RESUMEN
AIM: The aim of personalized medicine is to respond to the needs of individuals with appropriate treatment. Lab-on-a-chip systems (LOCs) can help to individualize therapeutic algorithms at the point of care. Herein, we discuss the perspectives, demands and concerns associated with LOCs. METHODS: Interviews with 30 experts in the field of personalized medicine were conducted, addressing the requirements, potentials and risks of LOCs. The interviews were transcribed and evaluated by means of qualitative content analysis. RESULTS: The majority of experts emphasize a considerable potential for the lab-on-a-chip industry with the largest potential in the context of point-of-care diagnostics. The direct-to-costumer use is regarded as risky, in particular with respect to the reliability of the results. CONCLUSION: In addition to a major potential of the implementation of LOCs, their impact on delivery of healthcare have to be considered, and early communication between physicians and LOC developers and manufacturers have to be ensured.
RESUMEN
Telemedicine is increasingly becoming a reality in medical care for the elderly. We performed a systematic literature review on telemedicine healthcare concepts for older patients. We included controlled studies in an ambulant setting that analyzed telemedicine interventions involving patients aged ≥60 years. 1585 articles matched the specified search criteria, thereof, 68 could be included in the review. Applications address an array of mostly frequent diseases, e.g. cardiovascular disease (N=37) or diabetes (N=18). The majority of patients is still living at home and is able to handle the telemedicine devices by themselves. In 59 of 68 articles (87%), the intervention can be categorized as monitoring. The largest proportion of telemedicine interventions consisted of measurements of vital signs combined with personal interaction between healthcare provider and patient (N=24), and concepts with only personal interaction (telephone or videoconferencing, N=14). The studies show predominantly positive results with a clear trend towards better results for "behavioral" endpoints, e.g. adherence to medication or diet, and self-efficacy compared to results for medical outcomes (e.g. blood pressure, or mortality), quality of life, and economic outcomes (e.g. costs or hospitalization). However, in 26 of 68 included studies, patients with characteristic limitations for older patients (e.g. cognitive and visual impairment, communication barriers, hearing problems) were excluded. A considerable number of projects use rather sophisticated technology (e.g. videoconferencing), limiting ready translation into routine care. Future research should focus on how to adapt systems to the individual needs and resources of elderly patients within the specific frameworks of the respective national healthcare systems.
