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1.
Biosens Bioelectron ; 142: 111508, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31325675

RESUMO

Incorporation of new readout methods with established analytical devices allows methodological innovations in analytical sciences. Herein, we present a new sensing platform by combining an ultrasensitive element analyzer, namely the laser-induced breakdown spectroscopy (LIBS) and a lateral flow strip (LFS). AgxAuy bimetallic nanoparticles (AgxAuyBNPs) are selected as the labels to deliver the optimal quantitative performance by analyzing the Ag (I) signal from the test (T) line of LFS. For prototypical application in pathogen detection, the LIBS-LFS sensor can achieve a detection limit of 1.6 cfu mL-1 of Staphylococcus aureus (S. aureus) within 10 min, which is superior to conventional methods. Importantly, the signals of AgxAuyBNPs for visual and LIBS analysis are stable and still readable after the detection is finished and the test strip is stored for up to 13 days, suggesting a potential for long-term data preservation. This combination of LIBS with LFS provides a new concept toward integrated nano/analytical devices that can benefit various application scenarios.


Assuntos
Técnicas Biossensoriais/instrumentação , Nanopartículas Metálicas/química , Fitas Reagentes/análise , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Animais , Técnicas Biossensoriais/economia , Água Potável/microbiologia , Desenho de Equipamento , Análise de Alimentos/economia , Análise de Alimentos/instrumentação , Microbiologia de Alimentos , Ouro/química , Humanos , Lasers , Limite de Detecção , Leite/microbiologia , Fitas Reagentes/economia , Prata/química , Análise Espectral/economia , Análise Espectral/instrumentação , Infecções Estafilocócicas/diagnóstico
2.
BMJ Open ; 8(3): e019924, 2018 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-29567849

RESUMO

OBJECTIVE: Screening for diabetes in low-resource countries is a growing challenge, necessitating tests that are resource and context appropriate. The aim of this study was to determine the diagnostic accuracy of a self-administered urine glucose test strip compared with alternative diabetes screening tools in a low-resource setting of Cambodia. DESIGN: Prospective cross-sectional study. SETTING: Members of the Borey Santepheap Community in Cambodia (Phnom Penh Municipality, District Dangkao, Commune Chom Chao). PARTICIPANTS: All households on randomly selected streets were invited to participate, and adults at least 18 years of age living in the study area were eligible for inclusion. OUTCOMES: The accuracy of self-administered urine glucose test strip positivity, Hemoglobin A1c (HbA1c)>6.5% and capillary fasting blood glucose (cFBG) measurement ≥126 mg/dL were assessed against a composite reference standard of cFBGmeasurement ≥200 mg/dL or venous blood glucose 2 hours after oral glucose tolerance test (OGTT) ≥200 mg/dL. RESULTS: Of the 1289 participants, 234 (18%) had diabetes based on either cFBG measurement (74, 32%) or the OGTT (160, 68%). The urine glucose test strip was 14% sensitive and 99% specific and failed to identify 201 individuals with diabetes while falsely identifying 7 without diabetes. Those missed by the urine glucose test strip had lower venous fasting blood glucose, lower venous blood glucose 2 hours after OGTT and lower HbA1c compared with those correctly diagnosed. CONCLUSIONS: Low cost, easy to use diabetes tools are essential for low-resource communities with minimal infrastructure. While the urine glucose test strip may identify persons with diabetes that might otherwise go undiagnosed in these settings, its poor sensitivity cannot be ignored. The massive burden of diabetes in low-resource settings demands improvements in test technologies.


