnancy care had benefits beyond improved glycemic control and was a stronger predictor of pregnancy outcome than maternal obesity, ethnicity, or social disadvantage.......OBJECTIVE - To implement and evaluate a regional prepregnancy care program in women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS - Prepregnancy care was promoted among patients and health professionals and delivered across 10 regional maternity units. A prospective cohort study...

  16. Point-of-care Devices: Non-Newtonian Whole Blood Behavior and Capillary Flow on Reagent-coated Walls

    Directory of Open Access Journals (Sweden)

    Jean BERTHIER

    2016-08-01

    Full Text Available Most point-of-care (POC and patient self-testing (PST devices are based on the analysis of whole blood taken from a finger prick. Whole blood contains a bountiful of information about the donor’s health. We analyze here two particularities of microsystems for blood analysis: the blood non-Newtonian behavior, and the capillary flow in reagent-coated channels. Capillarity is the most commonly used method to move fluids in portable systems. It is shown first that the capillary flow of blood does not follow the Lucas-Washburn-Rideal law when the capillary flow velocity is small, due to its non-Newtonian rheology and to the formation of rouleaux of RBCs. In a second step, the capillary flow of blood on reagent-coated surfaces is investigated; first experimentally by observing the spreading of a droplet of blood on different reagent-coated substrates; second theoretically and numerically using the general law for spontaneous capillary flows and the Evolver numerical program.

  17. [Primary care evaluation of the hypertensive patient management in specialized care after derivation (DERIVA-2 Study)].

    Science.gov (United States)

    Martell-Claros, Nieves; Galgo Nafría, Alberto; Abad-Cardiel, María; Álvarez-Álvarez, Beatriz; García Donaire, José Antonio; Márquez-Contreras, Emilio; Molino-González, Ángel

    2017-10-13

    To know the opinion/evaluation of the primary care physicians (PCPH) of the received information about patients that were attended in specialized care (SC). Cross-sectional study. Performed nationwide in primary care centers. Researchers from the primary care network. We used the SEH-LELHA derivation criteria guidelines, plus an ad hoc survey that included demographic and anthropometric data, blood pressure levels, and the main reason for derivation to SC at the baseline and final (post-derivation) visit. In addition, time deployed for the study of every patient, changes in diagnosis and treatment, type of follow-up, issues throughout the derivation process and assessment of the medical referred to the PCPH were evaluated. With participation of 578 researchers from primary, the study included 1715 patients aged 60.7±13.3years, 62.7% male. Patients were taking 2.3±1.2 (range 0-10) antihypertensive drugs pre-referral and 2.5±1.2 (0-9) after derivation. Blood pressure levels changed from 166±21.6 /97.7±12.6mmHg to 143±14.4 /85.5±10.5mmHg. The number of controlled patients (BP<140 and <90mmHg) increased from 5.8% to 32.2%. Time between pre- and post-derivation visit was 72±64days (median 57days, IQ26-99). The PCPH received a medical report in 80.3% of cases, 76.9% with an explanation of the results of the complementary tests, 75.8% with additional information or a reasoning of treatment and in 71% of cases information about the patient future management. 63% of PCPH were fully agreed with the management of the specialist, 29% agree and 2% strongly disagree. The derivation was evaluated as effective or very effective in 86% of patients and no effective in 9%. Communication between AE and SC in HTA is valued satisfactorily by MAP. However there is still room for improvement in the process. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  18. A Longitudinal Study of Usability in Health Care

    DEFF Research Database (Denmark)

    Kjeldskov, Jesper; Skov, Mikael B.; Stage, Jan

    2010-01-01

    We report from a longitudinal laboratory-based usability evaluation of a health care information system. The purpose of the study was to inquire into the nature of usability problems experienced by novice and expert users, and to see to what extend usability problems of a health care information...... system may or may not disappear over time, as the nurses get more familiar with it-if time heals poor design? As our method for studying this, we conducted a longitudinal study with two key studies. A usability evaluation was conducted with novice users when an electronic patient record system was being......, we discuss implications for evaluating usability in health care....

