Microneedle-based device for the one-step painless collection of capillary blood samples.

The advancement of point-of-care diagnostics and the decentralization of healthcare have created a need for the simple, safe, standardized and painless collection of blood specimens. Here, we describe the design and implementation of a capillary blood-collection device that is more convenient and less painful than a fingerstick and venepuncture, and collects 100 µl of blood. The technology integrates into a compact, self-contained device an array of solid microneedles, a high-velocity insertion mechanism, stored vacuum, and a microfluidic system containing lithium heparin anticoagulant. The use of the device requires minimal training, as blood collection is initiated by the single push of a button. In a clinical study involving 144 participants, haemoglobin A1c measurements from device-collected samples and from venous blood samples were equivalent, and the pain associated with the device was significantly less than that associated with venepuncture. The device, which has received premarket clearance by the US Food and Drug Administration, should help improve access to healthcare, and support healthcare decentralization.

Psychosocial benefits of cardiac rehabilitation among women compared with men.

PURPOSE: Cardiac rehabilitation (CR) has been shown to reduce cardiac risk and improve the psychosocial functioning of participants. This study examines gender differences on several psychosocial indicators across the course of CR. METHODS: Patients (N = 380; 67.9% men and 32.1% women) referred from local inpatient and outpatient settings at a southeastern US academic medical facility were assessed on reported levels of depression, anxiety, panic, anger, and relationship satisfaction, using the Burns Brief Mood Survey, at the start and conclusion of a CR program. Medical variables were also assessed but are not the focus of this report. Statistical analyses included 1-way, Kruskal-Wallis, and repeated-measures analysis of variance procedures, as well as χ analyses. RESULTS: Women reported more psychosocial symptoms at pre-CR than men, and overall, both groups improved across CR. Women with significant depression, anxiety, and panic experienced clinically significant benefit across CR. Although the percentage of men reporting clinically significant levels of anger decreased significantly across CR, clinically significant levels of anger did not significantly change among women. In addition, women did not report benefits in relationship dissatisfaction. CONCLUSION: This study provides further evidence that CR offers psychosocial benefit for women, as has been reported in several small clinical samples. Some notable gender differences on anger and relationship satisfaction were observed. Clinical attention may be warranted to facilitate improvement for symptoms of anger and relationship concerns among selected women who participate in CR.

Integrative health coaching: an organizational case study.

OBJECTIVE: The aim of this study was to describe integrative health (IH) coaching as developed in three different interventions offered through a major medical center, as a step toward further defining the field of health coaching. STUDY DESIGN: An organizational case study was conducted with document analysis and interviews. SETTING/PARTICIPANTS: Interviewees were the first six IH coaches at Duke Integrative Medicine who provided 360 clients with individual and/or group coaching (two to 28 sessions) in a randomized clinical study and two work-site wellness programs. ANALYSIS: Qualitative analysis using the constant comparative method was conducted. RESULTS: Integrative health coaching is characterized by a process of self-discovery that informs goal setting and builds internal motivation by linking clients' goals to their values and sense of purpose. Time, commitment, and motivation are necessary in the IH coaching process. CONCLUSIONS: The underpinnings of IH coaching are distinct from the medical model, and the process is distinct from health education, executive coaching, and psychotherapy. Integrative health coaching fits well with the assumptions of integrative medicine and has a role in supporting behavior change.

Further testing of the reliability and validity of the ASK-20 adherence barrier questionnaire in a medical center outpatient population .

OBJECTIVE: This study examined the psychometric properties of the ASK-20 questionnaire, which was developed to assess barriers to medication adherence. RESEARCH DESIGN AND METHODS: Patients with asthma, diabetes, and congestive heart failure were recruited from a university medical center. Participants in this convenience sample completed the ASK-20 questionnaire and other questionnaires. Approximately one-third of participants were randomized to a 2-week retest administration. Analyses examined the reliability and validity of the ASK-20. RESULTS: A total of 112 patients participated (75.9% female; mean age = 46.7 years). The ASK-20 had good internal consistency reliability (Cronbach's alpha = 0.76) and test-retest reliability (0.80). Concurrent validity was demonstrated through significant correlations with the Morisky Medication Adherence Scale (r = -0.61, p < 0.001), condition-specific measures, and the SF-12 Mental Component Summary score (r = -0.40, p < 0.001). The correlation of the ASK-20 with proportion of days covered by filled medication prescriptions in the past 6 months (based on pharmacy claims) was relatively weak (r = -0.13), but in the expected direction. The ASK-20 total score significantly discriminated among groups of patients who differed in self-reported indicators including the Morisky score; missing a medication dose in the past week; number of days medication was not taken as directed; and treatment satisfaction. CONCLUSION: The ASK-20 demonstrated adequate reliability and validity, and it may be a useful measure of barriers to treatment adherence across a spectrum of chronic diseases. Limitations related to scale construction, lack of longitudinal data, and item characteristics are discussed.