(In)Visible Disease: Motions and Emotions Engendered by Papers and Diagnostics of People Accessing Healthcare in Burkina Faso

2021 ◽  
Vol 8 (3) ◽  
pp. 1-20
Author(s):  
Pia Juul Bjertrup
Keyword(s):  
Burkina Faso ◽  
Healthcare System ◽  
Diagnostic Tests ◽  
Point Of Care ◽  
Sick People ◽  
Crucial Difference ◽  
Laboratory Facilities ◽  
Diagnostic Technologies ◽  
Different Levels ◽  
Health Agenda

Within the last decade, challenges of diagnosis have emerged on the global health agenda, accompanied by an expansion in the use of point-of-care and rapid detection devices in low-resource contexts where laboratory facilities are scarce. Few studies have explored how these changes are shaping people’s diagnostic journeys and their modes of accessing such technologies. In this paper I show how sick people and their families in a peri-urban area in Burkina Faso attempt to access diagnostic technologies and make themselves visible to the healthcare system through papers. In this context, I show how referral papers and diagnostic papers take on significance for people as they attempt to access care and diagnostic technologies and ‘carry’ knowledge between different levels of the healthcare system. The use of papers is often an uncertain undertaking, as they remain unintelligible to the sick and the layperson. I highlight how the form of the papers makes a crucial difference to the ways that sick people are able to use them. Papers and diagnostic technologies present both opportunities and challenges, and simultaneously engender hope, uncertainty, disappointment, and despair for the sick seeking a cure. Uncertainties, especially financial ones, arise with the possibility of new referrals and diagnostic tests, and along the way many give up or are immobilised when faced with diagnostic ambiguity.

scholarly journals Common evidence gaps in point-of-care diagnostic test evaluation: a review of horizon scan reports

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015760 ◽  
Author(s):  
Jan Y Verbakel ◽  
Philip J Turner ◽  
Matthew J Thompson ◽  
Annette Plüddemann ◽  
Christopher P Price ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Diagnostic Test ◽  
Diagnostic Tests ◽  
Clinical Performance ◽  
Point Of Care ◽  
Clinical Effectiveness ◽  
Diagnostic Test Evaluation ◽  
Diagnostic Technologies ◽  
Diagnostic Horizon ◽  
Evidence Generation

ObjectiveSince 2008, the Oxford Diagnostic Horizon Scan Programme has been identifying and summarising evidence on new and emerging diagnostic technologies relevant to primary care. We used these reports to determine the sequence and timing of evidence for new point-of-care diagnostic tests and to identify common evidence gaps in this process.DesignSystematic overview of diagnostic horizon scan reports.Primary outcome measuresWe obtained the primary studies referenced in each horizon scan report (n=40) and extracted details of the study size, clinical setting and design characteristics. In particular, we assessed whether each study evaluated test accuracy, test impact or cost-effectiveness. The evidence for each point-of-care test was mapped against the Horvath framework for diagnostic test evaluation.ResultsWe extracted data from 500 primary studies. Most diagnostic technologies underwent clinical performance (ie, ability to detect a clinical condition) assessment (71.2%), with very few progressing to comparative clinical effectiveness (10.0%) and a cost-effectiveness evaluation (8.6%), even in the more established and frequently reported clinical domains, such as cardiovascular disease. The median time to complete an evaluation cycle was 9 years (IQR 5.5–12.5 years). The sequence of evidence generation was typically haphazard and some diagnostic tests appear to be implemented in routine care without completing essential evaluation stages such as clinical effectiveness.ConclusionsEvidence generation for new point-of-care diagnostic tests is slow and tends to focus on accuracy, and overlooks other test attributes such as impact, implementation and cost-effectiveness. Evaluation of this dynamic cycle and feeding back data from clinical effectiveness to refine analytical and clinical performance are key to improve the efficiency of point-of-care diagnostic test development and impact on clinically relevant outcomes. While the ‘road map’ for the steps needed to generate evidence are reasonably well delineated, we provide evidence on the complexity, length and variability of the actual process that many diagnostic technologies undergo.

Magnetic Digital Microfluidics for Point-of-Care Testing: Where Are We Now?

