Point of care ultrasonography(POCUS)is emerging as an invaluable tool for guiding patient care at the bedside,providing real-time diagnostic information to clinicians.Today,POCUS is recognized as the fifth pillar of b...Point of care ultrasonography(POCUS)is emerging as an invaluable tool for guiding patient care at the bedside,providing real-time diagnostic information to clinicians.Today,POCUS is recognized as the fifth pillar of bedside clinical examination,alongside inspection,palpation,percussion,and auscultation.In spite of growing interest,the adoption of diagnostic POCUS in nephrology remains limited,and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs.Moreover,several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice.These include myths about its scope,utility,impact on patient outcomes and legal implications.In this minireview,we address some of these issues to encourage wider and proper utilization of POCUS.展开更多
Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer.It encompasses acute kidney injury(AKI),complex fluid,electrolyte,an...Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer.It encompasses acute kidney injury(AKI),complex fluid,electrolyte,and acid-base disorders,as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment.In many such scenarios including AKI and hyponatremia,objective evaluation of hemodynamics is vital for appropriate management.Point of care ultrasonography(POCUS)is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy.Compared to conventional physical examination,POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements.In this narrative review,we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.展开更多
In this editorial we comment on the article by Kuwahara et al,published in the recent issue of the World Journal of Cardiology.In this interesting paper,the authors showed a correlation between portal vein pulsatility...In this editorial we comment on the article by Kuwahara et al,published in the recent issue of the World Journal of Cardiology.In this interesting paper,the authors showed a correlation between portal vein pulsatility ratio,examined by bedside ultrasonography,and prognosis of hospitalized patients with acute heart failure.Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination,biomarkers,central venous pressure estimation and X-rays.However,congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis.Doppler flow assessment of the abdominal veins is gaining popularity worldwide,as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.展开更多
As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not...As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management,it is critical to examine the role of different modalities currently in use,such as baseline X-rays and computed tomography scans carefully.In this article,we will draw attention to the critical findings for the radiologist.Further,we will look at point of care ultrasound,an increasingly a popular tool in diagnostic medicine,as a component of COVID-19 management.展开更多
BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utili...BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.METHODS: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman plots.RESULTS: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.KEY WORDS: Sepsis; Point of care; Lactate; Emergency department;展开更多
Accurate assessment of the hemodynamic status is vital for appropriate management of patients with critical illness.As such,there has been a constant quest for reliable and non-invasive bedside tools to assess and mon...Accurate assessment of the hemodynamic status is vital for appropriate management of patients with critical illness.As such,there has been a constant quest for reliable and non-invasive bedside tools to assess and monitor circulatory status in order to ensure end-organ perfusion.In the recent past,point of care ultrasonography(POCUS)has emerged as a valuable adjunct to physical examination in various specialties,which basically is a clinician-performed bedside ultrasound to answer focused questions.POCUS allows visualization of the internal anatomy and flow dynamics in real time,guiding apt interventions.While both arterial(forward flow)and venous(organ outflow or afterload)limbs of hemodynamic circuit are important for tissue perfusion,the venous side remains relatively under-explored.With recent data underscoring the deleterious consequences of iatrogenic volume overload,objective evaluation of venous congestion is gaining attention.Bedside Doppler ultrasound serves this purpose and aids in diagnosing and monitoring the congestion/venous blood flow pattern.In this article,we summarize the rationale for integrating this technology into routine care of patients with volume-related disorders,discuss the normal and abnormal waveforms,limitations,and future directions.展开更多
As a diagnostic aid in emergency services,ultrasound has expanded considerably in recent years.Among its applications,ocular ultrasonography allows for a better evaluation of patients with ophthalmological emergencies...As a diagnostic aid in emergency services,ultrasound has expanded considerably in recent years.Among its applications,ocular ultrasonography allows for a better evaluation of patients with ophthalmological emergencies.In addition,it provides a simple and easy technique to obtain clinical information that may not be easily accessible either through the clinical examination or by using the ophthalmoscope.Ocular ultrasonography can help to diagnose hemorrhage and retinal detachment and/or vitreous,eye infections,foreign bodies,retrobulbar hematomas,papilledema,and eye trauma.By measuring the diameter of the optic nerve sheath,intracranial hypertension could be screened.This article reviewed the approach to eye exam by ultrasound and common ophthalmic pathologies diagnosed with ultrasound in the emergency department.展开更多
Objective: To examine the correlation between plasma hCG results obtained with the new i-STAT® hCG point of care test with those concomitantly obtained from the central hospital laboratory utilizing the same pa...Objective: To examine the correlation between plasma hCG results obtained with the new i-STAT® hCG point of care test with those concomitantly obtained from the central hospital laboratory utilizing the same patient samples. Methods: Prospective cross-sectional laboratory test evaluation. We compared plasma hCG results obtained with the i-STAT® hCG test (Abbott Point of Care, Princeton, NJ, USA) with Architect Ci8200 (Abbott Laboratories, Abbott Park, IL, USA). We also calculated the total coefficient of variation (CV) for the i-STAT® method. Results: The two methods showed a good linear correlation (R2 = 0.994;slope 1.03) and CV for the i-STAT® method was 2.1% - 5.2%. Conclusion: We suggest that the i-STAT® hCG blood assay could be used as a complement to urine hCG assays in clinical situations when rapid test results are needed and urine is not available.展开更多
