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Background: The use of clozapine demands regular monitoring of clozapine plasma concentrations and of white blood cell parameters. The delay between sending blood samples for analysis and receiving the results hinders clinical care. Point-of-care testing (POCT) can provide drug assay results within a few minutes. Aim: This study aimed to investigate the utility of a novel point-of-care device that can measure clozapine concentrations using capillary blood samples collected via a finger stick. Method: During a five-week period starting in June 2019 eligible patients were asked to provide a finger-stick capillary sample in addition to their usual venous blood sample. Samples were analysed by the novel point-of-care device and by the standard laboratory method. Capillary blood samples were tested by the MyCare™ Insite POCT analyser, and a quantitative measurement of clozapine concentration was provided within six minutes. Results: A total of 309 patients agreed to measurements by the two methods. Analysis revealed clozapine concentrations in venous blood as determined by the laboratory method ranged from 20 to 1310 ng/mL and by POCT from 7 to 1425 ng/mL. There was a strong positive correlation ( R = 0.89) between the results from the venous and the capillary sample methods. The slope of the association between standard assay and MyCare™ Insite was 1.0 with an intercept of –21 ng/mL, indicating minimal bias. Conclusion: Clozapine concentrations can be accurately measured at the point of care using capillary blood samples collected via a finger stick. This approach may be more acceptable than venous sampling to patients and, with almost instant results available, more useful to clinicians.

Convenient and widespread serology testing may alter the trajectory of the COVID-19 pandemic. This study seeks to leverage high-throughput, multiplexed serologic assays, which have been adopted as benchmarks for vaccine efficacy, to support large-scale surveys of SARS-CoV-2 immunity using finger-stick blood and/or saliva. Specifically, we optimized MSD’s serology assays, which were analytically validated for serum, to test self-collected finger-stick blood and saliva samples. We show that these assays can be used with FDA-registered specimen collection devices to obtain quantitative measurements for self-collected samples. Antibody levels were measured using an electrochemiluminescent (ECL) multiplex immunoassay, which has been used to measure humoral responses to several COVID-19 vaccines, including those funded by the U.S. Government’s Operation Warp Speed. First, we show that salivary antibodies are stable without refrigeration or preservatives for at least five days. Using matched samples, we show that testing of saliva and finger-stick blood equivalently identified individuals with humoral responses to CoV-2 antigens. Moreover, we piloted a simple saliva collection kit that can be used to safely send samples through the mail. This work demonstrates that robust methods for self-collection of finger-stick blood and saliva, in combination with quantitative, automated immunoassays, provide the technical capabilities needed to support large-scale serology testing.

During the COVID-19 pandemic, manufacturers have developed several diagnostic test kits that include lateral flow immunoassays (LFIA) also known as rapid cassette testing. Rapid cassette testing provides qualitative test results indicating the presence or absence of IgG and IgM antibodies to determine COVID-19 (SARS-CoV-2) infection among individuals. Venipuncture blood draws have been the traditional and widely proposed sample collection method but is costly and not applicable to point-of-care testing (POC) and in remote settings. Whole blood finger-stick blood collections traditionally used by diabetics for glucose level testing is an ideal scenario, but raises concerns regarding the outcome of test results in regards to specificity and sensitivity. In this study we directly compare simultaneous collections of venipuncture serum (SST) blood draws and whole blood finger-sticks (n = 75) to detect human Anti-COVID-19 IgG and IgM antibodies using an EUA-approved lateral flow immunoassay, showing equal to enhanced performance characteristics for this specimen type.

Background Phlebotomy plays a key role in clinical laboratory medicine but poses certain challenges for the patient and the laboratory. Dried blood spots simplify collection and stabilize specimens effectively, but clinical reference intervals are based primarily on serum or plasma. We evaluated use of dried separated blood plasma specimens to simplify plasma sample collection via finger stick; however, this sampling technique posed substantial analytical challenges. We discuss herein our efforts to overcome these challenges and provide accurate and precise clinical measurements. Methods Microsamples of whole blood were collected via finger stick using a collection device employing laminar-flow separation of cellular blood and plasma fractions with subsequent desiccation. Samples were analyzed on modern autoanalyzers with FDA-approved reagent and calibration systems, as well as commercially available reagents with laboratory-developed assay parameters. Measured analyte concentrations from extracted dried plasma samples were normalized to a coextracted endogenous analyte, chloride. Results Chloride normalization reduced variability incurred through extraction and undefined plasma volume. Excellent correlation of normalized measurements from dried finger-stick samples (whole blood and plasma) versus matched venous samples facilitated developing mathematical transformations to provide concordance between specimen types. Independent end-to-end performance verification yielded mean biases Conclusion Challenges inherent with this microsampling technique and alternate sample matrix were obviated through capabilities of modern autoanalyzers and implementation of chloride normalization. These results demonstrate that self-collected microsamples from a finger stick can give results concordant with those of venous samples.