  19. The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes.

    Science.gov (United States)

    Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P

    2014-05-22

    This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme 'On Your Own Feet Ahead!' in the Netherlands. A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1 year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. Transition programme. Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents' characteristics, multilevel regression analyses showed that team climate at T1 (pteam climate (pteam climate to enhance the quality of chronic care delivery to chronically ill adolescents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Person-centred care during prolonged weaning from mechanical ventilation, nurses' views: an interview study.

    Science.gov (United States)

    Cederwall, Carl-Johan; Olausson, Sepideh; Rose, Louise; Naredi, Silvana; Ringdal, Mona

    2018-03-19

    To determine: 1) if the three elements of person-centred care (initiating, working and safeguarding the partnership) were present, and 2) to identify evidence of barriers to person-centred care during prolonged weaning from mechanical ventilation. Secondary analysis of semi structured interviews with 19 critical care nurses using theoretical thematic analysis. This study was conducted in three Swedish intensive care units, one in a regional hospital and two in a university hospital. Three themes and nine subthemes related to person-centred care were identified. The three themes included: 1) 'finding a person behind the patient' related to the 'initiating the partnership' phase, 2) 'striving to restore patient́s sense of control' related to 'working the partnership' phase and 3) 'impact of patient involvement' related to 'safeguarding the partnership' phase of person-centred care'. Additionally a further theme 'barriers to person-centred care' was identified. We found evidence of all three person-centred care routines. Barriers to person-centred care comprised of lack team collaboration and resources. Facilitating patients to actively participate in decision-making during the weaning process may optimise weaning outcomes and warrants further research. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. Cardiac patients' perception of patient-centred care: a qualitative study.

    Science.gov (United States)

    Esmaeili, Maryam; Cheraghi, Mohammad A; Salsali, Mahvash

    2016-03-01

    The aim of this study was to explore cardiac patients' perception of patient-centred care. Despite patient's importance in the process of care, less attention has been paid to experiences and expectations of patients in definitions of patient-centred care. As patients are an important element in process of patient-centred care, organizing care programs according to their perceptions and expectations will lead to enhanced quality of care and greater patient satisfaction. This study is a descriptive qualitative study. Content analysis approach was performed for data analysis. Participants were 18 cardiac patients (10 women and 8 men) hospitalized in coronary care units of teaching hospitals affiliated to Tehran University of Medical Sciences. We collected the study data through conducting personal face-to-face semi-structured interviews. The participants' perceptions of patient-centred care fell into three main themes including managing patients uncertainty, providing care with more flexibility and establishing a therapeutic communication. The second theme consisted of two sub-themes: empathizing with patients and having the right to make independent decisions. Receiving patient-centred care is essential for cardiac patients. Attention to priorities and preferences of cardiac patients and making decisions accordingly is among effective strategies for achieving patient-centred care. Cardiac care unit nurses ought to be aware that in spite of technological developments and advances, it is still important to pay attention to patients' needs and expectations in order to achieve patient satisfaction. In planning care programs, they should consider accountability towards patients' needs, flexibility in process of care and establishing medical interactions as an effective strategy for improving quality of care. © 2014 British Association of Critical Care Nurses.

  2. Barriers to successful implementation of care in home haemodialysis (BASIC-HHD):1. Study design, methods and rationale.

    Science.gov (United States)

    Jayanti, Anuradha; Wearden, Alison J; Morris, Julie; Brenchley, Paul; Abma, Inger; Bayer, Steffen; Barlow, James; Mitra, Sandip