BACKGROUND: Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries(LMICs) such as Tanzania. The introductio...BACKGROUND: Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries(LMICs) such as Tanzania. The introduction of ultrasound can significantly impact treatment in these countries due to its portability, low cost, safety, and usefulness in various medical assessments. This study reviews the implementation of a four-week ultrasound course administered annually from 2013–2016 in a healthcare professional school in Mwanza, Tanzania by first-year allopathic US medical students.METHODS: Participants(n=582, over 4 years) were recruited from the Tandabui Institute of Health Sciences and Technology to take the ultrasound course. Subjects were predominantly clinical officer students, but other participants included other healthcare professional students, practicing healthcare professionals, and school employees. Data collected includes pre-course examination scores, post-course examination scores, course quiz scores, demographic surveys, and postcourse feedback surveys. Data was analyzed using two-tailed t-tests and the single factor analysis of variance(ANOVA).RESULTS: For all participants who completed both the pre-and post-course examinations(n=229, 39.1% of the total recruited), there was a significant mean improvement in their ultrasound knowledge of 42.5%, P<0.01.CONCLUSION: Our data suggests that trained first-year medical students can effectively teach a point of care ultrasound course to healthcare professional students within four weeks in Tanzania. Future investigation into the level of long-term knowledge retention, impact of ultrasound training on knowledge of human anatomy and diagnostic capabilities, and how expansion of an ultrasound curriculum has impacted access to care in rural Tanzania is warranted.展开更多
Colorectal cancer(CRC)is the second leading cause of cancer-related death worldwide.The five-year survival rate of CRC patients depends on the stage at diagnosis,being higher than 80%when CRC is diagnosed in the early...Colorectal cancer(CRC)is the second leading cause of cancer-related death worldwide.The five-year survival rate of CRC patients depends on the stage at diagnosis,being higher than 80%when CRC is diagnosed in the early stages but lower than 10%when CRC is diagnosed in advanced stages.Autoantibodies against specific CRC autoantigens(tumor-associated antigens(TAAs))in the sera of patients have been widely demonstrated to aid in early diagnosis.Thus,we herein aim to identify autoantigens target of autoantibodies specific to CRC that possess a significant ability to discriminate between CRC patients and healthy individuals by means of liquid biopsy.To that end,we examined the protein content of the exosomes released by five CRC cell lines and tissue samples from CRC patients by means of immunoprecipitation coupled with mass spectrometry analysis.A total of 103 proteins were identified as potential autoantigens specific to CRC.After bioinformatics and meta-analysis,we selected 15 proteins that are more likely to be actual CRC autoantigens in order to evaluate their role in CRC prognosis by Western blot(WB)and immunohistochemistry(IHC).We found dysregulation at the protein level for 11 of these proteins in both tissue and plasma exosome samples from patients,along with an association of nine of these proteins with CRC prognosis.After validation,all but one showed a statistically significant high diagnostic ability to distinguish CRC patients and individuals with premalignant lesions from healthy individuals,either by luminescence Halotag-based beads,or by a multiplexed biosensing platform involving the use of magnetic microcarriers as solid support modified with covalently immobilized Halotag fusion proteins constructed for CRC detection.Taken together,our results highlight the usefulness of the approach defined here to identify the TAAs specific to chronic diseases;they also demonstrate that the measurement of autoantibody levels in plasma against the TAAs identified here could be integrated into a point-of-care(POC)device for CRC detection with high diagnostic ability.展开更多
BACKGROUND: The purpose of this study was to use point-of-care ultrasound(POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery(CCA). The effect of ...BACKGROUND: The purpose of this study was to use point-of-care ultrasound(POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery(CCA). The effect of both primary and secondary smoking on CCA properties was evaluated.METHODS: We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness(CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease.RESULTS: We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness.CONCLUSION: Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confi rm the utility of ultrasound fi ndings of cardiovascular disease and stroke.展开更多
<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Craniosynostosis surgery is one of the most hemorrhagic interventions, ...<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Craniosynostosis surgery is one of the most hemorrhagic interventions, where transfusion rates vary from 20</span><span style="font-family:Verdana;">%</span><span style="font-family:""><span style="font-family:Verdana;"> to 100% depending on the study. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To describe intraoperative and postoperative outcomes in a secondary analysis of children who underwent craniosynostosis surgery included in the initial retrospective study with the aim of proposing intraoperative implementation optimization protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Secondary analysis. The study was approved by the </span><span><span style="font-family:Verdana;">Ethics Committee. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were 69 children with a median age of 10 </span></span></span><span style="font-family:Verdana;">[</span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">207</span><span style="font-family:Verdana;">]</span><span style="font-family:""><span style="font-family:Verdana;"> months. Eight (11.6%) patients had intraoperative and/or postoperative complications. One patient (1.5%) had intraoperative hemorrhagic shock, and two patients (2.9%) had intraoperative broncholaryngospasm. One patient (1.5%) had postoperative anaphylaxis. One patient (1.5%) had postoperative hemorrhagic shock. One patient (1.5%) had postoperative respiratory failure. Two patients (2.9%) had postoperative neurologic failure. One patient (1.5%) had neuro-meningeal sepsis. One patient (1.5%) had a re-operation. There was no in-hospital mortality. Fourty-eight patients (69.6%) had intraoperative transfusions. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Transfusion protocols guided with point-of-care tests should be included in patient blood management programs in craniosynostosis surgery.展开更多