Background Uptake of hepatitis C virus (HCV) testing remains inadequate globally. Simplified point-of-care tests should enhance HCV diagnosis and elimination. We aimed to assess the acceptability of finger-stick and venepuncture HCV RNA testing among people who inject drugs (PWID). Methods Participants were enrolled in an observational cohort study with recruitment at 13 sites between June 2016 and February 2018. Capillary whole-blood collected by finger-stick and plasma collected by venepuncture were performed for Xpert® HCV viral load testing. Participants completed a questionnaire on acceptability of, and preferences for, blood collection methods. Results Among 565 participants (mean age, 44 years; 69% male), 64% reported injecting drugs in the last month, and 63% were receiving opioid substitution treatment. Eighty three percent reported that finger-stick testing was very acceptable. Overall, 65% of participants preferred finger-stick over venepuncture testing, with 61% of these preferring to receive results in 60 min. The most common reason for preferring finger-stick over venepuncture testing was it was quick (62%) followed by venous access difficulties (21%). The main reasons for preferring venepuncture over finger-stick testing were that it was quick (61%) and accurate (29%). Females were more likely to prefer finger-stick testing than males (adjusted OR 1.96; 95% CI 1.30, 2.99; p = 0.002). Among people with recent (previous month) injecting drug use, Aboriginal and/or Torres Strait Islander people were less likely than non-Aboriginal people to prefer finger-stick testing (adjusted OR 0.57; 95% CI 0.34, 0.9; p = 0.033). Conclusions Finger-stick whole-blood collection is acceptable to people who inject drugs, with males and Aboriginal and/or Torres Strait Islander people with recent injecting drug use less likely to prefer finger-stick testing. Further research is needed to evaluate interventions integrating simplified point-of-care HCV testing to engage people in care in a single-visit, thereby facilitating HCV treatment scale-up.

Accidental finger sticks with EpiPens and EpiPen Jr (epinephrine auto-injectors) are a very real hazard in those who carry them and their families. The most feared complications are digital ischemia and necrosis; however, long-term adverse effects are extremely rare. Treatment for a finger stick is controversial, ranging from intra-arterial inj­­ections of vasodilating agents to topical vasodilators to conservative management. We report a pediatric patient suffering from an EpiPen Jr accidental stick to the distal first digit who was successfully managed in a conservative fashion.

INTRODUCTION: Oral health plays an important role for screening of many systemic diseases. Hence, dentists play an important role in screening for systemic diseases as well. Early diagnosis of any systemic diseases can prevent long‑term complications. Diabetic is one of the common chronic diseases. Hence, the study had been undertaken to evaluate whether gingival crevicular blood (GCB) can be used to screen for diabetes during routine oral health checkups. MATERIAL AND METHODS: This analytical study included thirty participants who visited the Department of Periodontics, who fulfilled inclusion criteria and were willing to participate. Blood samples were collected by finger stick method and periodontal probing. The glucose levels of both the samples were estimated using glucometer and correlated the levels from both the methods. RESULTS: Correlation between capillary finger stick blood glucose and GCB glucose was high (0.97) and was significant at 0.01 level. CONCLUSION: Blood oozing during routine periodontal examination can be used for diabetes mellitus screening in dental office.

BACKGROUND: Pleural fluid glucose (PFG) has diagnostic and therapeutic implications for the management of pleural effusion. The literature examining point-of-care testing of PFG is limited, and no studies exist for the bedside measurement of PFG using a glucometer (B-PFG). In this study, we compared the accuracy of B-PFG measurement to standard in-lab measurement (Lab-PFG). METHODS: Patients undergoing thoracentesis or thoracostomy were enrolled. PFG was measured at the bedside with a finger stick blood glucometer (ACCU-CHEK(®) Inform II, Roche) and in the laboratory. Two consecutive measurements were taken using the glucometer, and their mean was compared to the glucose concentration measured in the laboratory. Pearson correlation coefficient and Bland-Altman Plot analysis were used to compare the two measurements. RESULTS: Sixty patients were included. Mean age was 64.1 years. Forty-nine patients had exudative effusions (41% malignant, 26% parapneumonic, and 33% others). There was a significant correlation between the B-PFG and the Lab-PFG (r=0.98, 95% CI of 0.97 to 0.99; P