2020 ◽  
Vol 27 ◽  
Author(s):  
Yi Zhang
Keyword(s):  
System Integration ◽  
Diagnostic Tests ◽  
Point Of Care ◽  
Digital Microfluidics ◽  
Controlled Environment ◽  
Point Of Care Testing ◽  
Microfluidic Platforms ◽  
Interface System ◽  
Technical Issues ◽  
Sample System

: Point-of-care (POC) testing decentralizes the diagnostic tests to the sites near the patient. Many POC tests rely microfluidic platforms for sample-to-answer analysis. Compared to other microfluidic systems, magnetic digital microfluidics demonstrate compelling advantages for POC diagnostics. In this review, we have examined the capability of magnetic digital microfluidics-based POC diagnostic platforms. More importantly, we have categorized POC settings into three classes based on “where is the point”, “who to care” and “how to test”, and evaluated the suitability of magnetic digital microfluidics in various POC settings. Furthermore, we have addressed other technical issues associated with POC testing such as controlled environment, sample-system interface, system integration and information connectivity. We hope this review would provide a guideline for the future development of magnetic digital microfluidics-based platforms for POC testing.

scholarly journals Advances in Environmental Detection and Clinical Diagnostic Tests for Legionella Species

2021 ◽  
Author(s):  
Rajeshwari Vittal ◽  
Juliet Roshini Mohan Raj ◽  
Ballamoole Krishna Kumar ◽  
Indrani Karunasagar
Keyword(s):  
Developing Countries ◽  
Healthcare System ◽  
Diagnostic Tests ◽  
Clinical Manifestations ◽  
Cost Effective ◽  
Clinical Samples ◽  
Detection Techniques ◽  
Conventional Culture ◽  
Legionella Species ◽  
Mild Fever

Abstract Legionella is a fastidious organism that is difficult to culture in the lab but is widely distributed in environmental, domestic, and hospital settings. The clinical manifestations due to Legionella infections range from mild fever to fatal pneumonia and multiorgan pathologies. Legionella outbreaks though prevalent globally are not reported in developing countries due to difficulties in isolating this organism and the lack of simple diagnostic protocols. Here, we review the literature from across countries to present various methods used to detect Legionella from environmental and clinical samples. We compare the sensitivity and the specificity of the conventional culture-based assays with the recent methods and discuss approaches to develop better detection and diagnostic tests. With better cost-effective detection techniques and regular monitoring of the susceptible sites, which may harbor Legionella colonies, most of the Legionella infections can be prevented. As a result, considerable burden, caused by Legionella infections, on the healthcare system, in especially economically weaker countries, can be mitigated.

scholarly journals A qualitative study on the experiences of southern European immigrant parents navigating the Norwegian healthcare system

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Raquel Herrero-Arias ◽  
Esperanza Diaz
Keyword(s):  
Healthcare System ◽  
Health Beliefs ◽  
Diagnostic Tests ◽  
Home Country ◽  
Healthcare Services ◽  
Diagnosis And Treatment ◽  
Immigrant Parents ◽  
Health Providers ◽  
Treatment Practices ◽  
Cultural Health Beliefs

Abstract Background Patients’ experiences with health providers and their diagnostic and treatment expectations are shaped by cultural health beliefs and previous experiences with healthcare services in home country. This study explores how Southern European immigrant parents navigate the Norwegian healthcare system, through its focus on how this group manage their expectations on diagnosis and treatment practices when these are unmet. Methods The study had a qualitative research design. Fourteen in-depth interviews and two focus group discussions with 20 Southern European immigrant parents were conducted in 2017 in three Norwegian municipalities. With the help of NVivo software, data were transcribed verbatim and coded. Following a thematic analysis approach to identify patterns in immigrants’ experiences with the Norwegian healthcare services, the codes were organized into two themes. Results The first theme includes immigrants’ expectations on diagnostic tests and medical treatment. Southern European immigrants expected more diagnostic tests and pharmacological treatment than what was deemed necessary by Norwegian health providers. Experiences with unmet expectations influenced how immigrants addressed their and their children’s healthcare needs. The second theme comprises immigrants’ experiences of seeking healthcare in Norway (attending medical consultations in the private sector, seeking immigrant healthcare providers, and navigating the healthcare through their Norwegian social networks). This category includes also the alternative solutions immigrants undertook when they were dissatisfied with the diagnosis and treatment practices they were offered in Norway (self-medication and seeking healthcare in home countries). Conclusions Cultural health beliefs and previous experiences with healthcare services from home country shaped immigrants’ expectations on diagnosis and treatment practices. This had great implications for their navigation through the healthcare system and interactions with health providers in the host country. The study suggests that successful inclusion of immigrants into the Norwegian healthcare system requires an acknowledgement of the cultural factors that influence access and use of healthcare services. Exploring immigrants’ perspectives and experiences offers important information to understand the challenges of cross-cultural healthcare and to improve communication and equitable access.

scholarly journals A haemagglutination test for rapid detection of antibodies to SARS-CoV-2

2020 ◽  
Author(s):  
Alain Townsend ◽  
Pramila Rijal ◽  
Julie Xiao ◽  
Tiong Kit Tan ◽  
Kuan-Ying A Huang ◽  
...  
Keyword(s):  
High Performance ◽  
Point Of Care ◽  
Low Cost ◽  
Glycophorin A ◽  
Red Cell ◽  
Special Equipment ◽  
Cell Agglutination ◽  
Haemagglutination Test ◽  
Point Of Care Test ◽  
Laboratory Facilities