Rapid prototyping methods for the design and fabrication of polymeric labs-on-a-chip are on the rise,as they allow high degrees of precision and flexibility.For example,a microfluidic platform may require an optimizat...Rapid prototyping methods for the design and fabrication of polymeric labs-on-a-chip are on the rise,as they allow high degrees of precision and flexibility.For example,a microfluidic platform may require an optimization phase in which it could be necessary to continuously modify the architecture and geometry;however,this is only possible if easy,controllable fabrication methods and low-cost materials are available.In this paper,we describe the realization process of a microfluidic tool,from the computer-aided design(CAD)to the proof-of-concept application as a capture device for circulating tumor cells(CTCs).The entire platform was realized in polymethyl methacrylate(PMMA),combining femtosecond(fs)laser and micromilling fabrication technologies.The multilayer device was assembled through a facile and low-cost solvent-assisted method.A serpentine microchannel was then directly biofunctionalized by immobilizing capture probes able to distinguish cancer from non-cancer cells without labeling.The low material costs,customizable methods,and biological application of the realized platform make it a suitable model for industrial exploitation and applications at the point of care.展开更多
African swine fever(ASF)is a highly lethal disease of domestic and wild swine caused by African swine fever virus(ASFV).The disease currently circulates in Africa,Europe,Asia and on the island of Hispaniola.The ongoin...African swine fever(ASF)is a highly lethal disease of domestic and wild swine caused by African swine fever virus(ASFV).The disease currently circulates in Africa,Europe,Asia and on the island of Hispaniola.The ongoing epizootics in Europe and Asia have produced millions of animal deaths and severe economic losses.No effective vaccine is available for ASF,making rapid and accurate detection of ASFV essential for disease mitigation strategies.Currently available diagnostics for ASFV possess significant limitations related to assay performance,deployability,and/or turn-around time;therefore there is an unmet need for pen-side diagnostic tests with sufficient sensitivity and specificity.A chromatographic lateral flow immunoassay(LFIA)was developed for the detection of ASFV antigen in EDTA-treated whole blood using monoclonal antibodies targeting the viral p30 protein.The assay requires only water to perform and provides results in 25 min,making it well-suited for field use.The LFIA was capable of detecting genotype I and genotype II strains of ASFV in EDTA blood from experimentally infected pigs at varying time-points after infection,though it was unable to detect a genotype X ASFV strain.Diagnostic sensitivity correlated with clinical disease severity,body temperature,and viral DNA levels,and was over 90%in animals showing moderate to severe ASF-related symptoms after challenge with virulent genotype II virus.The LFIA also showed a robust diagnostic specificity of over 98%,which is essential to field testing for a high consequence to foregin animal disease.The LFIA targeting the viral p30 protein can reliably detect ASFV in whole blood from animals showing moderate to severe clinical signs of infection with virulent genotype I and II isolates,making it a promising candidate for use as a field-deployable antigen detection assay.Additional evaluation using field samples and different virus strains is required to further assess the utility of this rapid diagnostic test.展开更多
BACKGROUND Current clinical treatment options for symptomatic,partial-thickness rotator cuff tear(sPTRCT)offer only limited potential for true tissue healing and improvement of clinical results.In animal models,inject...BACKGROUND Current clinical treatment options for symptomatic,partial-thickness rotator cuff tear(sPTRCT)offer only limited potential for true tissue healing and improvement of clinical results.In animal models,injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon tissue.However,it is unclear whether such beneficial effects could also be observed in a human tendon treated with fresh,uncultured,autologous,adipose derived regenerative cells(UA-ADRCs).A specific challenge in this regard is that UA-ADRCs cannot be labeled and,thus,not unequivocally identified in the host tissue.Therefore,histological regeneration of injured human tendons after injection of UA-ADRCs must be assessed using comprehensive,immunohistochemical and microscopic analysis of biopsies taken from the treated tendon a few weeks after injection of UA-ADRCs.CASE SUMMARY A 66-year-old patient suffered from sPTRCT affecting the right supraspinatus and infraspinatus tendon,caused by a bicycle accident.On day 18 post injury[day 16 post magnetic resonance imaging(MRI)examination]approximately 100 g of abdominal adipose tissue was harvested by liposuction,from which approximately 75×10^(6) UA-ADRCs were isolated within 2 h.Then,UA-ADRCs were injected(controlled by biplanar X-ray imaging)adjacent to the injured supraspinatus tendon immediately after isolation.Despite fast clinical recovery,a follow-up MRI examination 2.5 mo post treatment indicated the need for open revision of the injured infraspinatus tendon,which had not been treated with UAADRCs.During this operation,a biopsy was taken from the supraspinatus tendon at the position of the injury.A comprehensive,immunohistochemical and microscopic analysis of the biopsy(comprising 13 antibodies)was indicative of newly formed tendon tissue.CONCLUSION Injection of UA-ADRCs can result in regeneration of injured human tendons by formation of new tendon tissue.展开更多
As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date...As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination.Since early in the pandemic,studies indicated a heightened risk of venous thromboembolism(VTE)in COVID-19 infected patients.There have been differing expert opinions about how to assess pretest probability of VTE in this patient population.This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE.Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough.Some have argued for more routine screening at different points of care.Others have even suggested empiric therapeutic anticoagulation in moderate to severely ill COVID-19 patients.In the following article,we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients.We also discuss research gaps and share pathways currently being used within our institution.展开更多
<b> Background: </b>The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of ...<b> Background: </b>The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of limited access to appropriate Point of Care Ultrasound Screening (POCUS) services in lower levels of developing countries’ Health Systems, cost of care, skills gap among care providers and unclear regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm viability of a pregnancy, gestational age, multiple pregnancies and it also helps rule out fetal abnormalities early enough. <b>Methods: </b>One year after intervention, a cross-sectional study was carried in the two pilot counties of <i>Kisii </i>(rural) and <i>Kajiado </i>(peri-urban). This followed after selected midwives in the two counties were trained on basic obstetric ultrasound screening for ANC women. A total of 366 women who were either in their last phases of pregnancy or had delivered within three months before the survey were interviewed. Cumulatively, the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies were identified. Open Data Kit (ODK) was used to collect quantitative data and analysed using STATA version 15. Descriptive statistics were used to summarize the data test associations between variables. Bivariate and logistic regression was used to identify predictive variables, and ORs with 95% confidence intervals