Determination of circulating prostate specific antigen (PSA) is commonly used in the diagnosis and treatment monitoring of prostate cancer [1]. Presently, PSA testing is performed in centralized laboratories, which is associated with prolonged time between venipuncture and the PSA value being available. In this prospective study, we present a new and rapid test system for the quantitative determination of PSA levels from finger-stick blood. The Claros1® analyzer is a rapid microfluidics-based point-of-care system for quantitative PSA analysis from 10-µl finger-stick blood that requires only 10 min for testing. Total PSA concentrations by the Claros system in 100 consecutive asymptomatic men (median age 57 years, range 44–81 years) were compared with two commercially available, commonly used PSA assays (Abbott and Elecsys by Roche) performed by a reference laboratory. Eighty-six percent of finger-stick blood-borne probes from 100 men were evaluable for PSA testing by the Claros1® analyzer system. In 13/14 cases the expiry date of the microfluid cassettes of the Claros system was exceeded and one blood puncture was performed inadequately. The correlations between the Claros results and OPKO–Abbott and OPKO–Roche assay results were high, with R2 values of 0.982 and 0.985, respectively. The R2 value for the Roche–Abbott correlation was 0.991 with a slope value of 1.160. Prostate cancer was diagnosed in seven cases, with a median PSA of 1.8 ng/ml in the Claros group compared to 1.75 ng/ml and 2.1 ng/ml in the Abbott and Roche groups, respectively. The Claros1® PSA assay combines the advantages of rapid, accurate detection with a low required sample volume, allowing the analysis to be performed using finger-stick blood. Provided that further analysis proves the reproducibility of the test, it may help to reduce the number of office visits, thus decreasing costs to the health care system.

ObjectivesNumerous serologic immunoassays have been launched to detect antibodies to SARS-CoV-2, including rapid tests. Here, we validate use of a lateral flow immunoassay (LFI) intended for rapid screening and qualitative detection of anti-SARS-CoV-2 IgM and IgG in serum, plasma, and whole blood, and compare results with ELISA. We also seek to establish the value of LFI testing on blood obtained from a capillary blood sample.MethodsSamples collected by venous blood draw and capillary finger stick were obtained from patients with SARS-CoV-2 detected by RT-qPCR and control patients negative for SARS-CoV-2. Samples were tested with the 2019-nCoV IgG/IgM Detection Kit (Colloidal Gold) lateral flow immunoassay, and antibody calls were compared with results obtained by ELISA.ResultsThe Biolidics LFI kit shows clinical sensitivity of 92% at 7 days after PCR diagnosis of SARS-CoV-2 on venous blood. Test specificity was 92% for IgM and 100% for IgG. There was no significant difference in detecting IgM and IgG with Biolidics LFI and ELISA at D0 and D7 (p=1.00), except for detection of IgM at D7 (p=0.04). Finger stick whole blood of SARS-CoV-2 patients showed 93% sensitivity for antibody detection.ConclusionsClinical performance of Biolidics 2019-nCoV IgG/IgM Detection Kit (Colloidal Gold) is comparable to ELISA and showed consistent results across different sample types. Furthermore, we show that capillary blood obtained by finger stick shows similar sensitivity for detecting anti-SARS-CoV-2 IgM and IgG antibodies as venous blood samples. This provides an opportunity for decentralized rapid testing in the community and may allow point-of-care and longitudinal self-testing for the presence of anti-SARS-CoV-2 antibodies.

Background Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock. Methods Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an “investigational use only” study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods. Results 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p, Highlights • Finger-stick capillary lactate correlates with blood gas and core lab values. • Capillary lactate trends closely over time with arterial lactate. • Rising or falling capillary lactate reflects the adequacy of global perfusion. • Capillary lactate measurements require a fraction of the time and blood to process. • Preliminary results imply capillary lactate may be used in lieu of invasive methods.