ABSTRACTSerological detection of antibodies to SARS-CoV-2 is essential for establishing rates of seroconversion in populations, detection of seroconversion after vaccination, and for seeking evidence for a level of antibody that may be protective against COVID-19 disease. Several high-performance commercial tests have been described, but these require centralised laboratory facilities that are comparatively expensive, and therefore not available universally. Red cell agglutination tests have a long history in blood typing, and general serology through linkage of reporter molecules to the red cell surface. They do not require special equipment, are read by eye, have short development times, low cost and can be applied as a Point of Care Test (POCT). We describe a red cell agglutination test for the detection of antibodies to the SARS-CoV-2 receptor binding domain (RBD). We show that the Haemagglutination Test (“HAT”) has a sensitivity of 90% and specificity of 99% for detection of antibodies after a PCR diagnosed infection. The HAT can be titrated, detects rising titres in the first five days of hospital admission, correlates well with a commercial test that detects antibodies to the RBD, and can be applied as a point of care test. The developing reagent is composed of a previously described nanobody to a conserved glycophorin A epitope on red cells, linked to the RBD from SARS-CoV-2. It can be lyophilised for ease of shipping. We have scaled up production of this reagent to one gram, which is sufficient for ten million tests, at a cost of ∼0.27 UK pence per test well. Aliquots of this reagent are ready to be supplied to qualified groups anywhere in the world that need to detect antibodies to SARS-CoV-2, but do not have the facilities for high throughput commercial tests.

scholarly journals Context-Specific Procedures for the Diagnosis of Human Schistosomiasis – A Mini Review

2021 ◽  
Vol 2 ◽  
Author(s):  
Pytsje T. Hoekstra ◽  
Govert J. van Dam ◽  
Lisette van Lieshout
Keyword(s):  
Diagnostic Tests ◽  
Point Of Care ◽  
Public Health Problem ◽  
Nucleic Acid Amplification ◽  
Antibody Detection ◽  
Infection Model ◽  
Related Factors ◽  
Human Schistosomiasis ◽  
Diagnostic Approaches ◽  
Context Specific

Schistosomiasis is a parasitic disease caused by trematode blood flukes of the genus Schistosoma, affecting over 250 million people mainly in the tropics. Clinically, the disease can present itself with acute symptoms, a stage which is relatively more common in naive travellers originating from non-endemic regions. It can also develop into chronic disease, with the outcome depending on the Schistosoma species involved, the duration and intensity of infection and several host-related factors. A range of diagnostic tests is available to determine Schistosoma infection, including microscopy, antibody detection, antigen detection using the Point-Of-Care Circulating Cathodic Antigen (POC-CCA) test and the Up-Converting Particle Lateral Flow Circulating Anodic Antigen (UCP-LF CAA) test, as well as Nucleic Acid Amplification Tests (NAATs) such as real-time PCR. In this mini review, we discuss these different diagnostic procedures and explore their most appropriate use in context-specific settings. With regard to endemic settings, diagnostic approaches are described based on their suitability for individual diagnosis, monitoring control programs, determining elimination as a public health problem and eventual interruption of transmission. For non-endemic settings, we summarize the most suitable diagnostic approaches for imported cases, either acute or chronic. Additionally, diagnostic options for disease-specific clinical presentations such as genital schistosomiasis and neuro-schistosomiasis are included. Finally, the specific role of diagnostic tests within research settings is described, including a controlled human schistosomiasis infection model and several clinical studies. In conclusion, context-specific settings have different requirements for a diagnostic test, stressing the importance of a well-considered decision of the most suitable diagnostic procedure.

scholarly journals Wired and Wireless Distributed e-Home Healthcare System

2016 ◽  
pp. 207-250
Author(s):  
Booma Devi Sekar ◽  
JiaLi Ma ◽  
MingChui Dong
Keyword(s):  
Healthcare System ◽  
Point Of Care ◽  
Access Point ◽  
Data Access ◽  
Medical Personnel ◽  
Home Healthcare ◽  
Information Communication ◽  
Healthcare Data ◽  
Remote Healthcare ◽  
Healthcare Monitoring

The proactive development in electronic health (e-health) has introduced seemingly endless number of applications such as telemedicine, electronic records, healthcare score cards, healthcare monitoring etc. Yet, these applications confront the key challenges of network dependence and medical personnel necessity, which hinders the development of universality of e-health services. To mitigate such key challenges, this chapter presents a versatile wired and wireless distributed e-home healthcare system. By exploiting the benefit of body sensor network and information communication technology, the dedicated system model methodically integrates some of the comprehensive functions such as pervasive health monitoring, remote healthcare data access, point-of-care signal interpretation and diagnosis, disease-driven uplink update and synchronization (UUS) scheme and emergency management to design a complete and independent e-home healthcare system.

