ANEMIA PROMISING ONE MINUTE POINT OF CARE TEST

A simple point-of-care testing device for anemia could provide more rapid diagnosis of the common blood disorder and allow inexpensive at-home self-monitoring of persons with chronic forms of the disease.

The disposable self-testing device analyzes a single droplet of blood using a chemical reagent that produces visible color changes corresponding to different levels of anemia. The basic test produces results in about 60 seconds and requires no electrical power. A companion smartphone application can automatically correlate the visual results to specific blood hemoglobin levels.

By allowing rapid diagnosis and more convenient monitoring of patients with chronic anemia, the device could help patients receive treatment before the disease becomes severe, potentially heading off emergency room visits and hospitalizations. Anemia, which affects two billion people worldwide, is now diagnosed and monitored using blood tests done with costly test equipment maintained in hospitals, clinics or commercial laboratories.

Because of its simplicity and ability to deliver results without electricity, the device could also be used in resource-poor nations.

A paper describing the device and comparing its sensitivity to gold-standard anemia testing was published August 30 in The Journal of Clinical Investigation. Development of the test has been supported by the FDA-funded Atlantic Pediatric Device Consortium, the Georgia Research Alliance, Children's Healthcare of Atlanta, the Georgia Center of Innovation for Manufacturing and the Global Center for Medical Innovation.

"Our goal is to get this device into patients' hands so they can diagnose and monitor anemia themselves," said Dr. Wilbur Lam, senior author of the paper and a physician in the Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta and the Department of Pediatrics at the Emory University School of Medicine. "Patients could use this device in a way that's very similar to how diabetics use glucose-monitoring devices, but this will be even simpler because this is a visual-based test that doesn't require an additional electrical device to analyze the results."

The test device was developed in a collaboration of Emory University, Children's Healthcare of Atlanta and the Georgia Institute of Technology -- all based in Atlanta. It grew out of a 2011 undergraduate senior design project in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. In 2013, it was among the winners of Georgia Tech's InVenture Prize, an innovation competition for undergraduate students, and won first place in the Ideas to SERVE Competition in Georgia Tech's Scheller College of Business.

Using a two-piece prototype device, the test works this way: A patient sticks a finger with a lance similar to those used by diabetics to produce a droplet of blood. The device's cap, a small vial, is then touched to the droplet, drawing in a precise amount of blood using capillary action. The cap containing the blood sample is then placed onto the body of the clear plastic test kit, which contains the chemical reagent. After the cap is closed, the device is briefly shaken to mix the blood and reagent.

"When the capillary is filled, we have a very precise volume of blood, about five microliters, which is less than a droplet -- much less than what is required by other anemia tests," explained Erika Tyburski, the paper's first author and leader of the undergraduate team that developed the device.

Blood hemoglobin then serves as a catalyst for a reduction-oxidation reaction that takes place in the device. After about 45 seconds, the reaction is complete and the patient sees a color ranging from green-blue to red, indicating the degree of anemia.

A label on the device helps with interpretation of the color, or the device could be photographed with a smartphone running an application written by Georgia Tech undergraduate student Alex Weiss and graduate student William Stoy. The app automatically correlates the color to a specific hemoglobin level, and could one day be used to report the data to a physician.

To evaluate sensitivity and specificity of the device, Tyburski studied blood taken from 238 patients, some of them children at Children's Healthcare of Atlanta and the others adults at Emory University's Winship Cancer Institute. Each blood sample was tested four times using the device, and the results were compared to reports provided by conventional hematology analyzers.

The work showed that the results of the one-minute test were consistent with those of the conventional analysis. The smartphone app produced the best results for measuring severe anemia.

"The test doesn't require a skilled technician or a draw of venous blood and you see the results immediately," said Lam, who is also an assistant professor in the Coulter Department of Biomedical Engineering. "We think this is an empowering system, both for the general public and for our patients."

Tyburski and Lam have teamed up with two other partners and worked with Emory's Office of Technology Transfer to launch a startup company, Sanguina, to commercialize the test, which will be known as AnemoCheck™. The test ultimately will require approval from the FDA. The team also plans to study how the test may be applied to specific diseases, such as sickle cell anemia -- which is common in Georgia.

The device could be on pharmacy shelves sometime in 2016, where it might help people like Tyburski, who has suffered mild anemia most of her life. "If I'd had this when I was kid, I could have avoided some trips to the emergency room when I passed out in gym class," she said.

About a third of the population is at risk for anemia, which can cause neurocognitive deficits in children, organ failure and less serious effects such as chronic fatigue. Women, children, the elderly and those with chronic conditions such as kidney disease are more likely to suffer from anemia.

Its Not What You Say Oh Wait A Minute It Is! A Guide For Pain Patient Supporters

Today's post from paindoctor.com is a very sensible list of better ways to support a pain patient via the things you say. It's not easy being a friend or relative of someone in chronic pain and most pain patients are well aware of that. Nevertheless, if people just took a second to think about how they phrase something, it can act as a positive and supporting moment for the patient. Unfortunately, thinking twice doesn't come naturally to most people. They think they're saying the right thing but are inadvertently hurting the patient's feelings by being a little insensitive. This article may just be able to act as a guide for friends and family; or at least make them think about how they approach certain issues.

Say This, Not That: Supporting The Chronic Pain Patient  
By Pain Doctor| September 30th, 2015

 People who have a chronic pain patient in their life often walk a fine line in terms of saying the wrong thing. Even the most caring person may inadvertently say things that can be hurtful. They may make assumptions or judgments in their language, not realizing they are doing so. In Say This, Not That, we identify some of these statements and offer alternatives.