Aim The present study was aimed to assess the fasting and postprandial gingival crevicular blood (GCB) glucose and finger stick blood glucose measurements using a glucometer. Materials and methods A total of 30 subjects with periodontitis and positive bleeding on probing were considered. Subjects were instructed to report to the department after overnight fasting. Gingival crevicular blood samples were collected from anterior region showing bleeding on probing followed by finger stick blood sample collection. Then, the patients were instructed to take 75 gm of glucose and after 2 hours blood samples from two sites were collected similarly. Results were analyzed using unpaired t test and Pearson's correlation. Results Mean glucose levels form GCB and finger stick blood did not differ either during fasting or postprandial (p > 0.05). Significant correlation was found between GCB glucose levels and capillary finger stick blood (CFB) glucose levels during fasting(r = 0.946, p < 0.001) and postprandial (r = 0.930, p < 0.001) blood estimation. Conclusion Periodontal probing can be considered as an alternate noninvasive method of blood glucose estimation for screening of diabetes mellitus (DM). The technique described is safe, easy to perform, and helps to increase the frequency of diabetes screening in dental office. Clinical significance The GCB from probing can be a good source of blood for estimating blood glucose levels and screening for diabetes using portable glucose monitors. Also, it will be a simple and relatively inexpensive in office screening procedure for any patient suspected to have diabetes. How to cite this article Shylaja MD, Punde PA, Sam G, Khan SN, Latheef AA, Thorat AJ. Noninvasive Technique for Estimating Blood Glucose Levels among diabetic Patients. J Contemp Dent Pract 2016;17(3):248-252.

The flow through the finger interstices and the micro voids in rough contact interface between finger sticks is considered as the side leakage flow of finger seal. The porous approach that the side leakage flow of finger seal is transformed into the seepage flow through a porous medium was proposed. The CFD model of total leakage of finger seal was established. When the side leakage flow is considered, the relative increment of total leakage of finger seal ranges from 3 to 6% in most cases. The work also shows that the total leakage without side leakage flow is between the leakage flowing into the main leakage clearance and the leakage exiting from the main leakage clearance when considering the side leakage flow.

Source Citation Lamoury FMJ, Bajis S, Hajarizadeh B, et al; LiveRLife Study Group. Evaluation of the Xpert HCV Viral Load Finger-Stick point-of-care assay. J Infect Dis. 2018;217:1889-96. 29534185

Fragala, MS, Goldman, SM, Goldman, MM, Bi, C, Colletti, JD, Arent, SM, Walker, AJ, and Clarke, NJ. Measurement of cortisol and testosterone in athletes: Accuracy of LC-MS/MS assays for cortisol and testosterone measurement in whole-blood microspecimens. J Strength Cond Res 32(9): 2425-2434, 2018-Biomarker monitoring provides insight into athletes' training tolerance but is limited by the need for office-based specimen collection. To facilitate self-collection during training, we developed liquid chromatography-tandem mass spectrometry-based tests that measure circulating total cortisol and testosterone using a finger stick volumetric absorptive microsampler. Here, we describe the analytical validation of these tests. Forty-six Division I athletes (18-22 years, 30 women, 16 men) provided a 20-µL finger stick microspecimen and a 5-ml venous blood specimen from the forearm; the venous blood sample was analyzed using both normal volume serum analysis and analysis of dried whole blood (from the microsampler). Liquid chromatography-tandem mass spectrometry on standard serum specimens obtained by venipuncture yielded total cortisol levels of 26.2 ± 11.6 µg·dl (women and men), and total testosterone levels of 37 ± 17 ng·dl in women and 564 ± 171 ng·dl in men. Analytical measurement ranges of the microspecimen assay were 0.3-440 µg·dl (CV

BACKGROUND: Measurement of glomerular filtration rate by iohexol disappearance (iGFR) has become a gold standard in the pediatric CKD population. The need for serial phlebotomy can be difficult and minimizing venipunctures would be beneficial. Furthermore, finger stick collection for dried blood spot (DBS) may be more tolerable in the pediatric population, and equivalence between these two methods may further simplify the process. METHODS: This was a cross-sectional study in children and adolescents 1 to 21 years with Stage I-IV CKD. Iohexol was infused and blood drawn 10, 30, 120, and 300 minutes later. Blood spots on filter paper were collected by finger-stick after each of the latter two blood draws. The rate of iohexol plasma disappearance was used to calculate GFR. Pearson’s correlation coefficient and bias, Students t-test and Bland Altman graphical representations were used to compare methods. RESULTS: Forty one patients were recruited. The mean creatinine was 1.13 mg/dL (SD 0.45), the mean 4-point iGFR was 73.2 ml/min/1.73m(2) (SD 27.5) and the mean 2-point iGFR was 75.6 ml/min/1.73m(2) (SD 27.3). Correlation between 2-point and 4-point venous GFR was r=0.97; p

