News
iPhone users will be able to download medical records from hospitals after Apple software update
iPhone users will be able to download medical records and hospital lab test results onto their mobiles as of spring this year.
Apple has announced that patients from 12 different hospitals in the US will be able to view their medical information in the Health app in the next upgrade to Apple's operating system. Medical records from various institutions, including allergies, medical conditions, immunizations and prescriptions will also be available.
Apple already allows iPhone users to store health information gathered by the Apple Watch and other connected devices in its Health app, but this is the first time a system for retrieving records from a variety of medical providers has been launched on a smartphone.
HIV-positive community says Ontario’s ruling on non-disclosure cases is first step of long process
A move by the Ontario government to limit the prosecution of HIV-positive people who don’t disclose their status to sexual partners is being called as a step in the right direction by some HIV-positive people in the province, but they say that there’s much more progress to be made.
The government announced on Friday that people with low viral loads who don’t have a realistic chance of transmitting the disease can’t be charged with a crime if they don’t disclose their medical status to a sexual partner.
Previously, non-disclosure could lead to an aggravated sexual assault charge that landed convicted people on a sex offender list.
However, advocates in the community say there are downsides to the ruling as well. Jeff Potts, managing director of the support and advocacy group Canadian Positive People Network, said that decriminalizing only people with low viral loads means the community will be divided between people who are fortunate enough to get the medical treatment they need, and marginalized people who are not.
“At the end of the day, laws that criminalize people living with HIV for any reason, unless it can be proven there was intentional harm, are unjust,” said Potts, who has been HIV-positive for three decades.
Ontario made the changes after studies showed that the risk of transmission is negligible if people are being treated for the disease or if appropriate precautions are taken.
Medical lab giant vows to put patients first
The Canadian arm of a giant global "life sciences company" that swallowed up a diagnostic lab business in Winnipeg promises to enhance the experience of patients and customers.
In a letter to physicians last month about its purchase of Unicity Laboratory and X-Ray Services, Dynacare said it was closing some locations where there was a duplication in services and where the company said it could provide "an improved customer experience at a larger location with more staff."
Dynacare operates 200 laboratory and health services centres in Ontario, Quebec, Manitoba and Saskatchewan. Their services include blood collection, urinalysis and allergy testing. The company now owns 63 locations in Winnipeg. Prior to the acquisition of Unicity, 21 locations were closed, Dynacare spokeswoman Andrea Price in Toronto said.
In the company’s letter to Winnipeg doctors, Dynacare did not list the closed locations. When asked on Friday, a spokeswoman for Dynacare didn’t provide an example of a lab that closed because of duplication. She did, however, provide an example of something expected to improve customer experience.
The company plans to introduce "Dynacare Net Check-In" in Manitoba early in 2018, Price said.
The free mobile app gives patients access to an electronic check-in service, Price said. Net Check-In lets patients hold their spot in line before they arrive at the lab, so they can arrive just in time for their test. The service was created to make it more convenient for patients by reducing on-site wait times. She said the service already is available in other provinces where Dynacare operates.
Except for hospital labs, Dynacare now owns all the facilities in Winnipeg that carry on services such as blood collection and urinalysis.
Critics have said consolidation of private labs could result in the erosion of Canada’s publicly-funded health care system.
Medical labs play a role in 80 per cent of medical diagnoses in Canada, Canadian Nurse reported in 2011. Laboratory workers make up the third-largest group of health-care professionals in Canada and medical laboratories consume more than $4 billion of public money every year, it said.
Dynacare is owned by LabCorp which has 52,000 employees in about 60 countries and bills itself as a "global life sciences company." It reported net revenues of nearly $9.5 billion for 2016.
Pre-Analytical
Researchers safely transport blood samples via 3-hour drone flight in hot climate
Results of hematology and chemistry tests performed on blood samples flown for 3 hours on mid-level drones showed that long drone flights of biological samples are feasible.
However, stringent environmental controls are required to ensure consistent results, according to Timothy K. Amukele, MD, PhD, and colleagues.
“Most tests were unchanged by the drone flight, but there were changes in glucose and potassium levels,” Amukele, pathologist at Johns Hopkins University School of Medicine, and colleagues wrote. “These changes were due to the long flight and high temperatures; however, these factors can be controlled.”
As HemOnc Today previously reported, the researchers showed in an earlier study that laboratory tests performed on blood samples flown on hobby-sized drones yielded results comparable to those performed on samples that never left the ground.