used to measure the strength of the associations. <b>Findings: </b>Slightly more than a third (36%) of the women had recently delivered. In total, Kisii (rural county) had a representation of 59% of the respondents. Half of the respondents were aged between 25 - 34 years, 55% of the women interviewed were housewives while 48% had secondary level of education. Only 21% of the women had undergone routine ultrasound screening before 24 weeks of gestation with the average distance travelled by majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation was the major (68.1%) motivator for seeking the service in the two pilot counties. Employment status, household income, education level, pregnancy gestation and distance to the facility had a statistical significance (<i>P</i> < 0.05) with ultrasound utilization. Highest education level, pregnancy gestation and distance to the nearest ultrasound screening facility were found to significantly predict the likelihood of utilizing the ultrasound services (<i>P </i>< 0.05). The initial training and continuous hands-on coaching of midwives by TOTs contributed a lot to acquisition of the desired basic obstetric ultrasound screening skills. <b>Conclusion: </b>Women in developing countries are eager to access obstetric ultrasound screening services but for limited opportunities and sustainable implementation frameworks on Point of Care Ultrasound Screening (POCUS) services. Training and continuous coaching of frontline health professionals are critical in deployment of POCUS but there is limited access to standardised training content.展开更多
Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)a...Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)at a community health center in Houston,TX.Methods:This was a before-and-after POC intervention among adult patients who received primary care services between 1 July 2014 and 31 December 2014(baseline visit)and who had at least one 3-month follow-up visit.Results:Three hundred eighty-seven patients were included in the study.The majority were<60 years of age(72.1%),female(60.5%),and Hispanic(63%),followed by black(16.5%)and Asian(11.1%).Almost 87%of the patients had uncontrolled T2D(HbA1c>9%)at baseline,with the highest average levels among Hispanic(10.9%)and black(10.7%)patients.There was a significant difference in the HbA1c level before(mean=10.65,SD=1.9291)and after(mean=9.25,SD=1.8187)intervention.The absolute reduction in the level of HbA1c was 1.4%(t=12.834,p<0.001),corresponding to a 13%overall percentage decrease from baseline.Conclusion:There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c,improving self-management,and reducing long-term costs.展开更多
Given the continuous and growing demand for point of care(POC)diagnostic tests,attention has been shifted toward integration and miniaturization of laboratory protocols into“sample-in-answer-out”devices.Microfluidic...Given the continuous and growing demand for point of care(POC)diagnostic tests,attention has been shifted toward integration and miniaturization of laboratory protocols into“sample-in-answer-out”devices.Microfluidic technologies have been considered an ideal solution to address the requirements of POC diagnostics since many laboratory functions can be miniaturized and incorporated onto a single integrated chip.In this review,we summarize the advances of integrated microfluidic devices for POC diagnostics in the last 3 years.Particularly,we summarize current materials used for microfluidic chip fabrication,discuss the innovation of versatile integrated microfluidic devices,especially the strategies for simplifying sample preparation in manual or self-driven systems,and new detection methods of microfluidic chips.In addition,we describe new integrated microfluidic devices for POC diagnostics of protein-targeted immunodiagnostics,nucleic acid molecular tests,and small molecule metabolites analysis.We also provide future perspectives and current challenges for clinical translation and commercialization of these microfluidic technologies.展开更多
Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 ...Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance.Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances.Elevated CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac preload.While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical improvement.Ultrasound-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating CVP.IJV parameters,including diameter and ratio,has demonstrated good correlation with CVP.Despite significant advancements in non-invasive CVP measurement,a reliable tool is yet to be found.Present methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.展开更多
文摘Point of care ultrasonography(POCUS)is emerging as an invaluable tool for guiding patient care at the bedside,providing real-time diagnostic information to clinicians.Today,POCUS is recognized as the fifth pillar of bedside clinical examination,alongside inspection,palpation,percussion,and auscultation.In spite of growing interest,the adoption of diagnostic POCUS in nephrology remains limited,and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs.Moreover,several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice.These include myths about its scope,utility,impact on patient outcomes and legal implications.In this minireview,we address some of these issues to encourage wider and proper utilization of POCUS.
文摘Onco-Nephrology is an emerging subspecialty of Nephrology that focuses on a broad spectrum of renal disorders that can arise in patients with cancer.It encompasses acute kidney injury(AKI),complex fluid,electrolyte,and acid-base disorders,as well as chronic kidney disease caused or exacerbated by cancer and/or its treatment.In many such scenarios including AKI and hyponatremia,objective evaluation of hemodynamics is vital for appropriate management.Point of care ultrasonography(POCUS)is a limited ultrasound exam performed at the bedside and interpreted by the treating physician intended to answer focused clinical questions and guide therapy.Compared to conventional physical examination,POCUS offers substantially higher diagnostic accuracy for various structural and hemodynamic derangements.In this narrative review,we provide an overview of the utility of POCUS enhanced physical examination for the Onconephrologist supported by the current evidence and our experience-based opinion.
文摘In this editorial we comment on the article by Kuwahara et al,published in the recent issue of the World Journal of Cardiology.In this interesting paper,the authors showed a correlation between portal vein pulsatility ratio,examined by bedside ultrasonography,and prognosis of hospitalized patients with acute heart failure.Systemic congestion is being notoriously underdetected in the acutely ill population with conventional methods like clinical examination,biomarkers,central venous pressure estimation and X-rays.However,congestion should be a key therapeutic target due to its deleterious effects to end organ function and subsequently patient prognosis.Doppler flow assessment of the abdominal veins is gaining popularity worldwide,as a valuable tool in estimating comprehensively congestion and giving a further insight into hemodynamics and patient management.