Assuntos
Diabetes Mellitus/urina , Glicosúria/diagnóstico , Glicosúria/epidemiologia , Programas de Rastreamento/métodos , Fitas Reagentes/normas , Adulto , Idoso , Camboja/epidemiologia , Estudos Transversais , Diabetes Mellitus/sangue , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Teste de Tolerância a Glucose , Hemoglobina A Glicada/análise , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fitas Reagentes/economia , Autoadministração , Sensibilidade e Especificidade , Urinálise/normas
3.
Am J Manag Care ; 24(2): e30-e36, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29461848

RESUMO

OBJECTIVES: To evaluate the relationship between cost sharing for blood glucose testing strips and glycemic control rates. STUDY DESIGN: A retrospective observational study using medical and pharmacy claims data integrated with laboratory glycated hemoglobin (A1C) values for patients using insulin and testing strips. A new user study design was utilized to identify individuals from 14 commercial US health plans who filled testing strips with assumed intention to monitor blood glucose. METHODS: Patients were divided into low (<20% of annual testing strip cost; n = 3575) and high (≥20%; n = 3580) cost-sharing categories. We compared the likelihood of patients in low and high cost-sharing categories achieving glycemic control (A1C <8.0%) through modified Poisson regression models. RESULTS: Patients with low cost sharing for testing strips had higher rates of control than those with high cost sharing (58.1% vs 50.3%; P <.001). Low cost sharing was associated with greater probability of glycemic control (adjusted risk ratio [aRR], 1.14; 95% CI, 1.09-1.20; P <.0001). Glycemic control was more likely for patients in areas with median household income greater than $60,000 versus less than $40,000 (aRR, 1.16; 95% CI, 1.07-1.25; P <.01) and greater than $80,000 versus less than $40,000 (aRR, 1.18; 95% CI, 1.06-1.32; P <.01). CONCLUSIONS: We found a statistically significant correlation between cost sharing for testing strips and better A1C control for patients using insulin medication. Lower cost sharing for testing strips can remove a barrier to diabetes self-management and may lead to improved glycemic control at the population level. Future efforts should study the potential benefits of reducing diabetic complications and associated cost savings.


Assuntos
Automonitorização da Glicemia/economia , Custo Compartilhado de Seguro/estatística & dados numéricos , Diabetes Mellitus/sangue , Hemoglobina A Glicada/análise , Seguro Saúde/estatística & dados numéricos , Fitas Reagentes/economia , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Autogestão/economia , Fatores Socioeconômicos , Adulto Jovem
4.
Talanta ; 179: 186-192, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29310220

RESUMO

The recent goal of sustainability in analytical chemistry has boosted the development of eco-designed analytical tools to deliver fast and cost-effective analysis with low economic and environmental impact. Due to the recent focus in sustainability, we report the use of low-cost filter paper as a sustainable material to print silver electrodes and to load reagents for a reagent-free electrochemical detection of chloride in biological samples, namely serum and sweat. The electrochemical detection of chloride ions was carried out by exploiting the reaction of the analyte (i.e. chloride) with the silver working electrode. During the oxidation wave in cyclic voltammetry the silver ions are produced, thus they react with chloride ions to form AgCl, while in the reduction wave, the following reaction occurs: AgCl + e- -->Ag + Cl-. These reactions at the electrode surface resulted in anodic/cathodic peaks directly proportional to the chloride ions in solution. Chloride ions were detected with the addition of only 10µL of the sample on the paper-based electrochemical cell, obtaining linearity up to 200mM with a detection limit equal to 1mM and relative standard deviation lower than 10%. The accuracy of the sensor was evaluated in serum and sweat samples, with percentage recoveries between 93 ± 10 and 108 ± 8%. Moreover, the results achieved with the paper-based device were positively compared with those obtained by using the gold standard method (Ion Selective Electrode) adopted in routine clinical analyses.


Assuntos
Técnicas Biossensoriais/métodos , Cloretos/análise , Técnicas Eletroquímicas/métodos , Fitas Reagentes/análise , Soro/química , Suor/química , Técnicas Biossensoriais/economia , Calibragem , Técnicas Eletroquímicas/economia , Humanos , Eletrodos Íon-Seletivos , Limite de Detecção , Oxirredução , Papel , Fitas Reagentes/economia , Prata/química
5.
J Am Chem Soc ; 139(33): 11616-11621, 2017 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-28782946

RESUMO

Early detection of ovarian cancer, the most lethal type of gynecologic cancer, can dramatically improve the efficacy of available treatment strategies. However, few screening tools exist for rapidly and effectively diagnosing ovarian cancer in early stages. Here, we present a facile "lock-key" strategy, based on rapid, specific detection of plasma lysophosphatidic acid (LPA, an early stage biomarker) with polydiacetylenes (PDAs)-based probe, for the early diagnosis of ovarian cancer. This strategy relies on specifically inserting LPA "key" into the PDAs "lock" through the synergistic electrostatic and hydrophobic interactions between them, leading to conformation transition of the PDA backbone with a concomitant blue-to-red color change. The detailed mechanism underlying the high selectivity of PDAs toward LPA is revealed by comprehensive theoretical calculation and experiments. Moreover, the level of LPA can be quantified in plasma samples from both mouse xenograft tumor models and patients with ovarian cancer. Impressively, this approach can be introduced into a portable point-of-care device to successfully distinguish the blood samples of patients with ovarian cancer from those of healthy people, with 100% accuracy. This work provides a valuable portable tool for early diagnosis of ovarian cancer and thus holds a great promise to dramatically improve the overall survival.


Assuntos
Detecção Precoce de Câncer/métodos , Lisofosfolipídeos/sangue , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/diagnóstico , Fitas Reagentes/análise , Animais , Detecção Precoce de Câncer/instrumentação , Desenho de Equipamento , Feminino , Humanos , Interações Hidrofóbicas e Hidrofílicas , Lisofosfolipídeos/análise , Camundongos , Camundongos Endogâmicos C57BL , Ovário/patologia , Polímero Poliacetilênico , Polímeros/química , Poli-Inos/química , Fitas Reagentes/economia , Eletricidade Estática
6.
Value Health ; 20(4): 556-566, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28407997

RESUMO

OBJECTIVE: To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care. METHODS: Decision analytic model synthesising data from a multicentre, prospective cohort study (DUTY) and the wider literature to estimate the short-term and lifetime costs and healthcare outcomes (symptomatic days, recurrent UTI, quality adjusted life years) of eight diagnostic strategies. We compared GP clinical judgement with three strategies based on a 'coefficient score' combining seven symptoms and signs independently associated with UTI and four strategies based on weighted scores according to the presence/absence of five symptoms and signs. We compared dipstick testing versus laboratory culture in children at intermediate risk of UTI. RESULTS: Sampling, culture and antibiotic costs were lowest in high-specificity DUTY strategies (£1.22 and £1.08) compared to clinical judgement (£1.99). These strategies also approximately halved urine sampling (4.8% versus 9.1% in clinical judgement) without reducing sensitivity (58.2% versus 56.4%). Outcomes were very similar across all diagnostic strategies. High-specificity DUTY strategies were more cost-effective than clinical judgement in the short- (iNMB = £0.78 and £0.84) and long-term (iNMB =£2.31 and £2.50). Dipstick tests had poorer cost-effectiveness than laboratory culture in children at intermediate risk of UTI (iNMB = £-1.41). CONCLUSIONS: Compared to GPs' clinical judgement, high specificity clinical rules from the DUTY study could substantially reduce urine sampling, achieving lower costs and equivalent patient outcomes. Dipstick testing children for UTI is not cost-effective.