Research examining stress reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis in young children has historically been hampered by a lack of reliable methods to invoke a cortisol stress response. This report details an effective method of eliciting a cortisol rise in one-year-old children (N = 83) by modifying and combining two naturalistic stressors previously used with infants and children. Salivary cortisol levels were collected from children before and after a finger stick blood draw and immunizations performed during their one year well-child checkup at their pediatrician’s office. Results indicated that the stressor was successful at eliciting a significant cortisol response. An extensive set of potential demographic and clinical confounds were also assessed in order to identify methodological considerations important in studies of infant cortisol. The stress paradigm presented here provides a promising alternative for studies of infant HPA activity to enable investigators to more effectively evaluate early functioning of the biological stress system during this developmentally important life stage.

Finger stick blood glucose meters are widely used in outpatient and inpatient settings. However, various factors can affect accuracy of readings from these meters. Here we present a patient who had spurious glucose elevation on these meters while being on intravenous ascorbic acid.

Introduction Opportunities for HIV testing could be enhanced by offering HIV self-testing (HIVST) in populations that fear stigma and discrimination when accessing conventional HIV counselling and testing in health care facilities. Methods The Exacto Test HIV (Biosynex, Strasbourg, France) fullfilled the following criteria I) Capillary blood-based test detecting early HIV infection; II) Sterile safety lancet; III) Simplified blood sampling system; IV) Simplified buffer delivery system; V) Specimen presence control by blood deposit assessment and migration control band; vi) Results in 10 min; VII) Simplified and easy-to-read leaflet in French, Lingala, Swahili and Sango. The practicability of HIVST was assessed in 630 adults living in Kisangani and Bunia, Democratic Republic of Congo (n=330) and Bangui, Central African Repulic (n=300), according to WHO recommendations. Results Design. Exacto self-test showed 100.0% sensitivity and 99.5% specificity. Practicability in lay users . 97.4% correctly performed HIVST and claimed the test was easy or very easy to carry out; however, 26.5% asked for telephone or oral assistance, and difficulty obtaining sufficient quantity of blood was observed in 2.6%; 47% used the notice in French, 10% in Lingala, 23% in Swahili and 20% in Sango. Overall, the results were correctly interpreted in 90.2%, the reading/interpretation errors concerned the positive (6.5%), negative (11.2%) or invalid (16.0%) self-tests. The notice was correctly understood in 78.5%. Conclusion Our field experience with Exacto self-test implemented for the first time in a French-speaking African country demonstrates very satisfactrory success rate of performance and interpretation. However, the main obstacle for HIVST was clearly the educational level, associated with execution and interpretation difficulties in illeterates or very poorly educated people. Notice design with pictures and in vernacular languages is essential. Supervised use of HIVST should be essential in poorly-educated people.

Guidelines recommend routine universal HIV testing in adults to reduce the pool of infected patients unaware of their status, without specific recommendations concerning the method. We compared acceptability and feasibility of HIV testing by ELISA tests or rapid tests from finger-stick whole blood.Prospective randomized multi-center study comparing acceptability and feasibility of routine universal HIV testing by ELISA tests, with a charge, subsequently reimbursed by Social Security for affiliated patients, or rapid tests from finger-stick whole blood, without any charge from the patients or the general practitioner for the study. A single investigator performed all interventions. After consent, all adults (18-70 years old) consulting their general practitioner in Paris, France, unaware of their status, were enrolled. Testing was performed immediately for the patients in the rapid test arm; a prescription was given for testing in a lab for the patients in the ELISA arm. The primary endpoint was acceptability of each method. The secondary endpoint was feasibility of each method, assessed one month after the consultation.Two hundred and seventy patients were enrolled: 133 patients in the ELISA arm, 137 in the rapid test arm. Acceptability of the rapid test (92%) was higher than that of the ELISA (63.9%), P0.0001. Feasibility of the rapid test (100%) was higher than that of the ELISA (50.5%), P0.0001. A center effect was shown concerning feasibility of ELISA but not concerning feasibility of rapid tests.Rapid testing from finger-stick whole blood is more acceptable and feasible than ELISA for routine universal HIV testing. A larger use of rapid tests, ideally free of charge, by general practitioners could reduce the pool of infected patients unaware of their status.