    2013-09-17

    Ten years on from the National Institute of Health and Clinical Excellence' technology appraisal guideline on haemodialysis in 2002; the clinical community is yet to rise to the challenge of providing home haemodialysis (HHD) to 10-15% of the dialysis cohort. The renal registry report, suggests underutilization of a treatment type that has had a lot of research interest and several publications worldwide on its apparent benefit for both physical and mental health of patients. An understanding of the drivers to introducing and sustaining the modality, from organizational, economic, clinical and patient perspectives is fundamental to realizing the full benefits of the therapy with the potential to provide evidence base for effective care models. Through the BASIC-HHD study, we seek to understand the clinical, patient and carer related psychosocial, economic and organisational determinants of successful uptake and maintenance of home haemodialysis and thereby, engage all major stakeholders in the process. We have adopted an integrated mixed methodology (convergent, parallel design) for this study. The study arms include a. patient; b. organization; c. carer and d. economic evaluation. The three patient study cohorts (n = 500) include pre-dialysis patients (200), hospital haemodialysis (200) and home haemodialysis patients (100) from geographically distinct NHS sites, across the country and with variable prevalence of home haemodialysis. The pre-dialysis patients will also be prospectively followed up for a period of 12 months from study entry to understand their journey to renal replacement therapy and subsequently, before and after studies will be carried out for a select few who do commence dialysis in the study period. The process will entail quantitative methods and ethnographic interviews of all groups in the study. Data collection will involve clinical and biomarkers, psychosocial quantitative assessments and neuropsychometric tests in patients. Organizational

  3. Tidal and seasonal variation in particulate and dissolved organic carbon in the western dutch Wadden Sea and Marsdiep tidal inlet

    Science.gov (United States)

    Cadée, G. C.

    Seasonal variation in POC and DOC was measured in the Marsdiep tidal inlet of the Wadden Sea from March 1978 to June 1981, and compared with tidal variation. A POC peak was coincident with the phytoplankton peak (except for 1981), whereas a DOC peak occurred about one month later indicating autolysis and degradation of phytoplankton rather than excretion as the main source of this DOC. DOC production calculated from the spring increase amounted to 4.2 mg C·1 -1 or about 40% of the annual phytoplankton primary production in the area. This means that a large part of the phytoplankton production is not used directly by primary consumers but is converted into DOC. Tidal variation in DOC was correlated with salinity, pointing to a fresh water source for the bulk of it. POC was correlated with suspended matter content and phaeopigment, and slightly less with chlorophyll. Compared with the seasonal variation, tidal variation in chlorophyll and temperature was relatively small, but large in POC, DOC, suspended matter and salinity. Although import of POC and export of DOC through the Marsdiep inlet is large on an annual base, the transport cannot be measured directly because of the variability and precision limits of the measurements and as differences in content between ebb and flood current are only 15 and 5% of the POC and DOC content, respectively.

  4. Towards culturally competent paediatric oncology care. A qualitative study from the perspective of care providers.

    Science.gov (United States)

    Suurmond, J; Lieveld, A; van de Wetering, M; Schouten-van Meeteren, A Y N

    2017-11-01

    In order to gain more insight on the influence of ethnic diversity in paediatric cancer care, the perspectives of care providers were explored. Semi-structured interviews were conducted among 12 paediatric oncologists and 13 nurses of two different paediatric oncology wards and were analysed using a framework method. We found that care providers described the contact with Turkish and Moroccan parents as more difficult. They offered two reasons for this: (1) language barriers between care provider and parents hindered the exchange of information; (2) cultural barriers between care provider and parents about sharing the diagnosis and palliative perspective hindered communication. Care providers reported different solutions to deal with these barriers, such as using an interpreter and improving their cultural knowledge about their patients. They, however, were not using interpreters sufficiently and were unaware of the importance of eliciting parents' perspectives. Communication techniques to overcome dilemmas between parents and care providers were not used and care providers were unaware of stereotypes and prejudice. Care providers should be offered insight in cultural barriers they are unaware of. Training in cultural competence might be a possibility to overcome manifest barriers. © 2017 John Wiley & Sons Ltd.

  5. Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

    Directory of Open Access Journals (Sweden)

    Assendelft Willem JJ

    2008-01-01

    Full Text Available Abstract Background Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively. Methods In eight family practices 1046 consulting patients (25–79 yrs were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP. Results In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.11.7. Anxiety disorders had no independent effect. Conclusion Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

  6. Reduced HIV symptoms and improved health-related quality of life correlate with better access to care for HIV-1 infected women: the ELLA study.