Assuntos
Técnicas Bacteriológicas/economia , Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde , Fitas Reagentes/economia , Urinálise/economia , Infecções Urinárias/diagnóstico , Fatores Etários , Antibacterianos/economia , Antibacterianos/uso terapêutico , Pré-Escolar , Análise Custo-Benefício , Árvores de Decisões , Custos de Medicamentos , Humanos , Julgamento , Valor Preditivo dos Testes , Prevalência , Atenção Primária à Saúde/economia , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Recidiva , Indução de Remissão , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Reino Unido/epidemiologia , Procedimentos Desnecessários/economia , Urinálise/instrumentação , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/economia , Infecções Urinárias/epidemiologia , Urina/microbiologia
7.
8.
J AOAC Int ; 99(2): 512-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26965994

RESUMO

Dipstick test kits are being widely used for the rapid screening of a range of antigens or toxins in food, agriculture, and health care. They provide specific results on-site within 10 min with suitable accuracy and are, therefore, cost-effective. Multiplex dipsticks also provide the opportunity for simultaneous detection of multiple antigens in the target sample without using expensive instrumentation, minimizing the cost of analysis as well as the duration of assay. Because of these benefits, dipstick kits are widely being used in the simultaneous detection of several antigens/toxins in large number of samples and in high-throughput manner. This review focuses on the current status of developed multiplex strips and its working principles and future direction of the technology in the agriculture, food, nutrition, and health care sectors.


Assuntos
Agricultura , Assistência à Saúde , Análise de Alimentos , Valor Nutritivo , Fitas Reagentes , Agricultura/economia , Antígenos/análise , Antígenos/economia , Assistência à Saúde/economia , Análise de Alimentos/economia , Humanos , Fitas Reagentes/economia
9.
Diabet Med ; 33(5): 681-90, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26443548

RESUMO

AIM: To determine the cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service, providing guidance for disinvestment and testing the hypothesis that advanced meter features may justify higher prices. METHODS: Using data from the Health and Social Care Information Centre concerning all 8 340 700 self-monitoring of blood glucose-related prescriptions during 2013/2014, we conducted a cost-minimization analysis, considering both strip and lancet costs, including all clinically equivalent technologies for self-monitoring of blood glucose, as determined by the ability to meet ISO-15197:2013 guidelines for meter accuracy. RESULTS: A total of 56 glucose monitor, test strip and lancet combinations were identified, of which 38 met the required accuracy standards. Of these, the mean (range) net ingredient costs for test strips and lancets were £0.27 (£0.14-£0.32) and £0.04 (£0.02-£0.05), respectively, resulting in a weighted average of £0.28 (£0.18-£0.37) per test. Systems providing four or more advanced features were priced equal to those providing just one feature. A total of £12 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of £23.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price. CONCLUSION: The study uncovered considerable variation in the price paid by the National Health Service for self-monitoring of blood glucose, which could not be explained by the availability of advanced meter features. A standardized approach to self-monitoring of blood glucose prescribing could achieve significant efficiency savings for the National Health Service, whilst increasing overall utilisation and improving safety for those currently using systems that fail to meet acceptable standards for measurement accuracy.


Assuntos
Automonitorização da Glicemia , Redução de Custos , Diabetes Mellitus/sangue , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde , Promoção da Saúde , Modelos Econômicos , Automonitorização da Glicemia/efeitos adversos , Automonitorização da Glicemia/economia , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/tendências , Terapia Combinada/economia , Terapia Combinada/instrumentação , Terapia Combinada/tendências , Custos e Análise de Custo , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Reforma dos Serviços de Saúde/economia , Promoção da Saúde/economia , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/economia , Hiperglicemia/prevenção & controle , Hipoglicemia/diagnóstico , Hipoglicemia/economia , Hipoglicemia/prevenção & controle , Guias de Prática Clínica como Assunto , Prescrições , Melhoria de Qualidade/economia , Qualidade da Assistência à Saúde , Fitas Reagentes/economia , Reprodutibilidade dos Testes , Medicina Estatal , Reino Unido
10.
Québec; INESSS; 2016.
Monografia em Francês | BRISA/RedTESA | ID: biblio-848870

