EH 2_2015

EUROPEAN HOSPITAL Vol 24 Issue 2/15 20 LABORATORY Interview: Walter Depner ‘The most popular apps are those which provide quick information on diseases and their symptoms, or those with different types of reminder functions, such as for taking medication, doctor’s appoint- ments etc. Of particular interest are the medical-diagnostic apps used to control blood pressure, body weight, body temperature, pulse, blood sugar levels and other labora- tory results,’ laboratory diagnostics expert Professor Norbert Gässler believes. ‘For skin diseases, such as malignant melanoma, photographic documentation is very helpful to assess the progression of the dis- ease. ‘There are also apps available for these types of diseases that calculate probabilities to predict malignancy with the help of algo- rithms. However, various studies have proved that these apps actually deliver false negative results in up to a third of cases.’ Depner: This implies they are not (yet) suitable as diagnostic tools. However, could they be used dif- ferently, for example, if a plastic foil could be put over the phone and blown into to check your alcohol level before driving home? Prof. G: ‘Yes, this has already been trialled, but the blood alcohol con- tent shown on the display is not precise enough, so we can only advise against this. Generally, the advice should be not to drive at all after alcohol consumption. Your conclusion that “diagnostic” apps are not (yet) suitable should be looked at with a little more dif- ferentiation. Simple measurements of blood sugar and lactate levels are already becoming quite precise. However, unfortunately these apps were not compared or validated with the methods used in precise laboratory medicine.’ Urine testing Cystitis is a very common prob- lem. An app currently available makes it possible to take a picture of a urine test strip, which can be purchased in pharmacies. The display then detects the disease based on the different colours and patterns of the different test fields. Would this not be useful? ‘And then maybe another app for medication? No, this approach can only be described as negligent. Clinical symptoms and scientifically sound diagnosis of pathogens are the fundamentals of precise medi- cal treatment. ‘Out of the more than 100,000 apps that promise medical benefits there is only a small num- ber of medical applications with measuring functions. These, how- ever, make up a large percentage of the turnover of these apps (in 2012 it was around €350 million world- wide). As shown using the example of the diagnostic procedure for cystitis, additional products such as urine test strips are often required. Some apps don’t require additional products and can be directly used with the smartphone functions. This includes hearing and eye tests to determine responsiveness.’ External sensors Certain external sensors can be connected to the smartphone, for instance to measure electric currents in the heart via ECG; measure blood pressure (with BP cuff); pulse (with finger cover); current blood glucose concentra- tion, as well as more specific diagnostic markers. The latter include measuring TSH to diagnose thyroid prob- lems, measuring HIV to diagnose AIDS, and measuring syphilis to diagnose sexually transmitted diseases. What do you think of this development? ