Improving Access to the Glycated Hemoglobin Test in Rural Communities With Point-of-Care Devices: An Application Study

Background: Living in a rural or remote area is frequently associated with impaired access to health services, which directly affects the possibility of early diagnosis and appropriate monitoring of diseases, mainly non-communicable ones, because of their asymptomatic onset and evolution. Point-of-care devices have emerged as useful technologies for improving access to several laboratory tests closely patients' beds or homes, which makes it possible to eliminate the distance barrier.Objective: To evaluate the application of point-of-care technology for glycated hemoglobin (HbA1c) estimation in the assessment of glycemic control and identification of new diagnoses of diabetes in primary care among rural communities in a Brazilian municipality.Materials and Methods: We included individuals aged 18 years or older among rural communities in a Brazilian municipality. From September 2019 to February 2020, participants were assessed for anthropometrics, blood pressure, and capillary glycemia during routine primary care team activities at health fairs and in patient groups. Participants previously diagnosed with diabetes but without recent HbA1c test results or those without a previous diagnosis but with random capillary glycemia higher than 140 mg/dL were considered positive and were tested for HbA1c by using a point-of-care device.Results: At the end of the study, 913 individuals were accessed. Of these, 600 (65.7%) had no previous diagnosis of diabetes, 58/600 (9.7%) refused capillary glycemia screening and 542/600 (90.7%) were tested. Among tested individuals, 73/542 (13.5%) cases without a previous diagnosis of diabetes, were positive for capillary glycemia. Among positives, 31/73 (42.5%) had HbA1c levels that were considered indicative of prediabetes and 16/73 (21.9%) were newly diagnosed with diabetes. Among the participants, 313/913 (34.3%) were previously diagnosed with diabetes. Recent HbA1c results were unavailable for 210/313 (67.1%). These individuals were tested using point-of-care devices. Among them, 143/210 (68.1%) had HbA1c levels higher than target levels (>7% and >8% for adults and elderly individuals, respectively.Conclusion: The application of point-of-care devices for HbA1c level measurement improved the access to this test for people living in rural or remote areas. Thus, it was possible to include this technology in the routine activities of primary health care teams, which increased the rates of new diagnoses and identification of patients with uncontrolled glycemia.

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C-reactive protein and neutrophil count laboratory test requests from primary care: what is the demand and would substitution by point-of-care technology be viable?

Journal of Clinical Pathology ◽

10.1136/jclinpath-2018-205688 ◽

2019 ◽

Vol 72 (7) ◽

pp. 474-481

Author(s):

José M Ordóñez-Mena ◽

Thomas R Fanshawe ◽

David McCartney ◽

Brian Shine ◽

Ann Van den Bruel ◽

...

Keyword(s):

Primary Care ◽

Neutrophil Count ◽

Point Of Care ◽

C Reactive Protein ◽

Reactive Protein ◽

Laboratory Services ◽

Number Of Patients ◽

Point Of Care Technology ◽

Care Technology ◽

The Uk

Aims C-reactive protein (CRP) and neutrophil count (NC) are important diagnostic indicators of inflammation. Point-of-care (POC) technologies for these markers are available but rarely used in community settings in the UK. To inform the potential for POC tests, it is necessary to understand the demand for testing. We aimed to describe the frequency of CRP and NC test requests from primary care to central laboratory services, describe variability between practices and assess the relationship between the tests.MethodsWe described the number of patients with either or both laboratory tests, and the volume of testing per individual and per practice, in a retrospective cohort of all adults in general practices in Oxfordshire, 2014–2016.Results372 017 CRP and 776 581 NC tests in 160 883 and 275 093 patients, respectively, were requested from 69 practices. CRP was tested mainly in combination with NC, while the latter was more often tested alone. The median (IQR) of CRP and NC tests/person tested was 1 (1–2) and 2 (1–3), respectively. The median (IQR) tests/practice/week was 36 (22–52) and 72 (50–108), and per 1000 persons registered/practice/week was 4 (3–5) and 8 (7–9), respectively. The median (IQR) CRP and NC concentrations were 2.7 (0.9–7.9) mg/dL and 4.1 (3.1–5.5)×109/L, respectively.ConclusionsThe high demand for CRP and NC testing in the community, and the range of results falling within the reportable range for current POC technologies highlight the opportunity for laboratory testing to be supplemented by POC testing in general practice.

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Are Semi-Quantitative Clinical Cultures Inadequate? Comparison to Quantitative Analysis of 1053 Bacterial Isolates from 350 Wounds

Diagnostics ◽

10.3390/diagnostics11071239 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1239

Author(s):

Thomas E. Serena ◽

Philip G. Bowler ◽

Gregory S. Schultz ◽

Anna D’souza ◽

Monique Y. Rennie

Keyword(s):

Quantitative Analysis ◽

Best Management Practices ◽

Management Practices ◽

Chronic Wounds ◽

Point Of Care ◽

Bacterial Load ◽

Quantitative Culture ◽

Simple Method ◽

Point Of Care Technology ◽

Care Technology

Early awareness and management of bacterial burden and biofilm is essential to wound healing. Semi-quantitative analysis of swab or biopsy samples is a relatively simple method for measuring wound microbial load. The accuracy of semi-quantitative culture analysis was compared to ‘gold standard’ quantitative culture analysis using 428 tissue biopsies from 350 chronic wounds. Semi-quantitative results, obtained by serial dilution of biopsy homogenates streaked onto culture plates divided into 4 quadrants representing occasional, light, moderate, and heavy growth, were compared to total bacterial load quantified as colony-forming units per gram (CFU/g). Light growth, typically considered an insignificant finding, averaged a clinically significant 2.5 × 105 CFU/g (SE = 6.3 × 104 CFU/g). Occasional growth (range: 102–106 CFU/g) and light growth (103–107 CFU/g) corresponded to quantitative values that spanned a 5-log range; moderate and heavy growth corresponded to a range of 4-log and 6-log, respectively, with a high degree of overlap in range of CFU/g per category. Since tissue biopsy and quantitative culture cannot be widely practiced and semi-quantitative analysis is unreliable, other clinically relevant approaches are required to determine wound bioburden and guide best management practices. Fluorescence imaging is a point-of-care technology that offers great potential in this field.

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Electronic Health Records and Point-of-Care Technology

Nursing Informatics for the Advanced Practice Nurse ◽

10.1891/9780826124890.0007 ◽

2015 ◽

Author(s):

Mary Beth Mitchell ◽

Susan McBride

Keyword(s):

Electronic Health Records ◽

Point Of Care ◽

Health Records ◽

Point Of Care Technology ◽

Electronic Health ◽

Care Technology

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COVID-19 Pandemic and Role of Human Saliva as a Testing Biofluid in Point-of-Care Technology

European Journal of Dentistry ◽

10.1055/s-0040-1713020 ◽

2020 ◽

Vol 14 (S 01) ◽

pp. S123-S129 ◽

Cited By ~ 12

Author(s):

Hiba Hamid ◽

Zohaib Khurshid ◽

Necdet Adanir ◽

Muhammad S. Zafar ◽

Sana Zohaib

Keyword(s):

Health Care Providers ◽

Point Of Care ◽

Virus Transmission ◽

Human Saliva ◽

Care Providers ◽

Viral Loads ◽

Point Of Care Technology ◽

Noninvasive Sample ◽

Novel Coronavirus ◽

Care Technology

AbstractNovel coronavirus disease 2019 (COVID-19) outbreak has termed as a controllable pandemic, and the entire world has come to a standstill trying to mitigate the disease with health systems. Health care providers, around the globe, are fighting day and night. Currently, rapid testing is taking place with the help of nasopharyngeal, oropharyngeal swab, bronchoalveolar lavage, sputum, urine, and blood. All these approaches are invasive or embarrassing to the infected person. It is observed that salivary glands are hosting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) because of angiotensin-converting enzyme 2 and the detection of high viral loads in the saliva and is playing a crucial role in virus transmission, especially from individuals showing absolutely no symptoms. Saliva is proving to be a promising noninvasive sample specimen for the diagnosis of COVID-19, thus helping to monitor the infection and prevent it from further spreading by prompt isolation.

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Finger-powered, capillary-driven blood diagnostic chip for point-of-care technology

Sensors and Actuators A Physical ◽

10.1016/j.sna.2020.112153 ◽

2020 ◽

Vol 312 ◽

pp. 112153

Author(s):

Eun Jong Lee ◽

Bo-kyu Kim ◽

Kang Kug Lee

Keyword(s):

Point Of Care ◽

Point Of Care Technology ◽

Care Technology

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Acute coronary syndrome: What is the cost-effectiveness of prevention, point-of-care technology and telemonitoring?

Health Policy and Technology ◽

10.1016/j.hlpt.2012.07.002 ◽

2012 ◽

Vol 1 (3) ◽

pp. 173-177 ◽

Cited By ~ 1

Author(s):

Walter Van Dyck ◽

Gergely Vértes ◽

Muhilan Palaniappan ◽

Daniel Gassull ◽

Prateek Jain ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Cost Effectiveness ◽

Point Of Care ◽

Coronary Syndrome ◽

Point Of Care Technology ◽

Care Technology ◽

The Cost

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Immune therapy in sepsis: Are we ready to try again?

Journal of the Intensive Care Society ◽

10.1177/1751143718765407 ◽

2018 ◽

Vol 19 (4) ◽

pp. 326-344 ◽

Cited By ~ 22

Author(s):

Roger Davies ◽

Kieran O’Dea ◽

Anthony Gordon

Keyword(s):

Patient Outcomes ◽

Point Of Care ◽

Secondary Infection ◽

Immune Therapy ◽

Immune Biomarkers ◽

Immune Therapies ◽

Point Of Care Technology ◽

Care Technology ◽

Past Experiences ◽

Improve Patient

Immune therapy to ease the burden of sepsis has thus far failed to consistently improve patient outcomes. Advances in cancer immune therapy and awareness that prolonged immune-suppression in sepsis can leave patients vulnerable to secondary infection and death have driven resurgence in the field of sepsis immune-therapy investigation. As we develop and evaluate these novel therapies, we must learn from past experiences where single-mediator targeted immune therapies were blindly delivered to heterogeneous patient cohorts with complex and evolving immune responses. Advances in genomics, proteomics, metabolomics, and point-of-care technology, coupled with a better understanding of sepsis pathogenesis, have meant that personalised immune-therapy is on the horizon. Here, we review the complex immune pathogenesis in sepsis and the contemporary immune therapies that are being investigated to manipulate this response. An outline of the immune biomarkers that may be used to support this approach is also provided.

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