Accurate assessment is critical in pediatric pain, and often adults gauge pain via children’s behavior. To measure adults’ gender biases in regard to children’s pain, 183 adults completed measures and rated the pain of a videotaped child receiving a finger stick blood test. Half of the participants were told the child was male and half female. Participants rated the “male” patient as having greater pain. Similarly, participants’ indicated beliefs that girls are more sensitive and reactive to pain than boys. Results suggest adults hold explicit and implicit biases that girls are more sensitive and reactive to pain than boys.

Self-monitoring of fasting, pre and postprandial blood glucose (SMBG) is an integral part of diabetic care. The validity and accuracy of different glucometer types vary significantly and at present ,none of the local authorities carry out pre or post marketing evaluation of these devices in Sri Lanka. This study evaluated the accuracy and validity of 3 types of SMBG devices available over the counter, Device 1, Device 2 and Device 3 against a standard laboratory reference method.A random sample of 103 capillary and venous blood samples were analyzed from diabetic pregnant patients admitted to Teaching Hospital Peradeniya for Blood Sugar Series Testing. Haematocrit value was also obtained by microhaematocrit method. Analytical and clinical accuracy were determined.The correlation coefficiencies were 0.856, 0.880 and 0.873 for Device 1, Device 2 and Device 3, respectively. Only Device 2 met the International Standardization Organization (ISO) performance standards for glucometers for glucose values100 mg/dL whereas none of them met the ISO criteria for values100 mg/dL. In surveillance error grids, 87.8%, 93.3% and 81.6% of the data points were within non risk zone for Device 1, Device 2 and Device 3 whereas 11.1%, 4.4% and 17.2 % were within slightly lower risk hypoglycemia area. All types of glucometers were less reliable in detecting hypoglyacaemia.The over the counter SMBG monitoring systems are encountering certain problems in terms of accuracy and validity. Clinicians should exercise caution in making clinical decisions based on glucometer values for diabetic pregnant patients.

Hematocrit (HCT) measurements are important clinical diagnostic variables that help physicians diagnose and treat various medical conditions, ailments, and diseases. In this work, we present the HCT Disc, a centrifugal microdevice fabricated by a Print, Cut and Laminate (PCL) method to generate a 12-sample HCT device from materials costing

Despite sustained public health efforts to publicize the risk of hepatitis B virus (HBV) infection outbreaks during assisted monitoring of blood glucose (AMBG), outbreaks continue to occur. Here, we highlight several outbreaks and patient notifications due to AMBG, discuss prevention initiatives, and highlight gaps that remain.We reviewed available data and information from investigations of health care-associated HBV infection outbreaks and patient notification events associated with AMBG in the United States between 2009 and 2010.Four HBV infection outbreaks were reported, all in assisted living facilities. Common infection control breaches included use of reusable finger stick devices, which are intended for personal use, on multiple persons; use of BG meters for more than one person without cleaning and disinfection between each use; and comingling of contaminated and clean equipment and supplies. Twenty-nine (88%) of the 33 residents who acquired acute HBV infection as part of these outbreaks received AMBG. Compared with those who did not, residents undergoing AMBG had significantly increased risk of acquiring acute HBV infection (relative risk: 27.7, 95% confidence interval: 10.3 to 74.4). During two patient notifications, approximately 320 persons were recommended to undergo bloodborne pathogen testing after being placed at risk for exposure to another person's blood when personal-use multilancet finger stick devices were selected for use on multiple persons.Misperception on the risk for bloodborne pathogen transmission and confusion regarding selection and appropriate use of BG monitoring devices for AMBG remain a problem. In addition to public health outreach and infection control recommendations, clear labeling, packaging, instructions for device use, and appropriate device marketing will assist in infection prevention efforts.

White blood cell counts (WBC) and absolute neutrophil counts (ANC) are well-established predictors of a patient's risk of fever and infections or febrile neutropenia (FN). Currently, patients at risk of FN due to cancer chemotherapy, idiosyncratic drug-reactions or congenital neutrophil disorders are monitored at hospital or clinic laboratories. For many patients, effective and frequent monitoring is difficult due to the time required and costs of repeated laboratory visits. We herein present the first results for a novel device called Athelas One, a miniature point-of-care hematology analyzer suitable for at home monitoring of WBC and ANC. Methods: Athelas One (A1) is a small cylindrical device with a built-in, single head, light microscope. To determine the WBC and ANC, a small drop of blood (~ 3.5 uL) from a finger stick or an anticoagulated blood sample is drawn by capillary action onto a specially designed microfluidic test strip which creates a stained, precisely dimensioned monolayer of blood cells. The slide is then inserted into the device which scans the test strip and reports the WBC and ANC based on an image analysis process (Computer Vision). We compared results for A1 with a standard laboratory counter [Sysmex XE5000 (SX)]. Results: Initially, A1's reproducibility was demonstrated using 43 blood samples with a wide range of known WBCs (i.e., samples with normal counts, leukocytosis, leukopenia, neutropenia, neutrophilia) run on 4 devices using a single lot of test strips. The A1 results were then compared to SX results using the Passing Bablok Regression with Bootstrap method. These results showed strong linearity and comparability between paired anti-coagulated venous blood samples and the blood samples compared to finger prick capillary blood samples collected almost simultaneously. The slope and intercept indicated a linear relationship, with a 95% confidence for interval slope and intercept containing 1 and 0 respectively. (Comparisons: A1 blood to SX blood: WBC, r=0.998, ANC, r=0.989; A1 capillary to SX blood: WBC, r=0.998, ANC, r=0.97). Table 1 and Figure 1 show a summary of the comparisons. In addition to these results, we have tested 18 samples with WBC < 1.0 x 109/L with closely comparable results for A1 and standard hospital counter. Summary: These initial results show that the WBC and ANC can be accurately determined with a finger stick drop of blood and this point-of-care hematology analyzer. Given its small size, ease of use and accuracy, the device is suitable for home monitoring. Disclosures Dale: Athelas, Inc.: Equity Ownership; Amgen: Consultancy, Research Funding; Sanofi-Aventi: Consultancy, Honoraria; Cellerant: Other: Scientific Advisory Board; Hospira: Consultancy; Prolong: Consultancy; Beheringer-Ingelheim: Consultancy; Coherus: Consultancy. Navarro-De La Vega:Athelas, Inc.: Employment. Parthasarathy:Athelas, Inc.: Employment, Equity Ownership. Bodapati:Athelas, Inc.: Employment, Equity Ownership, Patents & Royalties: patent owned by Athelas on the Athelas One device. Virey:Athelas, Inc.: Employment, Equity Ownership, Patents & Royalties: patent owned by Athelas on the Athelas One device. Moffatt:Athelas, Inc.: Employment, Equity Ownership, Patents & Royalties: patent owned by Athelas on the Athelas One device. Tandon:Athelas, Inc.: Employment, Equity Ownership, Patents & Royalties: patent owned by Athelas on the Athelas One device.

Background: High levels of insulin and lipids following a meal are recognized risk factors for atherosclerosis. Monitoring such risk factors in the general population is hampered by the inconvenience of venipuncture blood collection, particularly for both premeal and postmeal analyses. This study examined insulin and triglyceride levels in dried blood spots (DBSs) collected after different breakfast meal challenges to assess the potential of this method for risk assessment. Methods: Glucose levels were measured using a glucose meter, and insulin and triglycerides were determined in DBS samples collected from 19 healthy volunteers before and at four time points up to 2.5 h after consuming each of five typical breakfast meals varying in nutritional composition. Results: At 2 h, glucose was within normal postprandial values (

The purpose of this study was to determine if providing a sticker after a finger stick for hemoglobin check reduced pain perception among preschool-aged children. The hypothesis was: Sticker rewards influence the perception of pain as measured by the Oucher scale following a finger stick to check hemoglobin. Preschoolers from Headstart Centers in a southeastern city were recruited for the study. The age range of participants was between 3 and 5 years. The children were assigned randomly into two groups: those receiving stickers (Group I), and those not receiving a sticker (Group II). Subsequently, each participant's pain level was assessed using the Oucher scale within 1 minute of the finger stick. There was no statistically significant difference in pain scale ratings between the two groups when comparing whether or not a cartoon sticker was given t (–.937, df 128, P = .351; 95% confidence interval). This study was clinically significant in that nonpharmacological interventions were utilized in an attempt to reduce pain in young children. Future research should determine whether receiving rewards (such as a cartoon sticker, adhesive bandages, or small toys) alone or in conjunction with distraction measures are efficacious in pain reduction in younger children.