文摘As healthcare professionals continue to combat the coronavirus disease 2019(COVID-19)infection worldwide,there is an increasing interest in the role of imaging and the relevance of various modalities.Since imaging not only helps assess the disease at the time of diagnosis but also aids evaluation of response to management,it is critical to examine the role of different modalities currently in use,such as baseline X-rays and computed tomography scans carefully.In this article,we will draw attention to the critical findings for the radiologist.Further,we will look at point of care ultrasound,an increasingly a popular tool in diagnostic medicine,as a component of COVID-19 management.
文摘BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.METHODS: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman plots.RESULTS: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.KEY WORDS: Sepsis; Point of care; Lactate; Emergency department;
文摘Accurate assessment of the hemodynamic status is vital for appropriate management of patients with critical illness.As such,there has been a constant quest for reliable and non-invasive bedside tools to assess and monitor circulatory status in order to ensure end-organ perfusion.In the recent past,point of care ultrasonography(POCUS)has emerged as a valuable adjunct to physical examination in various specialties,which basically is a clinician-performed bedside ultrasound to answer focused questions.POCUS allows visualization of the internal anatomy and flow dynamics in real time,guiding apt interventions.While both arterial(forward flow)and venous(organ outflow or afterload)limbs of hemodynamic circuit are important for tissue perfusion,the venous side remains relatively under-explored.With recent data underscoring the deleterious consequences of iatrogenic volume overload,objective evaluation of venous congestion is gaining attention.Bedside Doppler ultrasound serves this purpose and aids in diagnosing and monitoring the congestion/venous blood flow pattern.In this article,we summarize the rationale for integrating this technology into routine care of patients with volume-related disorders,discuss the normal and abnormal waveforms,limitations,and future directions.
文摘As a diagnostic aid in emergency services,ultrasound has expanded considerably in recent years.Among its applications,ocular ultrasonography allows for a better evaluation of patients with ophthalmological emergencies.In addition,it provides a simple and easy technique to obtain clinical information that may not be easily accessible either through the clinical examination or by using the ophthalmoscope.Ocular ultrasonography can help to diagnose hemorrhage and retinal detachment and/or vitreous,eye infections,foreign bodies,retrobulbar hematomas,papilledema,and eye trauma.By measuring the diameter of the optic nerve sheath,intracranial hypertension could be screened.This article reviewed the approach to eye exam by ultrasound and common ophthalmic pathologies diagnosed with ultrasound in the emergency department.
文摘Objective: To examine the correlation between plasma hCG results obtained with the new i-STAT® hCG point of care test with those concomitantly obtained from the central hospital laboratory utilizing the same patient samples. Methods: Prospective cross-sectional laboratory test evaluation. We compared plasma hCG results obtained with the i-STAT® hCG test (Abbott Point of Care, Princeton, NJ, USA) with Architect Ci8200 (Abbott Laboratories, Abbott Park, IL, USA). We also calculated the total coefficient of variation (CV) for the i-STAT® method. Results: The two methods showed a good linear correlation (R2 = 0.994;slope 1.03) and CV for the i-STAT® method was 2.1% - 5.2%. Conclusion: We suggest that the i-STAT® hCG blood assay could be used as a complement to urine hCG assays in clinical situations when rapid test results are needed and urine is not available.
文摘BACKGROUND: Diagnostic imaging is an integral aspect of care that is often insufficient, if not altogether absent, in rural and remote regions of low to middle income countries(LMICs) such as Tanzania. The introduction of ultrasound can significantly impact treatment in these countries due to its portability, low cost, safety, and usefulness in various medical assessments. This study reviews the implementation of a four-week ultrasound course administered annually from 2013–2016 in a healthcare professional school in Mwanza, Tanzania by first-year allopathic US medical students.METHODS: Participants(n=582, over 4 years) were recruited from the Tandabui Institute of Health Sciences and Technology to take the ultrasound course. Subjects were predominantly clinical officer students, but other participants included other healthcare professional students, practicing healthcare professionals, and school employees. Data collected includes pre-course examination scores, post-course examination scores, course quiz scores, demographic surveys, and postcourse feedback surveys. Data was analyzed using two-tailed t-tests and the single factor analysis of variance(ANOVA).RESULTS: For all participants who completed both the pre-and post-course examinations(n=229, 39.1% of the total recruited), there was a significant mean improvement in their ultrasound knowledge of 42.5%, P<0.01.CONCLUSION: Our data suggests that trained first-year medical students can effectively teach a point of care ultrasound course to healthcare professional students within four weeks in Tanzania. Future investigation into the level of long-term knowledge retention, impact of ultrasound training on knowledge of human anatomy and diagnostic capabilities, and how expansion of an ultrasound curriculum has impacted access to care in rural Tanzania is warranted.
基金This work was supported by the financial support of the PI17CIII/00045 and PI20CIII/00019 grants from the AES-ISCIII program to R.B.The financial support of the PID2019-103899RB-I00(Ministerio de Ciencia e Innovación)Research Project and the TRANSNANOAVANSENS-CM Program from the Comunidad de Madrid(S2018/NMT-4349)to S.C.are gratefully acknowledged.+3 种基金G.D.acknowledges the financial support of PI15/00246 grant of the FIS and Cátedra UAM-Roche en Medicina de InnovaciónThe FPU predoctoral contract to A.M.-C.is supported by the Spanish Ministerio de Educación,Cultura y Deporte.G.S.-F.is recipient of a predoctoral contract(1193818 N)supported by The Flanders Research Foundation(FWO).M.A.-N.was supported by a contract of the Programa Operativo de Empleo Juvenily la Iniciativa de Empleo Juvenil(YEI)with the participation of the Consejería de Educación,Juventud y Deporte de la Comunidad de Madrid y del Fondo Social EuropeoThe predoctoral contract from the Spanish Ministerio de Economía y Competitividad(BES-2016-076606,E.P.)Talento-Contract from Comunidad de Madrid(2019-T2/IND-15965,R.M.T.-R.)are also gratefully acknowledged.