RESUMO

INTRODUCTION: Le diabète mellitus est une maladie chronique qui se caractérise par une hyperglycémie, qui apparaît lorsque l'organisme est incapable de sécréter une quantité suffisante d'insuline, en présence ou non de résistance à celle-ci. Selon les estimations publiées par l'Association canadienne du diabète, environ 3,4 millions de Canadiens étaient atteints de diabète, en 2015. Parmi les différentes formes existantes, le diabète de type 2 est de loin le plus répandu. L'autosurveillance glycémique (ASG) est l' une des approches offertes pour aider la personne atteinte de diabète à contrôler sa glycémie. L'utilisation de bandelettes et d'un glucomètre permet de mesurer la glycémie capillaire et d'ajuster, si nécessaire, les habitudes de vie ou la médication. En 2015, les dépenses liées à la classe des bandelettes ont totalisé près de 104 millions de dollars et concerné environ 285 000 personnes couvertes par le régime public d'assurance médicaments (RPAM) du Québec. Or, d'après les mesures instaurées dans les autres provinces anadiennes, près de 30 % des utilisateurs assurés au RPAM et non traités à l'insuline semblent en faire un usage non optimal, ce qui entraîne des coûts pour le réseau de la santé et des services sociaux, sans gain de santé pour les utilisateurs. Les autres provinces canadiennes, à l'exception du Québec, ont mis en place des mesures encadrant le remboursement des bandelettes afin de favoriser un usage optimal et de limiter les coûts. C'est dans ce contexte


INTRODUCTION: Diabetes mellitus is a chronic disease characterized by hyperglycemia, which occurs when the body is unable to produce sufficient insulin, whether or not in the presence of insulin resistance. According to the estimates published by the Canadian Diabetes Association (CDA), around 3.4 million Canadians lived with diabetes in 2015. Of the different existing forms, type 2 diabetes is by far the most widespread. Self-monitoring of blood glucose (SMBG) is one of the approaches offered to help people with diabetes control their blood glucose (BG) levels. The use of BG test strips and a meter helps to measure capillary glycemia and to make any necessary lifestyle or medication adjustments. In 2015, expenditures tied to the class of BG test strips totalled nearly $104 million and concerned around 285,000 people covered by Québec's public prescription drug insurance plan (PPDIP). Based on the measures introduced in the other Canadian provinces, about 30% of users covered by the PPDIP and not treated with insulin seem to make non-optimal use of them, which leads to costs for the health and social services system, without health benefits for users. The other Canadian provinces, except for Québec, have introduced measures governing the reimbursement of BG test strips to encourage their optima


Assuntos
Automonitorização da Glicemia/métodos , Diabetes Mellitus/sangue , Políticas Públicas de Saúde , Avaliação em Saúde/economia , Fitas Reagentes/economia , Mecanismo de Reembolso/economia , Avaliação da Tecnologia Biomédica
12.
J Diabetes Sci Technol ; 9(6): 1275-81, 2015 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-26071426

RESUMO

BACKGROUND: The prevalence of diabetes is increasing in low-resource settings; however, accessing glucose monitoring is extremely difficult and expensive in these regions. Work is being done to address the multitude of issues surrounding diabetes care in low-resource settings, but an affordable glucose monitoring solution has yet to be presented. An inkjet-printed test strip solution is being proposed as a solution to this problem. METHODS: The use of a standard inkjet printer is being proposed as a manufacturing method for low-cost glucose monitoring test strips. The printer cartridges are filled with enzyme and dye solutions that are printed onto filter paper. The result is a colorimetric strip that turns a blue/green color in the presence of blood glucose. RESULTS: Using a light-based spectroscopic reading, the strips show a linear color change with an R(2) = .99 using glucose standards and an R(2) = .93 with bovine blood. Initial testing with bovine blood indicates that the strip accuracy is comparable to the International Organization for Standardization (ISO) standard 15197 for glucose testing in the 0-350 mg/dL range. However, further testing with human blood will be required to confirm this. A visible color gradient was observed with both the glucose standard and bovine blood experiment, which could be used as a visual indicator in cases where an electronic glucose meter was unavailable. CONCLUSIONS: These results indicate that an inkjet-printed filter paper test strip is a feasible method for monitoring blood glucose levels. The use of inkjet printers would allow for local manufacturing to increase supply in remote regions. This system has the potential to address the dire need for glucose monitoring in low-resource settings.