    Science.gov (United States)

    Baran, Robert; Mulcahy, Fiona; Krznaric, Ivanka; Monforte, Antonella d'Arminio; Samarina, Anna; Xi, He; Cassetti, Isabel; Madruga, Jose Valdez; Zachry, Woodie; van Wyk, Jean; Martinez, Marisol

    2014-01-01

    Global HIV-1 prevalence is 35.3 million [1]; women comprise >50% of those infected. The majority of women may lack regular care and only one-fourth are virologically suppressed [2]. ELLA is a cross-sectional, non-interventional study conducted across Europe, Latin America, Canada and Asia that describes barriers to care for HIV-infected women and associations with disease stage, symptoms and health-related quality of life (HRQoL). HIV-infected women eligible for ELLA (≥18 years) completed: Barrier to Care Scale (BACS) comprising 12 items in four domains (Index range 0-12, Overall range 1-4, greater=more barriers, Overall score ≥2 considered severe); AIDS Clinical Trials Group (ACTG) Health Status Assessment comprising 21 items assessing 9 HRQoL domains (range 0-100, greater=better); and ACTG Symptom Distress Module comprising 20 symptoms rated on bother (range 0-4, greater=more bother). Healthcare providers documented medical history and HIV clinical data. Correlations of BACS response and last reported VL/CD4 count with HIV symptoms and HRQoL were analyzed. Spearman rank order was used to test correlations with statistical significance set at p50 years); 47.7% education HIV was acquired heterosexually in 83.0%; 88.2% of subjects were on ART; 57.5% had VLsymptom count and less symptom bother (psymptom count and less symptom bother correlated with better HRQoL on all nine domains (pHIV symptoms and less bother (pHIV-infected women, reduced barriers to care correlated with fewer symptoms, less symptom bother and better HRQoL. Improved HRQoL may be mediated by greater CD4 counts and fewer symptoms. Better access to care may improve HRQoL outcomes in this population.

  7. Developing evidence-based maternity care in Iran: a quality improvement study

    Directory of Open Access Journals (Sweden)

    Mohammad Kazem

    2008-06-01

    Full Text Available Abstract Background Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. Methods The major steps of the study were to (1 identify women's needs, values and preferences via interviews, (2 select through a process of professional consensus the top evidence-based clinical recommendations requiring local implementation (3 redesign care based on the selected evidence-based recommendations and women's views, and (4 implement the new care model. We measured the impact of the new care model on maternal satisfaction and caesarean birth rates utilising maternal surveys and medical record audit before and after implementation of the new care model. Results Twenty women's needs and requirements as well as ten evidence-based clinical recommendations were selected as a basis for improving care. Following the introduction of the new model of care, women's satisfaction levels improved significantly on 16 of 20 items (p Conclusion The introduction of a quality improvement care model improved compliance with evidence-based guidelines and was associated with an improvement in women's satisfaction levels and a reduction in rates of caesarean birth.

  8. Personality, personal model beliefs, and self-care in adolescents and young adults with Type 1 diabetes

    DEFF Research Database (Denmark)

    Chas Skinner, T.; Hampson, Sarah E.; Fife-Schaw, Chris

    2002-01-01

    This study compared 3 models of association between personality, personal model beliefs, and self-care in a cross-sectional design. These models were as follows: (a) Emotional stability determines self-care indirectly through personal model beliefs, and conscientiousness is a direct predictor of ....... Participants (N = 358, aged 12-30 years) with Type 1 diabetes completed measures of personality, personal model beliefs, and self-care. Structural equation modeling indicated that Model C was the best fit to the data....

  9. Human microcephaly protein RTTN interacts with STIL and is required to build full-length centrioles.

    Science.gov (United States)

    Chen, Hsin-Yi; Wu, Chien-Ting; Tang, Chieh-Ju C; Lin, Yi-Nan; Wang, Won-Jing; Tang, Tang K

    2017-08-15

    Mutations in many centriolar protein-encoding genes cause primary microcephaly. Using super-resolution and electron microscopy, we find that the human microcephaly protein, RTTN, is recruited to the proximal end of the procentriole at early S phase, and is located at the inner luminal walls of centrioles. Further studies demonstrate that RTTN directly interacts with STIL and acts downstream of STIL-mediated centriole assembly. CRISPR/Cas9-mediated RTTN gene knockout in p53-deficient cells induce amplification of primitive procentriole bodies that lack the distal-half centriolar proteins, POC5 and POC1B. Additional analyses show that RTTN serves as an upstream effector of CEP295, which mediates the loading of POC1B and POC5 to the distal-half centrioles. Interestingly, the naturally occurring microcephaly-associated mutant, RTTN (A578P), shows a low affinity for STIL binding and blocks centriole assembly. These findings reveal that RTTN contributes to building full-length centrioles and illuminate the molecular mechanism through which the RTTN (A578P) mutation causes primary microcephaly.Mutations in many centriolar protein-encoding genes cause primary microcephaly. Here the authors show that human microcephaly protein RTTN directly interacts with STIL and acts downstream of STIL-mediated centriole assembly, contributing to building full-length centrioles.

  10. Nurse staffing, medical staffing and mortality in Intensive Care: An observational study.

    Science.gov (United States)

    West, Elizabeth; Barron, David N; Harrison, David; Rafferty, Anne Marie; Rowan, Kathy; Sanderson, Colin

    2014-05-01

    To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital mortality. After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on

  11. Care coordination in primary health care: an evaluative study in a municipality in the Northeast of Brazil.

    Science.gov (United States)

    Aleluia, Italo Ricardo Santos; Medina, Maria Guadalupe; Almeida, Patty Fidelis de; Vilasbôas, Ana Luiza Queiroz

    2017-06-01

    International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.

  12. Variation pattern of particulate organic carbon and nitrogen in oceans and inland waters

    Science.gov (United States)

    Huang, Changchun; Jiang, Quanliang; Yao, Ling; Yang, Hao; Lin, Chen; Huang, Tao; Zhu, A.-Xing; Zhang, Yimin

    2018-03-01

    We examined the relationship between, and variations in, particulate organic carbon (POC) and particulate organic nitrogen (PON) based on previously acquired ocean and inland water data. The latitudinal dependency of POC / PON is significant between 20 and 90° N but weak in low-latitude areas and in the Southern Hemisphere. The mean values of POC / PON in the Southern Hemisphere and Northern Hemisphere were 7.40 ± 3.83 and 7.80 ± 3.92, respectively. High values of POC / PON appeared between 80-90 (12.2 ± 7.5) and 70-80° N (9.4 ± 6.4), while relatively low POC / PON was found from 20 (6.6 ± 2.8) to 40° N (6.7 ± 2.7). The latitudinal variation of POC / PON in the Northern Hemisphere is much stronger than in the Southern Hemisphere due to the influence of more terrestrial organic matter. Higher POC and PON could be expected in coastal waters. POC / PON growth ranged from 6.89 ± 2.38 to 7.59 ± 4.22 in the Northern Hemisphere, with an increasing rate of 0.0024 km from the coastal to open ocean. Variations of POC / PON in lake water also showed a similar latitude-variation tendency of POC / PON with ocean water but were significantly regulated by the lakes' morphology, trophic state and climate. Small lakes and high-latitude lakes prefer relatively high POC / PON, and large lakes and low-latitude lakes tend to prefer low POC / PON. The coupling relationship between POC and PON in oceans is much stronger than in inland waters. Variations in POC, PON and POC / PON in inland waters should receive more attention due to the implications of these values for the global carbon and nitrogen cycles and the indeterminacy of the relationship between POC and PON.

  13. Influenza sentinel surveillance network: a public health-primary care collaborative action to assess influenza A(H1N1)pmd09 in Catalonia, Spain.