This study compared the accuracy and precision of five blood glucose (BG) meters.Diabetes patients undergoing venipuncture for glucose testing were randomized to one of two groups consisting of three meters: FreeStyle Flash (Abbott Diabetes Care, Alameda, CA), Accu-Chek Advantage (Roche Diagnostics Corp., Indianapolis, IN), and Accu-Chek Compact Plus (Roche Diagnostics) or FreeStyle Flash, Ascensia Contour (Bayer Healthcare, Diagnostic Division, Tarrytown, NY), and BD Logic (BD Diabetes Care, Franklin Lake, NJ). Within 5 min following venipuncture, duplicate finger BG measurements from three ipsilateral fingers were taken. Finger glucose measurements were compared with laboratory reference values. Accuracy was assessed by a Clarke error grid analysis (EGA) and within 10% of the laboratory value criteria. Meter precision was determined by calculating the absolute mean differences in glucose values between duplicate samples.Finger sticks were obtained from 202 patients. Mean venipuncture BG was 148 mg/dL (SD +/- mg/64 dL; range 25-439 mg/dL). Accuracy by Clarke EGA (Zone A results) was demonstrated in 69% of Advantage samples, 75% of Compact Plus, and 96% of the first group of Flash versus 88% of the Contour, 67% of the Logic, and 91% of the second Flash samples (P0.05 for both Flash and Contour). Meter accuracy using the 10% criteria was demonstrated in 30%, 38%, 70%, 46%, 48%, and 68% of the samples, respectively (P0.05 for both Flash groups compared to each of the other meters). There were no differences in meter precision.No statistically significant differences in accuracy were evident using the Clarke EGA criteria (pooled results of Zone A and B), though the more strict 20% accuracy criteria (Zone A results only) found the Flash and Contour to have significantly greater accuracy compared to the Advantage, Compact Plus, and the Logic. Using the 10% accuracy criteria found the Flash to have significantly greater accuracy than each of the other four meters. All five meters demonstrated similar precision.

Objectives . To examine the acceptability of non-medical, community-based interviewers obtaining blood samples during in-home interviews from low-income study participants. Methods . Two separate focus groups were conducted, one with ten non-medical community-based interviewers and the other with eight research participants from a low- income population. (Both the interviewers and the research participants had previously taken part in a research project over the course of five years.) Results . Participants and interviewers were comfortable with finger stick blood samples performed in the home. The interviewers felt that adequate training was critical. Participants identified key issues: blood would not be used for other purposes and that the interviewers would be trained to handle blood safely. Both groups felt that it was crucial to communicate the study purpose and results. Recommendations from the focus groups were implemented and the acceptance rate for blood sampling was 99.5% (205/206). Conclusion. Proper training of interview- ers, organization of supplies, and communication with participants can be combined to maximize acceptance of in-home, finger stick blood sample collection by community-based interviewers among a low-income population.

Metabolic studies utilizing stable isotope tracer in humans have typically used intravenous tracer infusions and venous blood sampling. These studies explore subcutaneous infusion of isotope and "finger stick" capillary blood sampling to measure glucose turnover. Five subjects received simultaneous 8-h infusions of glucose labeled with isotope: [1-(13)C]glucose subcutaneously and [6,6-(2)H(2)]glucose intravenously. At regular intervals, venous and finger stick blood specimens were obtained. Finger stick blood was applied to filter paper. Substrate and isotopic steady state was reached after 7.0 h with both routes of infusion. The isotopic enrichments of finger stick and venous specimens did not differ significantly for the subcutaneously infused [1-(13)C]glucose (p = 0.33 and p = 0.23, respectively) but the finger stick [6,6-(2)H(2)]glucose enrichment was slightly higher (p0.03) than that of the venous sample. Using [6,6-(2)H(2)]glucose infusion and venous plasma sampling as the reference method, the [1-(13)C]glucose gave estimates of glucose R(a) that were 13% (plasma) and 17% (finger stick) lower (p0.001 and p0.02, respectively). This difference could be attributed to recycling of (13)C label. In conclusion, subcutaneous infusion and finger stick specimen collection onto filter paper represent a potential method of conducting in vivo studies of substrate metabolism outside of a hospital-based research unit.

Small, hand-held monitoring devices are available that patients undergoing long-term warfarin therapy can use to monitor their prothrombin time (PT) and international normalized ratio (INR). PT and INR can be quickly and accurately measured, using only a drop of capillary blood obtained from a finger stick. Convenient monitoring allows for frequent monitoring, which results in improved client outcomes and fewer of the complications commonly associated with anticoagulation therapy. As the use of this technology increases, nurses will assume an active role in the safe and effective implementation of anticoagulation self-monitoring.