In that proof-of-concept study, the biologics were transported in ambient temperatures for maximum flight times of 40 minutes — equivalent to 40 km — in a fixed-wing vehicle and 27 minutes, equivalent to 13 km to 20 km, in a multirotor.
However, “these times and distances were not sufficient to address the needs of real-world drone networks,” the researchers wrote.
Point-of-Care
Scientists still seek a reliable DUI test for marijuana
Despite the increased use of cannabis in many states, cops still don’t have the equivalent of a reliable alcohol breathalyzer or blood test — a chemically based way of estimating what the drug is doing in the brain. Though a blood test exists that can detect some of marijuana’s components, there is no widely accepted, standardized amount in the breath or blood that gives police or courts or anyone else a good sense of who is impaired.
Coming up with a standardized blood or breath test is also a really tricky chemistry problem because of the properties of the main psychoactive chemical in cannabis: delta-9-tetrahydrocannabinol, or THC.
Ethanol, the chemical in alcoholic drinks that dulls thinking and reflexes is small and dissolves in water. Because humans are mostly water, it gets distributed fairly quickly and easily throughout the body and is usually cleared within a matter of hours. But THC, the main chemical in cannabis that produces some of the same symptoms, dissolves in fat. That means the length of time it lingers in the body can differ from person to person even more than alcohol — influenced by things like gender, amount of body fat, frequency of use, and the method and type of cannabis product consumed.
Tara Lovestead, a chemical engineer at the National Institute of Standards and Technology in Boulder, CO. believes an accurate breath test would likely involve looking at a lot more than just THC — probably a whole combination of chemicals.
“One thing to look for would be metabolites — something that comes out of the breath that shows it actually went through your system,” she said. Such a test would greatly reduce the possibility that someone might test positive from inhaling secondhand smoke, she said.
She recently published a paper in the journal Forensic Chemistry where she found the vapor pressure of THC — one of its fundamental physical properties. Lovestead believes finding and standardizing that measurement is a small but significant step toward a more objective route for evaluating intoxicated drivers.
Clinical Chemistry
A ‘Shark Tank’-funded test for food sensitivity is medically dubious, experts say
What EverlyWell describes as one of its best-sellers — a test for food sensitivity — is of dubious medical value, according to experts. The $199 test promises to use a fingerprick’s worth of blood to gauge whether a person’s immune system is active against 96 common foods, including asparagus, garlic, and eggs. An immune protein called immunoglobulin G, the company’s website says, could be to blame for symptoms such headaches, stomach pain, diarrhea, and fatigue.
Yet physician groups have for years advised against using immunoglobulin G tests to evaluate for so-called food sensitivities or intolerances. And allergy experts told STAT that the test is useless at best and could even cause harm if it leads customers to unnecessarily cut nutritious foods from their diet.
Food sensitivity is an umbrella term that encompasses symptoms that can arise, for example, from difficulty digesting a food, as in lactose intolerance, or susceptibility to the effect of a food, as in caffeine sensitivity. These symptoms, however, do not involve an immune response. (Food allergies, on the other hand, have more serious symptoms and are driven by the immune system; validated tests for them do exist.)
Patients who ask Dr. Robert Wood, an allergist at Johns Hopkins Children’s Center, whether they have a food sensitivity would never undergo an immunoglobulin G test. Immunoglobulin G tests “are completely useless and do dramatic harm” because they may compel patients to unnecessarily avoid broad swaths of a healthy diet, Wood said.
That’s because immunoglobulin G stems from the body’s normal immune response to exposure to many substances, including food. High levels don’t indicate a problem; they simply point to foods a person recently has eaten.
EverlyWell’s food sensitivity tests exploit a frustrating fact for those wondering whether their symptoms stem from the food they eat: There is no easy way to find an answer. The doctor-advised approach is to cut common offenders from the diet one by one — a so-called elimination diet — but that is cumbersome, time-consuming, and, by its very nature, restrictive.
“It is hard to remove certain foods from the American diet, and people may want a definitive way to know which foods cause symptoms without eliminating it,” said Dr. Christina Ciaccio, an allergist at the University of Chicago. “Unfortunately, such a test doesn’t exist.”
Hematology
Research Could Improve Treatment of Pregnancy Complications
A study in AACC's The Journal of Applied Laboratory Medicine has for the first time established female-specific reference ranges for several biological variables that play key roles in thrombosis during pregnancy. This research could help lower the high U.S. maternal death rate by enabling more precise identification of pregnant women at risk for thrombosis-related complications such as preeclampsia.
