Point‐of‐care testing as a tool for screening for diabetes and pre‐diabetes

Aim To determine the utility of finger‐prick point‐of‐care testing (POCT) of blood glucose for the detection of dysglycaemia. Methods A fasting POCT and an oral glucose tolerance test (OGTT) with laboratory assays were performed as part of the baseline screening for 5309 participants enrolled in the Te Wai o Rona Diabetes Prevention Strategy. Participants were aged 46 ± 19 years with no self‐reported diabetes. Dysglycaemia, including diabetes, was defined using World Health Organization criteria. Agreement between the two fasting plasma glucose measurements and their screening properties (with sensitivity and specificity for cut points) were compared using receiver operator characteristic analysis. Results A total of 3225 participants had both capillary and venous fasting blood sampled within 30 min and then underwent OGTT. New diabetes was found in 161 participants (5.0%) and pre‐diabetes in 414 [impaired glucose tolerance 299 (9.3%), impaired fasting glucose 115 (3.6%)]. The mean difference in capillary and venous measures was 0.02 mmol/l (95% confidence interval ?0.04 to +0.01; limits of agreement –1.37 to 1.33 mmol/l). Capillary POCT was a poorer predictor of dysglycaemia and impaired glucose tolerance and new diabetes (area under curve 0.76 and 0.71) than venous laboratory analysis (area under curve 0.87 and 0.81 respectively). Optimal screening criteria were best at a venous glucose of 5.4 mmol/l; 77% sensitivity/specificity. Conclusions POCT significantly underestimated the true blood glucose at diagnostic levels for diabetes. POCT cannot be recommended as a means of screening for or diagnosing diabetes or pre‐diabetes.     

Feasibility and acceptability of CD‐ROM‐based cognitive‐behavioural treatment for binge‐eating disorder

We compared preliminary feasibility and acceptability of CD‐ROM‐delivered CBT for overweight individuals with binge‐eating disorder (BED) to 10 weekly group CBT sessions (Group) and to a waiting list control (WL). Attrition was numerically greater in the Group than the CD‐ROM condition; although only Group differed significantly from WL in dropout rates. Those in the CD‐ROM condition reported continued use of their CD‐ROM after treatment. Also, the majority of WL participants elected to receive CD‐ROM over Group treatment at the end of the waiting period. Preliminarily, no significant differences emerged across the active treatment groups on most outcome measures. However, there was a significantly greater decline in binge days in the two active groups relative to WL. CD‐ROM appears to be an acceptable and at least initially preferred method of CBT delivery for overweight individuals with BED. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

B‐type natriuretic peptide and C‐terminal‐pro‐endothelin‐1 for the prediction of severely impaired peak oxygen consumption

Objective. To assess the utility of B‐type natriuretic peptide (BNP) and C‐terminal‐pro‐endothelin‐1 (CT‐proET‐1) to predict a severely impaired peak oxygen consumption (peak VO₂, < 14 mL kg^?1 min^?1) in patients referred for cardiopulmonary exercise testing. Design. Cross‐sectional study. Setting. Tertiary care center. Methods. Peak VO₂, BNP and CT‐proET‐1 were assessed in 141 consecutive patients referred for cardiopulmonary exercise testing. Results. B‐type natriuretic peptide [median (interquartile range) 48 (38–319) vs. 33 (15–86) pg mL^?1; P = 0.002] and CT‐proET‐1 [87 (76–95) vs. 60 (52–74) pmol L^?1; P < 0.001] were higher in patients with a peak VO₂ < 14 mL kg^?1 min^?1 (n = 30) than in those with a peak VO₂ ≥ 14 mL kg^?1 min^?1 (n = 111). CT‐pro‐ET‐1 had a higher area under the receiver‐operator‐characteristics curve (AUC) to predict a peak VO₂ < 14 mL kg^?1 min^?1 than BNP (0.79 vs. 0.68; P = 0.04). The optimal BNP cut‐off of 37.2 pg mL^?1 had a sensitivity of 80% and a specificity of 56%. The optimal CT‐proET‐1 cut‐off of 74.4 pmol L^?1 had a sensitivity of 80% and specificity of 76%. A five‐item score composed of body mass index, diabetes, forced expiratory volume within the first second, alveolo–arterial oxygen pressure difference, and BNP had an AUC of 0.88 to predict a peak VO₂ < 14 mL kg^?1 min^?1. Adding CT‐proET‐1 to the score resulted in an AUC of 0.92. Conclusions. C‐terminal‐pro‐endothelin‐1 is superior to BNP for the prediction of a peak VO₂ < 14 mL kg^?1 min^?1 in patients referred for CPET. A score incorporating body mass index, diabetes status, spirometry, blood gases, BNP and CT‐proET‐1 improves the prediction of a peak VO₂ < 14 mL kg^?1 min^?1 based on single biomarkers.     

Another tool for the fork‐in‐the‐road toolbox

• A provisional stent strategy for bifurcation disease is a good rule of thumb.
• The Tryton bifurcation stent is an additional potential useful tool for use in complex coronary disease.
• If and when this device has a drug‐eluting side branch, its true role may be clearer.

     

The Search for High‐Impact Diagnostic and Management Tools for Low‐ and Middle‐Income Countries: A Self‐Powered Low‐Cost Blood Pressure Measurement Device Powered by a Solid‐State Vibration Energy Harvester

The World Health Organization has established recommendations for blood pressure measurement devices for use in low‐resource venues, setting the “triple A” expectations of Accuracy, Affordability, and Availability. Because of issues related to training and assessment of proficiency, the pendulum has swung away from manual blood pressure devices and auscultatory techniques towards automatic oscillometric devices. As a result of power challenges in the developing world, there has also been a push towards semiautomatic devices that are not dependent on external power sources or batteries. Beyond solar solutions, disruptive technology related to solid‐state vibrational energy harvesting may be the next iterative solution to attain the ultimate goal of a self‐powered low‐cost validated device that is simple to use and reliable.     

