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Transitioning the Nutritional Support Patient to Homecare
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Having the patient hospitalized gives you the opportunity to monitor the vital signs and clinical exam during the cycle progression. Look for evidence of volume overload during the cycling process. Fingerstick glucoses can be obtained during and after the infusion to determine the glucose excursion. Electrolyte balance can be examined, along with triglyceride levels, renal and hepatic function.
Syphilis
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Point of care testing is now being used, primarily in resource poor settings. Syphilis Health Check is the only point of care test currently FDA approved. It was approved in 2011, and received waver from the Clinical Laboratory Improvement Amendment (CLIA) to allow the test to be used by untrained personnel and outside of conventional lab settings in 2015. It is a rapid immunochromatographic test that qualitatively screens for antibodies to T. pallidum in serum, plasma, or whole blood. It can be performed on a fingerstick whole blood specimen, and yields result in 12 minutes. It is a screening test, so positive results should be followed up with confirmatory diagnostic testing. If confirmatory testing is not possible, immediate treatment of screen positive women and their partners has the potential to reduce transmission to the fetus and to sexual contacts. A number of logistical and technical problems have been reported with this approach, and so far no clear reduction in perinatal death has been observed. More trials are needed to adequately assess the risks and benefits of this strategy [21].
Peripheral Blood and Bone Marrow
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Fermina Maria Mazzella, Gerardo Perrotta
The glass slide method is shown in Fig. 1. Blood from a fingerstick is preferable, although ethylenediaminetetraacetic acid (EDTA)-anticoagulated blood is used more frequently. Glass slides have the advantages of Ease of handling and labelingEase of smear production and stainingLack of fragility—easy to store and transport
Highlighting and addressing barriers to widespread adaptation of HIV self-testing in the United States
Published in Expert Review of Molecular Diagnostics, 2023
The United States has a single second-generation oral fluid test, which detects only IgG antibodies [33]. Third-generation tests, which detect both IgM and IgG responses, have a shorter ‘window period’ after acute infection when serologic tests may be falsely negative as a serologic response has not yet occurred. Both the WHO and European Union have approved third-generation tests (Table 1). Although oral HIV self-tests are preferred due to their ease of collection of samples, their slightly lower sensitivity due to lower and more variable concentration of antibodies in the oral fluid may also result in a larger ‘window period’ of non-detection [33,51]. More research will need to be done to increase acceptability of blood-based self-tests or improve alternative detection methods using oral fluid, but the majority of tests preapproved by the WHO have been fingerstick blood.
Artifactual hypoglycemia in a patient with systemic sclerosis
Published in Acta Clinica Belgica, 2022
Jonathan Mertens, Maryam Haddad
Measurement of glycemia is essential in clinical practice, both in the primary assessment as in follow-up of hospitalized patients with disturbances in glucose metabolism. Since glucose levels are very dynamic and rapidly changing, it is common that multiple, repeated measurements are necessary. However, frequent venous or arterial whole blood sampling is unpleasant or even painful for the patient. Furthermore, they are expensive, timely and burden hospital resource utilization. Therefore, inpatient glucose levels are regularly assessed via bedside POC tests. POC testing is less invasive and cheaper, reduces waiting time and does not rely on phlebotomy which can be difficult to perform. It is generally performed via sampling of whole blood obtained via fingerstick which only requires one droplet of blood. Normally, the degree of agreement between capillary and arterial or venous blood glucose measurements is high, but certain factors can induce discrepancies between both techniques [25–27]. Well-known technical factors that commonly interfere are calibration of the meters, room temperature, dirt, high oxygen tension, humidity and aging of the strips. Certain drugs like ascorbic acid, acetaminophen, dopamine and mannitol also interfere with POC accuracy on some POC devices [28,29]. Some pathological factors can also interfere with the accuracy of POC testing, but knowledge about these clinical factors is generally lacking.
The host response as a tool for infectious disease diagnosis and management
Published in Expert Review of Molecular Diagnostics, 2018
Emily C. Lydon, Emily R. Ko, Ephraim L. Tsalik
Clearly, the perfect diagnostic test that enables early diagnosis of infection, reliably differentiates between bacterial and non-bacterial etiologies, and provides prognostic information may not be possible from a traditional, single analyte biomarker. Instead, panels of complementary single analyte biomarkers have been tested in the hope of greater diagnostic and prognostic utility. A combination of biomarkers from the same biological pathway are unlikely to demonstrate additive diagnostic utility. Instead, combining biomarkers from different biological pathways is more likely to demonstrate improved performance. For example, measurement of lactate and PCT perform better than either alone for sepsis diagnosis and predicting sepsis progression in ED patients [54,55]. Combining five protein biomarkers, Wong et al. developed a decision tree through the PERSERVERE study to reliably stratify pediatric sepsis risk [56,57]. Further down the diagnostic pipeline, FebriDx® is a diagnostic test manufactured by Rapid Pathogen Screening Diagnostics® that combines CRP (upregulated with bacterial infection) and myxovirus resistance protein A (associated with viral infection) to discriminate between viral and bacterial causes of respiratory illness with 80–87% sensitivity and 83–94% specificity [58]. Notably, this point-of-care, fingerstick-based diagnostic test produces results in under 15 min. Currently, FebriDX is available for commercial use in Canada and Europe, but not in the United States.