文摘Colorectal cancer(CRC)is the second leading cause of cancer-related death worldwide.The five-year survival rate of CRC patients depends on the stage at diagnosis,being higher than 80%when CRC is diagnosed in the early stages but lower than 10%when CRC is diagnosed in advanced stages.Autoantibodies against specific CRC autoantigens(tumor-associated antigens(TAAs))in the sera of patients have been widely demonstrated to aid in early diagnosis.Thus,we herein aim to identify autoantigens target of autoantibodies specific to CRC that possess a significant ability to discriminate between CRC patients and healthy individuals by means of liquid biopsy.To that end,we examined the protein content of the exosomes released by five CRC cell lines and tissue samples from CRC patients by means of immunoprecipitation coupled with mass spectrometry analysis.A total of 103 proteins were identified as potential autoantigens specific to CRC.After bioinformatics and meta-analysis,we selected 15 proteins that are more likely to be actual CRC autoantigens in order to evaluate their role in CRC prognosis by Western blot(WB)and immunohistochemistry(IHC).We found dysregulation at the protein level for 11 of these proteins in both tissue and plasma exosome samples from patients,along with an association of nine of these proteins with CRC prognosis.After validation,all but one showed a statistically significant high diagnostic ability to distinguish CRC patients and individuals with premalignant lesions from healthy individuals,either by luminescence Halotag-based beads,or by a multiplexed biosensing platform involving the use of magnetic microcarriers as solid support modified with covalently immobilized Halotag fusion proteins constructed for CRC detection.Taken together,our results highlight the usefulness of the approach defined here to identify the TAAs specific to chronic diseases;they also demonstrate that the measurement of autoantibody levels in plasma against the TAAs identified here could be integrated into a point-of-care(POC)device for CRC detection with high diagnostic ability.
文摘BACKGROUND: The purpose of this study was to use point-of-care ultrasound(POCUS) to investigate the relationship between tobacco smoke exposure and the characteristics of the common carotid artery(CCA). The effect of both primary and secondary smoking on CCA properties was evaluated.METHODS: We performed a prospective cross-sectional study across 20 primary care clinics in Bandung, West Java, Indonesia in July 2016. Point of care ultrasound was performed on a convenience sample of Indonesian patients presenting to clinic. The CCA wall stiffness and carotid intima-media thickness(CIMT) were measured during diastole and systole. These measurements were correlated with smoke exposure and cardiovascular disease.RESULTS: We enrolled 663 patients in the study, with 426 patients enrolled in the smoking category and 237 patients enrolled in the second-hand smoke category. There was an overall positive correlation with the measured lifestyle factors and the ultrasound-measured variables in the group of individuals who smoked. For all variables, age seemed to contribute the most out of all of the lifestyle factors for the positive changes in CIMT and CCA wall stiffness.CONCLUSION: Our data yielded correlations between CCA properties and cardiovascular risk, as well as between CIMT and arterial stiffness. We were also able to demonstrate an increase in thickness of the CIMT in patients who have been exposed by tobacco through the use of ultrasound. Further large scale studies comparing patients with multiple cardiac risk factors need to be performed to confi rm the utility of ultrasound fi ndings of cardiovascular disease and stroke.
文摘<b><span style="font-family:Verdana;">Background:</span></b><span style="font-family:Verdana;"> Craniosynostosis surgery is one of the most hemorrhagic interventions, where transfusion rates vary from 20</span><span style="font-family:Verdana;">%</span><span style="font-family:""><span style="font-family:Verdana;"> to 100% depending on the study. </span><b><span style="font-family:Verdana;">Objective: </span></b><span style="font-family:Verdana;">To describe intraoperative and postoperative outcomes in a secondary analysis of children who underwent craniosynostosis surgery included in the initial retrospective study with the aim of proposing intraoperative implementation optimization protocols for postoperative outcome improvement. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> Secondary analysis. The study was approved by the </span><span><span style="font-family:Verdana;">Ethics Committee. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">There were 69 children with a median age of 10 </span></span></span><span style="font-family:Verdana;">[</span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;"> - </span><span style="font-family:Verdana;">207</span><span style="font-family:Verdana;">]</span><span style="font-family:""><span style="font-family:Verdana;"> months. Eight (11.6%) patients had intraoperative and/or postoperative complications. One patient (1.5%) had intraoperative hemorrhagic shock, and two patients (2.9%) had intraoperative broncholaryngospasm. One patient (1.5%) had postoperative anaphylaxis. One patient (1.5%) had postoperative hemorrhagic shock. One patient (1.5%) had postoperative respiratory failure. Two patients (2.9%) had postoperative neurologic failure. One patient (1.5%) had neuro-meningeal sepsis. One patient (1.5%) had a re-operation. There was no in-hospital mortality. Fourty-eight patients (69.6%) had intraoperative transfusions. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Transfusion protocols guided with point-of-care tests should be included in patient blood management programs in craniosynostosis surgery.
基金This work was supported by SMILE(a SAW-MIP Integrated device for oraL cancer Early detection)project,part of the ATTRACT program that has received funding from the European Union’s Horizon 2020 Research and Innovation Program(777222).