The U.S. has a higher maternal death rate than any other industrialized country, with an estimated 26.4 mothers dying for every 100,000 live births as of 2015. Many of these deaths are caused by thrombosis-related complications such as preeclampsia, for which women are at higher risk if they have an underlying condition known as thrombophilia. Because of this, if a woman experiences a thrombosis-related complication during pregnancy, it is important that she undergo testing for thrombophilia after delivery (when clotting factors are no longer influenced by pregnancy). This information is integral to guiding care in potential future pregnancies.
Diagnosing thrombophilia with accuracy in women is challenging, however, in part because the range of normal values for thrombophilia tests are based on male or mixed-sex populations, even though levels of certain clotting and anti-clotting factors differ significantly between women and men.
A team of researchers led by Moniek P.M. de Maat, PhD, of Erasmus University Medical Center Rotterdam in the Netherlands, has now demonstrated that the use of precise female-specific reference ranges significantly refines thrombophilia test results. Overall, de Maat's team found that female-specific reference ranges ruled out a greater number of women as negative for thrombophilia.
Microbiology
How often should you actually wash your sheets? A Microbiologist weighs in
There's nothing like that just-crawled-under-fresh-sheets feeling, but sometimes getting there can be a pain. While it's always tempting to leave the laundry for another day, it turns out we should all be scheduling a wash into our weekly calendars.
Clinical microbiologist Douglas Toal, Ph.D., is intimately familiar with the unseen chemicals and microbes that live among us, and he's quick to point out that beds attract tons of them. "One study found that between 4 and 17 different species of fungi can be found on pillows of various ages," he tells mbg. "In addition to fungal and bacterial species, bed coverings contain all sorts of microscopic debris including pet dander, lint, soil, dust, dust mites and their droppings, various excrements from the body, skin cells, cosmetics, synthetic chemicals, and other particles."
While plenty of microbes in our environment are not harmful, Toal advises keeping them in check. When inhaled, certain microbial assemblies can cause or exacerbate existing respiratory disease and allergies. "Since the microscopic particles in our bed are in close proximity to our airways, we can be confident that the microbes, debris, and allergens that have built up in our sheets and pillows are in frequent contact with our airways and skin," he explains.
In order to make sure your dreams are sweet and allergen-free, Toal recommends cleaning or changing your bed sheets once a week, more so if you're prone to infection. When you think about the fact that we spend a third of our life rolling around on our sheets, this rigid schedule makes a lot of sense. According to a small 2016 study, a good amount of people—nearly 46 percent—are already washing their sheets weekly, while 30 percent do so a few times a month, and 22 percent do so once a month or less.
Ethics
A New Generation of Prenatal Testing Raises Ethical Questions
A new generation of simple blood tests is allowing would-be parents to learn about the sex and potential genetic anomalies of their babies in the first trimester, a stage of the pregnancy when it's relatively easy to get an abortion in Canada.
Known as non-invasive prenatal testing (NIPT), the approach has the advantage of giving some women more time to make decisions about their pregnancies, while helping others to avoid unnecessary invasive procedures such as amniocentesis, which carry a small risk of miscarriage.
But NIPT also raises difficult ethical questions, especially among opponents of sex-selective abortion and people with Down syndrome, who fear NIPT will make it easier to screen their condition out of future generations.
Complicating matters further, for-profit genetic testing companies are, in some cases, offering to screen for conditions that are much rarer than Down syndrome and therefore harder to reliably detect.
"There is some concern that because it's a very good test, doctors and patients would consider it a 100-per-cent reliable test that could replace amniocentesis or other invasive tests, which is not true," said Dr. Audibert, who is also one of the lead authors of a new prenatal screening guideline published in September by the Society of Obstetricians and Gynaecologists of Canada and the Canadian College of Medical Geneticists.
That caveat is even more important when NIPT is used to detect rarer genetic conditions such as trisomy 13 (Patau syndrome), trisomy 18 (Edwards syndrome) or Turner syndrome, a condition that arises when a female is missing all or part of the X chromosome, which helps to determine the sex of a fetus.
The waters get even murkier when it comes to screening for a slew of different microdeletion syndromes, which occur when a small segment of a chromosome is missing. Several companies already offer microdeletion screening to women who can pay, but the new Canadian guidelines recommend against it, saying there isn't enough good evidence that cfDNA can reliably detect microdeletions.
Vardit Ravitsky, a professor of bioethics at the University of Montreal, predicted it won't be long before the companies vying for dominance of the NIPT market begin to offer screening for dozens more potential genetic flaws whose effects on a baby's future health are unclear.
In the meantime, doctors, ethicists, pregnant women and their partners are wrestling with the choices NIPT already provides.
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