Community ‐and hospital laboratory‐based surveillance for respiratory viruses

Traditional surveillance for respiratory viruses relies on symptom detection and laboratory detection during medically attended encounters for acute respiratory infection/influenza‐like illness (ARI/ILI). Ecological momentary reporting using text messages is a novel method for surveillance. This study compares respiratory viral activity detected through longitudinal community‐based surveillance using text message responses for sample acquisition and testing to respiratory viral activity obtained from hospital laboratory data from the same community. We demonstrate a significant correlation between community‐ and hospital laboratory‐based surveillance for most respiratory viruses, although the relative proportions of viruses detected in the community and hospital differed significantly.     

Amyloid‐ß‐directed immunotherapy for Alzheimer's disease

Current treatment options for Alzheimer's disease (AD) are limited to medications that reduce dementia symptoms. Given the rapidly ageing populations in most areas of the world, new therapeutic interventions for AD are urgently needed. In recent years, a number of drug candidates targeting the amyloid‐ß (Aß) peptide have advanced into clinical trials; however, most have failed because of safety issues or lack of efficacy. The Aß peptide is central to the pathogenesis, and immunotherapy against Aß has attracted considerable interest. It offers the possibility to reach the target with highly specific drugs. Active immunization and passive immunization have been the most widely studied approaches to immunotherapy of AD. A favourable aspect of active immunization is the capacity for a small number of vaccinations to generate a prolonged antibody response. A potential disadvantage is the variability in the antibody response across patients. The potential advantages of passive immunotherapy include the reproducible delivery of a known amount of therapeutic antibodies to the patient and rapid clearance of those antibodies if side effects develop. A disadvantage is the requirement for repeated infusions of antibodies over time. After more than a decade of research, anti‐amyloid immunotherapy remains one of the most promising emerging strategies for developing disease‐modifying treatments for AD. In this review, we examine the presently ongoing Aß‐directed immunotherapies that have passed clinical development Phase IIa.     

Cognitive‐behavioural,fluoxetine and combined treatment for bulimia nervosa: short‐ and long‐term results

This study examined the short‐ and long‐term effectiveness of cognitive‐behavioural group treatment (CBT), pharmacological treatment with fluoxetine and combined treatment in patients with DSM‐III‐R bulimia nervosa. Fifty‐three patients were randomly assigned to the three conditions. Outcome measures were frequency of bingeing and purging, attitudes toward weight and shape, depression and self‐concept. Patients were followed for 1 year post‐treatment. Thirty‐five patients completed treatment. Drop‐out rates were 42 per cent for CBT, 25 per cent for the fluoxetine and 33 per cent for the combined condition. All treatments led to significant improvements in eating disorder symptoms and in other psychological disturbances between pre‐ and post‐treatment, which could be maintained at 1‐year follow‐up. Abstinence rates for completers were highest for CBT at both post‐treatment and follow‐up. The short‐ and long‐term results of this study do not favour the combined treatment in comparison to CBT alone. Cultural differences in health systems as well as in the acceptance of treatments offered in a treatment trial are discussed. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association.     

Novel mobile telemedicine system for real‐time transmission of out‐of‐hospital ECG data for ST‐elevation myocardial infarction

The guidelines recommend routine use of 12‐lead electrocardiogram (ECG) and advance notification to the emergency department for patients with ST‐elevation myocardial infarction (STEMI). However, transmission of out‐of‐hospital 12‐lead ECG to emergency department is still not widely practiced and ECG interpretation before arrival at the emergency department is not established. We have developed a novel mobile telemedicine system to transmit real‐time 12‐lead ECG data between moving ambulances and in‐hospital physicians in cardiovascular emergency cases. When used, this system immediately identifies patients with STEMI and it is coupled to a centralized system to alert the cardiac catheterization teams to prepare for prompt intervention. This report presents the first case with STEMI who was successfully treated using this novel mobile telemedicine system. © 2009 Wiley‐Liss, Inc.     

Targeting anti‐beta‐1‐adrenergic receptor antibodies for dilated cardiomyopathy

Anti‐beta‐1‐adrenergic receptor antibodies (anti‐β₁AR Abs) have long been implicated in the pathogenesis of dilated cardiomyopathy (DCM). It is believed that these autoantibodies bind to and constitutively stimulate the β₁AR to promote pathological cardiac remodelling and β₁AR desensitization and downregulation. The prevalence of anti‐β₁AR Abs in patients with DCM ranges from 26% to 60%, and the presence of these autoantibodies correlates with a poor prognosis. Several small studies have shown improvements in functional status, haemodynamics, and biomarkers of heart failure upon removal or neutralization of these antibodies from the sera of affected patients. Traditionally, removal of anti‐β₁AR Abs required immunoadsorption therapy with apheresis columns directed against human immunoglobulins (Igs) and subsequent i.v. Ig infusion, thereby essentially performing a plasma exchange transfusion. However, recent advances have allowed the development of small peptides and nucleotide sequences that specifically target and neutralize anti‐β₁AR Abs, providing a hopeful avenue for future drug development to treat DCM. Herein, we briefly review the clinical literature of therapy directed against anti‐β₁AR Abs and highlight the opportunity for further research and development in this area.