文摘Rapid prototyping methods for the design and fabrication of polymeric labs-on-a-chip are on the rise,as they allow high degrees of precision and flexibility.For example,a microfluidic platform may require an optimization phase in which it could be necessary to continuously modify the architecture and geometry;however,this is only possible if easy,controllable fabrication methods and low-cost materials are available.In this paper,we describe the realization process of a microfluidic tool,from the computer-aided design(CAD)to the proof-of-concept application as a capture device for circulating tumor cells(CTCs).The entire platform was realized in polymethyl methacrylate(PMMA),combining femtosecond(fs)laser and micromilling fabrication technologies.The multilayer device was assembled through a facile and low-cost solvent-assisted method.A serpentine microchannel was then directly biofunctionalized by immobilizing capture probes able to distinguish cancer from non-cancer cells without labeling.The low material costs,customizable methods,and biological application of the realized platform make it a suitable model for industrial exploitation and applications at the point of care.
基金Funding for this study was provided through grants from the National Bio and Agro-Defense Facility(NBAF)Transition Fund from the State of Kansas,and the AMP Core of the Center of Emerging and Zoonotic Infectious Diseases(CEZID)from National Institute of General Medical Sciences(NIGMS)under award number P20GM130448.
文摘African swine fever(ASF)is a highly lethal disease of domestic and wild swine caused by African swine fever virus(ASFV).The disease currently circulates in Africa,Europe,Asia and on the island of Hispaniola.The ongoing epizootics in Europe and Asia have produced millions of animal deaths and severe economic losses.No effective vaccine is available for ASF,making rapid and accurate detection of ASFV essential for disease mitigation strategies.Currently available diagnostics for ASFV possess significant limitations related to assay performance,deployability,and/or turn-around time;therefore there is an unmet need for pen-side diagnostic tests with sufficient sensitivity and specificity.A chromatographic lateral flow immunoassay(LFIA)was developed for the detection of ASFV antigen in EDTA-treated whole blood using monoclonal antibodies targeting the viral p30 protein.The assay requires only water to perform and provides results in 25 min,making it well-suited for field use.The LFIA was capable of detecting genotype I and genotype II strains of ASFV in EDTA blood from experimentally infected pigs at varying time-points after infection,though it was unable to detect a genotype X ASFV strain.Diagnostic sensitivity correlated with clinical disease severity,body temperature,and viral DNA levels,and was over 90%in animals showing moderate to severe ASF-related symptoms after challenge with virulent genotype II virus.The LFIA also showed a robust diagnostic specificity of over 98%,which is essential to field testing for a high consequence to foregin animal disease.The LFIA targeting the viral p30 protein can reliably detect ASFV in whole blood from animals showing moderate to severe clinical signs of infection with virulent genotype I and II isolates,making it a promising candidate for use as a field-deployable antigen detection assay.Additional evaluation using field samples and different virus strains is required to further assess the utility of this rapid diagnostic test.
文摘BACKGROUND Current clinical treatment options for symptomatic,partial-thickness rotator cuff tear(sPTRCT)offer only limited potential for true tissue healing and improvement of clinical results.In animal models,injections of adult stem cells isolated from adipose tissue into tendon injuries evidenced histological regeneration of tendon tissue.However,it is unclear whether such beneficial effects could also be observed in a human tendon treated with fresh,uncultured,autologous,adipose derived regenerative cells(UA-ADRCs).A specific challenge in this regard is that UA-ADRCs cannot be labeled and,thus,not unequivocally identified in the host tissue.Therefore,histological regeneration of injured human tendons after injection of UA-ADRCs must be assessed using comprehensive,immunohistochemical and microscopic analysis of biopsies taken from the treated tendon a few weeks after injection of UA-ADRCs.CASE SUMMARY A 66-year-old patient suffered from sPTRCT affecting the right supraspinatus and infraspinatus tendon,caused by a bicycle accident.On day 18 post injury[day 16 post magnetic resonance imaging(MRI)examination]approximately 100 g of abdominal adipose tissue was harvested by liposuction,from which approximately 75×10^(6) UA-ADRCs were isolated within 2 h.Then,UA-ADRCs were injected(controlled by biplanar X-ray imaging)adjacent to the injured supraspinatus tendon immediately after isolation.Despite fast clinical recovery,a follow-up MRI examination 2.5 mo post treatment indicated the need for open revision of the injured infraspinatus tendon,which had not been treated with UAADRCs.During this operation,a biopsy was taken from the supraspinatus tendon at the position of the injury.A comprehensive,immunohistochemical and microscopic analysis of the biopsy(comprising 13 antibodies)was indicative of newly formed tendon tissue.CONCLUSION Injection of UA-ADRCs can result in regeneration of injured human tendons by formation of new tendon tissue.
文摘As we continue to fight against the current coronavirus disease-2019(COVID-19)pandemic,healthcare professionals across the globe are trying to answer questions surrounding how to best help patients with the up-to-date available science while awaiting the development of new therapies and mass vaccination.Since early in the pandemic,studies indicated a heightened risk of venous thromboembolism(VTE)in COVID-19 infected patients.There have been differing expert opinions about how to assess pretest probability of VTE in this patient population.This has been partly due to the high prevalence of respiratory failure in this patient population and the use of D-dimer as a prognostic test which is also frequently elevated in patients with COVID-19 in absence of VTE.Some experts have argued for an approach similar to usual care with testing if clinical suspicion is high enough.Some have argued for more routine screening at different points of care.Others have even suggested empiric therapeutic anticoagulation in moderate to severely ill COVID-19 patients.In the following article,we review and summarize the most current literature in hopes of assisting clinicians in decision making and guidance for when to be concerned for VTE in COVID-19 patients.We also discuss research gaps and share pathways currently being used within our institution.