    Science.gov (United States)

    Torner, Nuria; Baricot, Maretva; Martínez, Ana; Toledo, Diana; Godoy, Pere; Dominguez, Ángela

    2013-03-01

    The aim of this study was to evaluate the outcome of a collaborative action between Public Health services and Primary Care in the context of a case-control study on effectiveness of pharmaceutical and non-pharmaceutical measures to prevent hospitalization in a pandemic situation. To carry out this research the collaborative action of the primary care physicians members of the Influenza surveillance network was needed, they had to recall clinical information from influenza A(H1N1)pmd09 confirmed outpatient cases and negative outpatient controls matching their corresponding hospitalized confirmed case.   A survey questionnaire to assess involvement of Influenza Sentinel Surveillance Primary care physicians' Network of Catalonia (PIDIRAC) regarding the outpatient case and control outreach during the pandemic influenza season was performed. A total of 71,1% of completed surveys were received. Perception of pandemic activity was considered to be similar to seasonal influenza activity in 43.8% or higher but not unbearable in 37.5% of the replies. There was no nuisance reported from patients regarding neither the questions nor the surveyor. Collaborative research between Public Health services and Primary Care physicians enhances Public Health actions and research.

  14. Towards biomarker-based tests that can facilitate decisions about prevention and management of preeclampsia in low-resource settings.

    Science.gov (United States)

    Acestor, Nathalie; Goett, Jane; Lee, Arthur; Herrick, Tara M; Engelbrecht, Susheela M; Harner-Jay, Claudia M; Howell, Bonnie J; Weigl, Bernhard H

    2016-01-01

    In recent years, an increasing amount of literature is emerging on candidate urine and blood-based biomarkers associated with incidence and severity of preeclampsia (PE) in pregnant women. While enthusiasm on the usefulness of several of these markers in predicting PE is evolving, essentially all work so far has focused on the needs of high-resource settings and high-income countries, resulting primarily in multi-parameter laboratory assays based on proteomic and metabolomics analysis techniques. These highly complex methods, however, require laboratory capabilities that are rarely available or affordable in low-resource settings (LRS). The importance of quantifying maternal and perinatal risks and identifying which pregnancies can be safely prolonged is also much greater in LRS, where intensive care facilities that can rapidly respond to PE-related health threats for women and infants are limited. For these reasons, simple, low cost, sensitive, and specific point-of-care (POC) tests are needed that can be performed by antenatal health care providers in LRS and that can facilitate decisions about detection and management of PE. Our study aims to provide a comprehensive systematic review of current and emerging blood and urine biomarkers for PE, not only on the basis of their clinical performance, but also of their suitability to be used in LRS-compatible test formats, such as lateral flow and other variants of POC rapid assays.

  15. Electron multibeam technology for mask and wafer writing at 0.1 nm address grid

    Science.gov (United States)

    Platzgummer, Elmar; Klein, Christof; Loeschner, Hans

    2013-07-01

    IMS Nanofabrication realized a 50 keV electron multibeam proof-of-concept (POC) tool confirming writing principles with 0.1 nm address grid and lithography performance capability. The POC system achieves the predicted 5 nm 1 sigma blur across the 82 μm×82 μm array of 512×512 (262,144) programmable 20 nm beams. 24-nm half pitch (HP) has been demonstrated and complex patterns have been written in scanning stripe exposure mode. The first production worthy system for the 11-nm HP mask node is scheduled for 2014 (Alpha), 2015 (Beta), and first-generation high-volume manufacturing multibeam mask writer (MBMW) tools in 2016. In these MBMW systems the max beam current through the column is 1 μA. The new architecture has also the potential for 1× mask (master template) writing. Substantial further developments are needed for maskless e-beam direct write (EBDW) applications as a beam current of >2 mA is needed to achieve 100 wafer per hour industrial targets for 300 mm wafer size. Necessary productivity enhancements of more than three orders of magnitude are only possible by shrinking the multibeam optics such that 50 to 100 subcolumns can be placed on the area of a 300 mm wafer and by clustering 10 to 20 multicolumn tools. An overview of current EBDW efforts is provided.