scholarly journals Molecular Sovereignty: Building a Blood Screening Test for the Brazilian Nation

2021 ◽  
Vol 8 (2) ◽  
pp. 1-25
Author(s):  
Koichi Kameda
Keyword(s):  
Healthcare System ◽  
Transition To Democracy ◽  
Universal Healthcare ◽  
National Imaginary ◽  
Constitutional Right ◽  
National Boundaries ◽  
Acid Test ◽  
Diagnostic Technologies ◽  
Universal Healthcare System ◽  
Blood Screening

This article interrogates the relationship between the development of national diagnostic technologies and the exercise of sovereignty, by analysing a Brazilian project to produce a nucleic acid test (NAT) for the country’s blood screening programme. The concept of ‘molecular sovereignty’ is proposed to demonstrate that exercising sovereignty demands not only technological resources but also a sufficiently powerful and national imaginary to support local knowledge production as a means of advancing national healthcare priorities. First, this research article contextualises the political importance of blood safety for Brazil during its transition to democracy in the 1980s and the creation of its universal healthcare system. Then, it investigates how adopting the NAT led the state to invest in the production of a national technology. Third, the article unpacks the diagnostic test to consider how certain aspects of the project might ultimately strengthen the ability of global capital to cross national boundaries and create new markets. Lastly, it discusses how the project ended up creating a centralised and ‘closed’ system to avoid leaving the country vulnerable to the entry of global diagnostic companies. This case demonstrates how the molecularisation of blood, through the construction of a unified healthcare system driven by the constitutional right to health, can be deployed to construct imagined communities on the scale of a nation.

scholarly journals Assessing the Impacts of Hierarchical Healthcare System on the Accessibility and Spatial Equality of Healthcare Services in Shenzhen, China

2021 ◽  
Vol 10 (9) ◽  
pp. 615
Author(s):  
Zhuolin Tao ◽  
Wenchao Han
Keyword(s):  
Healthcare System ◽  
Catchment Area ◽  
Healthcare Services ◽  
Utilization Efficiency ◽  
Delivery Of Healthcare ◽  
Healthcare Accessibility ◽  
Set Up ◽  
Different Levels

The hierarchical healthcare system is widely considered to be a desirable mode of the delivery of healthcare services. It is expected that the establishment of a hierarchical healthcare system can help provide better and more equal healthcare accessibility. However, limited evidence has been provided on the impacts of a hierarchical healthcare system on healthcare accessibility. This study develops an improved Hierarchical two-step floating catchment area (2SFCA) method, which incorporates variable catchment area sizes, distance friction effects and utilization efficiency for facilities at different levels. Leveraging the Hierarchical 2SFCA method, various scenarios are set up to assess the accessibility impacts of a hierarchical healthcare system. The methods are applied in a case study of Shenzhen. The results reveal significant disparity and inequality in healthcare accessibility and also differences between various facility levels in Shenzhen. The overall healthcare accessibility and its equality can be significantly improved by fully utilizing existing facilities. It is also demonstrated that allocating additional supply to lower-level facilities can generate larger accessibility gains. Furthermore, allocating new supply to primary facilities would mitigate the inequality in healthcare accessibility, whereas inequality tends to be aggravated with new supply allocated to tertiary facilities. These impacts cannot be captured by traditional accessibility measures. This study demonstrates the pivotal role of primary facilities in the hierarchical healthcare system. It can contribute to the literature by providing transferable methods and procedures for measuring hierarchical healthcare accessibility and assessing accessibility impacts of a hierarchical healthcare system in developing countries.

Usability Lessons for COVID-19 Diagnostic Tests

2021 ◽  
Vol 65 (1) ◽  
pp. 186-190
Author(s):  
Sarah Farmer
Keyword(s):  
Diagnostic Tests ◽  
Paradigm Shift ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Use Cases ◽  
Time Constraints ◽  
Agile Methods ◽  
Limited Access ◽  
Design Cycle ◽  
Practical Design

As the need for increased and widespread COVID-19 diagnostic testing has arisen, testing has also become decentralized: where testing was originally primarily conducted in clinic or laboratory settings, testing now frequently occurs at community testing sites, pharmacies, workplaces, schools, and in the home. With this paradigm shift comes new usability barriers as companies rapidly adapt laboratory- and point-of-care-based tests for other use cases. This paper outlines the agile methods used to evaluate the usability of diagnostic tests in various phases of the design cycle and under limited access and time constraints, provides an overview of the most commons usability issues found, and lists practical design principles for practice.

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