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Wk4 POC Testing/Automation & Diabetes - Coggle Diagram
Wk4 POC Testing/Automation & Diabetes
Evidence-Based Medicine (EBM)
Conscientious, judicious, & explicit use of the best evidence in making decisions about care of indiv patients
Point of care (POC) Testing
Performed at or near site of patient care
Blood glucose testing
Blood gas & electrolyte analysis
Rapid coagulation testing
Drugs of abuse screening
Alcohol screening
Pregnancy testing
Food pathogen screening
Cholesterol screening
Advantages
Reduced turnaround time
Modification of patient care from results
Testing in remote areas
Allows mobile clinics
Reduces burden of samples to be analysed
Reduce need for out-of-hours testing
Automation
Why automate?
Reduce human error
Decrease lab costs
Increase productivity
Improve turnaround time
Retain lower operating costs
Barcoding
Point of Care Testing Examples
cTnT -
immunostrip Ab based assay (sandwich ELISA) with internal control
Pregnancy test (hCG)
, immunostrip assay
Glucose
Single blood drop (capillary) assay (e.g. AccuChek)
Based on same method as for standard lab test (enzyme assay)
Coupled to electrochemical signal output
Continuous monitoring (interstitial), microneedle samples every few minutes and relays levels to patient (iPhone)
Can be coupled with insulin pump for automatic infusion
Blood clotting time, capillary blood group, clotting activated with thromboplastin & measure electrochemically, measure INR for management of warfarin therapy
Glucose
Main energy source for body
Digestion of carbs from food
Carbs can be simple or complex
Simple carbs
Monosaccharides; glucose, fructose, galactose
Complex carbs
Polysaccharides; starches
Insulin
Lowers glucose levels in blood
Stimulates body cells to
absorb
glucose, liver to store glucose as glycogen & fat cells to convert glucose into fatty acids
Glucagon
Raises glucose levels in blood
Stimulates
breakdow
n of glycogen stored in liver & in muscle cells
Amylin & GLP-1
Regulate blood glucose by controlling food intake & appetite & stomach emptying, as well as insulin & glucagon secretion
Diabetes
Type 1
- Early onset, autoimmune disease of insulin deficiency (10%)
Type 2
- Late onset, obesity related with insulin resistance (90%)
Diagnosis
HbA1c (glycated Hb)
Glucose measured by either of two assay methods
Hexokinase
Glucose oxidase
Complications
Acute (Ketoacidosis, hyperosmolar coma)
Chronic (retinopathy, nephropathy, atherosclerosis)
Treatment
Type 1 DM = insulin injections/pump
Type 2 DM = from lifestyle (diet & exercise) to medication (e.g. metformin, sulfonylurea), all all aimed to return blood glucose, HbA1c, lipids & BP to normal ranges
Hypoglycemia - a potential of over-treatment esp. for type 1 DM
Metformin for type 2 DM acts at multiple levels to help control blood glucose levels