  16. Rationing critical care medicine: recent studies and current trends.

    Science.gov (United States)

    Ward, Nicholas S

    2005-12-01

    This paper reviews the literature on the rationing of critical care resources. Although much has been written about the concept of rationing, there have been few scientific studies as to its prevalence. A recent meta-analysis reviewed all previously published studies on rationing access to intensive care units but little is known about practices within the intensive care unit. Much literature in the past few years has focused on the growing use of critical care resources and projections for the future. Several authors suggest there may be a crisis in financial or personnel resources if some rationing does not take place. Other papers have argued that the methods of rationing critical care previously proposed, such as limiting the care of dying patients or using cost-effectiveness analysis to determine care, may not be effective or viewed as ethical by some. Finally, several recent papers review how critical care is practiced and allocated in India and Asian countries that already practice open rationing in their health care systems. There is currently no published evidence that overt rationing is taking place in critical care medicine. There is growing evidence that in the future, the need for critical care may outstrip financial resources unless some form of rationing takes place. It is also clear from the literature that choosing how to ration critical care will be a difficult task.

  17. MHD Program Plan, FY 1992

    International Nuclear Information System (INIS)

    1991-10-01

    The current MHD program being implemented is a result of a consensus established in public meetings held by the Department of Energy in 1984. Essential elements of the current program include: (1) develop technical and environmental data for the integrated MHD topping cycle system through POC testing (1,000 hours); (2) develop technical and environmental data for the integrated MHD bottoming cycle sub system through POC testing (4,000 hours); (3) design, construct, and operate a seed regeneration POC facility (SRPF) capable of processing spent seed materials from the MHD bottoming cycle; (4) prepare conceptual designs for a site specific MHD retrofit plant; and (5) continue system studies and supporting research necessary for system testing. The current MHD program continues to be directed toward coal fired power plant applications, both stand-alone and retrofit. Development of a plant should enhance the attractiveness of MHD for applications other than electrical power. MHD may find application in electrical energy intensive industries and in the defense sector

  18. Top studies relevant to primary care practice.

    Science.gov (United States)

    Perry, Danielle; Kolber, Michael R; Korownyk, Christina; Lindblad, Adrienne J; Ramji, Jamil; Ton, Joey; Allan, G Michael

    2018-04-01

    To summarize 10 high-quality studies from 2017 that have strong relevance to primary care practice. Study selection involved routine literature surveillance by a group of primary care health professionals. This included screening abstracts of important journals and Evidence Alerts, as well as searching the American College of Physicians Journal Club. Topics of the 2017 articles include whether treating subclinical hypothyroidism improves outcomes or symptoms; whether evolocumab reduces cardiovascular disease as well as low-density lipoprotein levels; whether lifestyle interventions reduce medication use in patients with diabetes; whether vitamin D prevents cardiovascular disease, cancer, or upper respiratory tract infections; whether canagliflozin reduces clinical events in patients with diabetes; how corticosteroid injections affect knee osteoarthritis; whether drained abscesses benefit from antibiotic treatment; whether patients with diabetes benefit from bariatric surgery; whether exenatide reduces clinical events in patients with diabetes; and whether tympanostomy tubes affect outcomes in recurrent acute otitis media or chronic otitis media. We provide brief summaries, context where needed, and final recommendations for 10 studies with potential effects on primary care. We also briefly review 5 "runner-up" studies. Research from 2017 produced several high-quality studies in diabetes management. These have demonstrated benefit for alternative therapies and offered evidence not previously available. This year's selection of studies also provided information on a variety of conditions and therapies that are, or might become, more common in primary care settings. Copyright© the College of Family Physicians of Canada.

  19. Bio-functionalization of silicon nitride-based piezo-resistive ...

    Indian Academy of Sciences (India)

    Methods of bio-functionalize silicon nitride involve process steps to ... substance in applications such as clinical analysis, environmental control and industrial pro- ... anisms could be optical (measure the deflection), or measurement of a change in ... point of care (PoC), and the instrumentation involved is quite sophisticated.

  20. 17 CFR 1.21 - Care of money and equities accruing to customers.

    Science.gov (United States)

    2010-04-01

    ... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Care of money and equities... COMMISSION GENERAL REGULATIONS UNDER THE COMMODITY EXCHANGE ACT Customers' Money, Securities, and Property § 1.21 Care of money and equities accruing to customers. All money received directly or indirectly by...