Instead of: Does it really hurt that bad? Man up!

Suggesting that a chronic pain patient is less of a “man” or somehow less tough because they are in pain can be not only hurtful to the patient but also permanently damaging to your relationship with them.

Say: Time to call it a day? No problem. I’m ready, too.

Pain is the body’s way of protecting itself against further injury. In some cases, certain types of pain, such as the pain an athlete may feel in training, may be okay. When it comes to chronic pain, “manning up” can cause days or even weeks of backlash with intense pain and difficulty moving. Going at a chronic pain patient’s pace is telling them that it’s okay to feel what they are feeling and allows them the freedom to stop when they are done.

Instead of: There’s a lot you can’t do, isn’t there?

Talk about hurtful! Chronic pain patients are well aware that their condition has made life more challenging. There are activities that are no longer available to them, and they may never recover those abilities. To point this out is not only unsupportive but also downright cruel. There is no sense in highlighting what a chronic pain patient is missing out on.

Say: What do you enjoy doing?

Highlight the things that a chronic pain patient enjoys doing, and work towards those. If a patient says they loved to ride horses before their spinal injury, find a local horse rescue to visit. Do they love playing sports? Many types of adaptive sporting equipment are available for that. While they may never be able to compete in a hunter-pace or golf in a major tournament again, there are ways for chronic pain patients to enjoy the things they love. Accentuate what they can do instead of dwelling on what they can’t.

Instead of: Let me do that for you.

Chronic pain is often interpreted as helplessness. Even though awareness is growing, many still believe that chronic pain patients are unable to care for themselves in any capacity. Others may believe that physical exertion and activity are to be strenuously avoided and will rush in to take over every task, from little things like chopping onions to more physical actions like rearranging furniture.

Say: How can I help?

Before you take those groceries away from a chronic pain patient, ask first if you can help. Although chronic pain patients have days when even blinking is a painful activity, not every day is quite as challenging.

Treating a chronic pain patient as an invalid promotes a cycle of learned helplessness wherein the patient does little and then develops the ability to do even less. Physical activity and movement are actually recommended as much as possible for chronic pain patients, especially for those with conditions that worsen with inactivity (like rheumatoid arthritis). If you see a chronic pain patient struggling or about to fall from a burden they are carrying, don’t hesitate to assist. Otherwise, ask if they need help before swooping in.

Instead of: You are in pain? Here’s some aspirin/ibuprofen.

There are many different things that are wrong and potentially harmful in this statement.
Offering a chronic pain patient an aspirin for their pain is like bailing the ocean out with a teaspoon. Many chronic pain patients suffer from pain that an over-the-counter medication won’t even touch.
Assuming that chronic pain can be fixed by popping a pill – prescription or otherwise – is uninformed and plays into the stereotype of the addicted chronic pain patient.
Chronic pain patients who do take medication under the supervision of their doctors may have already taken their dose for the day, and to offer them more of anything can be dangerous.

Say: You are in pain? Is there any way I can help?

Chances are good that the answer to that question will be “no,” but asking to help instead of offering what you feel is the best solution is the fastest way to earn a chronic pain patient’s respect and trust. In doing so, you are not assuming anything about the chronic pain patient’s experience. You are making yourself available to help in any way that the patient needs, and that is an invaluable gift.
Instead of: Wow, you take a lot of pills!

Chronic pain patients who are taking prescription or over-the-counter medications for pain are already completely aware that they take “a lot” of pills. This statement may be embarrassing for them and may make them less likely to be open about their treatments with you.

If you are a caregiver, the last thing you want is a patient who feels like they have to hide their pills. This can make patients feel ashamed of their treatment and potentially less likely to follow it closely. There is also a strong emotional aspect of chronic pain, and treating a chronic pain patient like an overeager pill-popper is the fastest way to make them feel isolated and alone.

Say: I want to understand your treatment regimen. Are you willing to share?

Again, the answer to this might also be “no,” but asking the question instead of making assumptions is respectful and opens the door for better communication. In some cases, chronic pain patients may, indeed, be taking higher doses of over-the-counter medications than healthy people would take for muscle soreness or a headache. Encouraging the patient to communicate about their treatments, including medication and therapies, can build trust and let the patient know that you truly care about them getting better. If there is any question about medication amounts or you have concerns later on about prescription abuse, this foundation of nonjudgmental trust can make it easier to talk about your concerns.

Instead of: Have you tried______ (examples include: juicing, yoga, meditation, etc.)?

While some chronic pain patients have found relief from some of their symptoms through diet, low-impact exercise, and mindfulness meditation, others have tried everything they can find, to no avail. It can be very frustrating to have a pain-free person suggest treatments that may be scientifically unfounded and/or considered sham treatments or “snake oil.”

Say: What treatments have worked for you?

Chronic pain patients often have a long list of treatments they have tried, some of which may have worked better than others. Rather than assuming you can fix your friend’s pain with a well-intentioned but potentially uniformed suggestion, ask them what has worked or what they might try next. There is a fine line between wanting to be helpful by providing suggestions and being condescending and ignorant in assuming the patient hasn’t tried what they can. If you are a caregiver of a chronic pain patient, you will know where that line is. Others need to be more sensitive when offering suggestions and seek first to understand what has already been tried.

It is important to assume nothing and communicate with kindness and compassion. What are some other potentially hurtful questions or statements, and how can they be turned around?

https://paindoctor.com/say-this-not-that-supporting-the-chronic-pain-patient/