Assuntos
Automonitorização da Glicemia/economia , Automonitorização da Glicemia/instrumentação , Glicemia/análise , Países em Desenvolvimento/economia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Custos de Cuidados de Saúde , Impressão/economia , Fitas Reagentes/economia , Animais , Biomarcadores/sangue , Automonitorização da Glicemia/normas , Calibragem , Bovinos , Colorimetria/economia , Colorimetria/instrumentação , Análise Custo-Benefício , Diabetes Mellitus/sangue , Desenho de Equipamento , Estudos de Viabilidade , Humanos , Modelos Lineares , Teste de Materiais , Valor Preditivo dos Testes , Impressão/normas , Fitas Reagentes/normas , Reprodutibilidade dos Testes
13.
Am J Trop Med Hyg ; 92(6 Suppl): 17-23, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25897064

RESUMO

Carrying out chemical analysis of antimalarials to detect low-quality medications before they reach a patient is a costly venture. Here, we show that a library of chemical color tests embedded on a paper card can presumptively identify formulations corresponding to very low quality antimalarial drugs. The presence or absence of chloroquine (CQ), doxycycline (DOX), quinine, sulfadoxine, pyrimethamine, and primaquine antimalarial medications, in addition to fillers used in low-quality pharmaceuticals, are indicated by patterns of colors that are generated on the test cards. Test card sensitivity for detection of these pure components ranges from 90% to 100% with no false positives in the absence of pharmaceutical. The color intensities from reactions characteristic of CQ or DOX allowed visual detection of formulations of these medications cut with 60% or 100% filler, although samples cut with 30% filler could not be reliably detected colorimetrically. However, the addition of unexpected fillers, even in 30% quantities, or substitute pharmaceuticals, could sometimes be detected by other color reactions on the test cards. Tests are simple and inexpensive enough to be carried out in clinics, pharmacies, and ports of entry and could provide a screening method to presumptively indicate very low quality medicines throughout the supply chain.


Assuntos
Antimaláricos/química , Antimaláricos/normas , Papel , Fitas Reagentes/química , Colorimetria/instrumentação , Colorimetria/métodos , Medicamentos Falsificados/química , Países em Desenvolvimento , Reações Falso-Positivas , Controle de Qualidade , Fitas Reagentes/economia , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
15.
J Diabetes Sci Technol ; 8(3): 615-8, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24876627

RESUMO

This case study describes the clinical impact of moving to a single brand of glucose test strips. In 2013 the New Zealand public health system completed a move to procure test strips at a significant discount. The associated direct savings is estimated at around 40% of the total glucose strip budget. Half the local diabetes population undertake glucose monitoring using government-funded diabetes supplies. These patients no longer have a choice of brand of meters and strips. Although the majority of patients adapted well to this change, a small percentage did not. Also, some consumers expressed concerns about analytical performance of the new strips, when used in everyday life. A pragmatic postmarketing surveillance system, designed with consumer input, may help address these residual concerns.


Assuntos
Automonitorização da Glicemia/instrumentação , Glicemia/análise , Assistência à Saúde , Diabetes Mellitus/diagnóstico , Equipamentos para Diagnóstico/provisão & distribução , Fitas Reagentes/provisão & distribução , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Automonitorização da Glicemia/economia , Comportamento de Escolha , Redução de Custos , Assistência à Saúde/economia , Diabetes Mellitus/sangue , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Equipamentos para Diagnóstico/economia , Custos de Cuidados de Saúde , Humanos , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Nova Zelândia , Satisfação do Paciente , Valor Preditivo dos Testes , Fitas Reagentes/economia , Avaliação da Tecnologia Biomédica , Resultado do Tratamento
16.
Prim Care Diabetes ; 8(1): 13-21, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24360230

RESUMO

OBJECTIVE: Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. METHODOLOGY: A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by expert's persons. RESULTS: Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. CONCLUSIONS: The use of AMGC has an uncertainty efficiency. More studies are needed.