文摘<b> Background: </b>The World Health Organization recommends to have all pregnant women to undergo an obstetric ultrasound scan before 24 weeks gestation. However, this has been a challenge as a result of limited access to appropriate Point of Care Ultrasound Screening (POCUS) services in lower levels of developing countries’ Health Systems, cost of care, skills gap among care providers and unclear regulatory policy frameworks. Obstetric Ultrasound scan helps to confirm viability of a pregnancy, gestational age, multiple pregnancies and it also helps rule out fetal abnormalities early enough. <b>Methods: </b>One year after intervention, a cross-sectional study was carried in the two pilot counties of <i>Kisii </i>(rural) and <i>Kajiado </i>(peri-urban). This followed after selected midwives in the two counties were trained on basic obstetric ultrasound screening for ANC women. A total of 366 women who were either in their last phases of pregnancy or had delivered within three months before the survey were interviewed. Cumulatively, the 36 midwives had screened 1,250 mothers out of whom 18 high risk pregnancies were identified. Open Data Kit (ODK) was used to collect quantitative data and analysed using STATA version 15. Descriptive statistics were used to summarize the data test associations between variables. Bivariate and logistic regression was used to identify predictive variables, and ORs with 95% confidence intervals used to measure the strength of the associations. <b>Findings: </b>Slightly more than a third (36%) of the women had recently delivered. In total, Kisii (rural county) had a representation of 59% of the respondents. Half of the respondents were aged between 25 - 34 years, 55% of the women interviewed were housewives while 48% had secondary level of education. Only 21% of the women had undergone routine ultrasound screening before 24 weeks of gestation with the average distance travelled by majority (45%) of the respondents to access the POCUS service being 3 - 5 km. The need to confirm a pregnancy’s gestation was the major (68.1%) motivator for seeking the service in the two pilot counties. Employment status, household income, education level, pregnancy gestation and distance to the facility had a statistical significance (<i>P</i> < 0.05) with ultrasound utilization. Highest education level, pregnancy gestation and distance to the nearest ultrasound screening facility were found to significantly predict the likelihood of utilizing the ultrasound services (<i>P </i>< 0.05). The initial training and continuous hands-on coaching of midwives by TOTs contributed a lot to acquisition of the desired basic obstetric ultrasound screening skills. <b>Conclusion: </b>Women in developing countries are eager to access obstetric ultrasound screening services but for limited opportunities and sustainable implementation frameworks on Point of Care Ultrasound Screening (POCUS) services. Training and continuous coaching of frontline health professionals are critical in deployment of POCUS but there is limited access to standardised training content.
基金This research received no specific grant from any funding agency in the public,commercial,or not-for-profit sectors.
文摘Objective:This quality improvement project evaluated the impact of a point-of-care(POC)HbA1c stat lab intervention and a nurse-assisted expanded visit implemented among patients with uncontrolled type 2 diabetes(T2D)at a community health center in Houston,TX.Methods:This was a before-and-after POC intervention among adult patients who received primary care services between 1 July 2014 and 31 December 2014(baseline visit)and who had at least one 3-month follow-up visit.Results:Three hundred eighty-seven patients were included in the study.The majority were<60 years of age(72.1%),female(60.5%),and Hispanic(63%),followed by black(16.5%)and Asian(11.1%).Almost 87%of the patients had uncontrolled T2D(HbA1c>9%)at baseline,with the highest average levels among Hispanic(10.9%)and black(10.7%)patients.There was a significant difference in the HbA1c level before(mean=10.65,SD=1.9291)and after(mean=9.25,SD=1.8187)intervention.The absolute reduction in the level of HbA1c was 1.4%(t=12.834,p<0.001),corresponding to a 13%overall percentage decrease from baseline.Conclusion:There is a distinct advantage in using a stat HbA1c lab when combined with shared POC visits to assist patients with uncontrolled T2D in lowering the HbA1c,improving self-management,and reducing long-term costs.
基金Fundamental Research Funds for the Central Universities,Grant/Award Number:ZQN-818State Key Laboratory of Chemo/Biosensing and Chemometrics,Grant/Award Number:2019006+1 种基金Natural Science Foundation of Fujian Province,China,Grant/Award Number:2021J01310National Natural Science Foundation of China,Grant/Award Numbers:21775128,21804022。
文摘Given the continuous and growing demand for point of care(POC)diagnostic tests,attention has been shifted toward integration and miniaturization of laboratory protocols into“sample-in-answer-out”devices.Microfluidic technologies have been considered an ideal solution to address the requirements of POC diagnostics since many laboratory functions can be miniaturized and incorporated onto a single integrated chip.In this review,we summarize the advances of integrated microfluidic devices for POC diagnostics in the last 3 years.Particularly,we summarize current materials used for microfluidic chip fabrication,discuss the innovation of versatile integrated microfluidic devices,especially the strategies for simplifying sample preparation in manual or self-driven systems,and new detection methods of microfluidic chips.In addition,we describe new integrated microfluidic devices for POC diagnostics of protein-targeted immunodiagnostics,nucleic acid molecular tests,and small molecule metabolites analysis.We also provide future perspectives and current challenges for clinical translation and commercialization of these microfluidic technologies.
文摘Central venous pressure(CVP)serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume,venous compliance,cardiac output,and orthostasis.Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance.Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances.Elevated CVP can lead to fluid accumulation in the interstitial space,impairing venous return and reducing cardiac preload.While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate,they carry risk of complications and their usage has not shown clinical improvement.Ultrasound-based assessment of the internal jugular vein(IJV)offers real-time,non-invasive measurement of static and dynamic parameters for estimating CVP.IJV parameters,including diameter and ratio,has demonstrated good correlation with CVP.Despite significant advancements in non-invasive CVP measurement,a reliable tool is yet to be found.Present methods can offer reasonable guidance in assessing CVP,provided their limitations are acknowledged.