Assuntos
Automonitorização da Glicemia/economia , Glicemia/metabolismo , Orçamentos , Diabetes Mellitus Tipo 2/diagnóstico , Custos de Cuidados de Saúde , Biomarcadores/sangue , Glicemia/efeitos dos fármacos , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Valor Preditivo dos Testes , Fitas Reagentes/economia
17.
J Obstet Gynaecol ; 34(1): 21-4, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24359043

RESUMO

Detection of asymptomatic bacteriuria (ASB) in pregnancy is important to avert the attendant morbidities. Therefore, we assessed the use of chlorhexidine reaction to detect ASB in pregnancy. This was a prospective study, which compared chlorhexidine reaction with dipstick tests and urine culture in 150 asymptomatic pregnant women. Urine cultures detected bacteriuria in seven women (4.7%). Chlorhexidine detected ASB in 72 women (48%) and had sensitivity, specificity and accuracy of 100%, 54% and 56%, respectively. Leucocyte esterase (LE) and nitrite detected bacteriuria in 31 (20.7%) women and 12 (8.0%) women, respectively. Singly, LE had a sensitivity and specificity of 14.3% and 79%, respectively, while nitrite's sensitivity and specificity was 42.9% and 93.7%, respectively. Combined, LE and nitrite had better sensitivity (97.9%) and accuracy (94%). Since the accuracy of chlorhexidine is low, other than urine culture, combined dipstick urinalysis of leucocyte esterase and nitrite tests is good to detect asymptomatic bacteriuria in pregnancy.


Assuntos
Bacteriúria/diagnóstico , Clorexidina , Desinfetantes , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Bacteriúria/urina , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/urina , Estudos Prospectivos , Fitas Reagentes/economia , Urinálise/economia , Adulto Jovem
18.
J Forensic Leg Med ; 20(8): 1126-30, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24237835

RESUMO

The screening and confirmatory tests available to a forensic laboratory allow evidence to be examined for the presence of bodily fluids. With the majority of evidence being submitted involving sexual assaults, it is important to have confirmatory tests for the identification of semen that are straightforward, quick, and reliable. The purpose of this study was to compare two commonly used semen identification kits utilized by forensic laboratories: ABAcard(®) p30 and Rapid Stain Identification of Human Semen (RSID™-Semen). These kits were assessed with aged semen stains, fresh and frozen post-vasectomy semen, post-coital samples collected on different substrates, post-vasectomy semen mixed with blood, saliva, and urine, a series of swabs collected at increasing time intervals after sexual intercourse, and multiple non-semen samples. The test kits were compared on the basis of sensitivity, specificity, and the cost and time effectiveness of each protocol. Overall, both semen identification tests performed well in the studies. Both kits proved specificity for identifying semen, however the ABAcard(®) p30 test surpassed the RSID™-Semen test in sensitivity, cost per test, and simplified test protocol.


Assuntos
Cromatografia de Afinidade/métodos , Fitas Reagentes , Sêmen/química , Biomarcadores/análise , Análise Química do Sangue , Líquidos Corporais , Coito , Análise Custo-Benefício , Criopreservação , Feminino , Medicina Legal/instrumentação , Humanos , Masculino , Antígeno Prostático Específico/isolamento & purificação , Fitas Reagentes/economia , Saliva/química , Proteínas Secretadas pela Vesícula Seminal/isolamento & purificação , Sensibilidade e Especificidade , Manejo de Espécimes , Urina/química
19.
J Diabetes Sci Technol ; 7(2): 328-38, 2013 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-23566989

RESUMO

It has been estimated that 24 million Americans have diabetes, many of whom are Medicare beneficiaries. These individuals carefully monitor their blood glucose levels primarily through the use of in-home blood glucose testing kits. Although the test is relatively simple, the cumulative expense of providing glucose test strips and lancets to patients is ever increasing, both to the Medicare program and to uninsured individuals who must pay out-of-pocket for these testing supplies. This article discusses the diabetes durable medical equipment (DME) coverage under Part B Medicare, the establishment and role of DME Medicare administrative contractors, and national and local coverage requirements for diabetes DME suppliers. This article also discusses the federal government's ongoing concerns regarding the improper billing of diabetes testing supplies. To protect the Medicare Trust Fund, the federal government has contracted with multiple private entities to conduct reviews and audits of questionable Medicare claims. These private sector contractors have conducted unannounced site visits of DME supplier offices, interviewed patients and their families, placed suppliers on prepayment review, and conducted extensive postpayment audits of prior paid Medicare claims. In more egregious administrative cases, Medicare contractors have recommended that problematic providers and/or DME suppliers have their Medicare numbers suspended or, in some instances, revoked. More serious infractions can lead to civil or criminal liability. In the final part of this article, we will examine the future of enforcement efforts by law enforcement and Medicare contractors and the importance of understanding and complying with federal laws when ordering and supplying diabetes testing strips and lancets.


Assuntos
Diabetes Mellitus/terapia , Equipamentos Médicos Duráveis , Setor de Assistência à Saúde/legislação & jurisprudência , Pessoal de Saúde/legislação & jurisprudência , Legislação de Dispositivos Médicos , Automonitorização da Glicemia/economia , Automonitorização da Glicemia/instrumentação , Serviços Contratados/economia , Serviços Contratados/legislação & jurisprudência , Serviços Contratados/organização & administração , Diabetes Mellitus/sangue , Equipamentos Médicos Duráveis/economia , Equipamentos Médicos Duráveis/provisão & distribução , Fidelidade a Diretrizes/legislação & jurisprudência , Fidelidade a Diretrizes/organização & administração , Fidelidade a Diretrizes/tendências , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Pessoal de Saúde/economia , Pessoal de Saúde/organização & administração , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Legislação de Dispositivos Médicos/economia , Legislação de Dispositivos Médicos/organização & administração , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/organização & administração , Fitas Reagentes/economia , Fitas Reagentes/provisão & distribução , Estados Unidos
20.
Analyst ; 138(9): 2620-3, 2013 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-23478509

RESUMO

Interferons (IFNs) play a role in inhibition of tumor growth and participate in immunoreactions. Among IFNs, interferon-γ (IFNγ) is one of the most important therapeutic proteins and its immunodulation ability is better than that of other types. The objective of this study is to develop a manual self-assembled colloidal gold nanoparticle-immunochromatographic strip for human IFNγ using anti-human IFNγ polyclonal and monoclonal antibodies. Colloidal gold with a 25 nm diameter was made from chloroauric acid (HAuCl4), and labeled on anti-IFNγ mAbs as a chrominance reagent. A good linear relationship existed between the pixel intensity and the human IFNγ concentrations from 10-1000 ng mL(-1) in mouse serum and buffer, respectively, the regression equation was Y = 0.159logX + 0.0648, R(2) = 0.992 in mouse serum; Y = 0.294logX + 0.091, R(2) = 0.9969 in phosphate buffer by this proposed strip. Moreover, in the determination for mouse serum samples no cross-reaction occurred and the detection time was approximately 10 minutes. The shelf life of the strip was above 28 days at room temperature. The major advantages of the manual operation model were no expensive instruments and less reagents required. This proposed strip was highly specific, economic, convenient, and no machine was needed in clinical diagnosis.


Assuntos
Cromatografia de Afinidade/instrumentação , Coloide de Ouro/química , Interferon gama/sangue , Fitas Reagentes/análise , Animais , Anticorpos Imobilizados/química , Cromatografia de Afinidade/economia , Humanos , Interferon gama/análise , Limite de Detecção , Camundongos , Camundongos Endogâmicos BALB C , Fitas Reagentes/economia , Fatores de Tempo
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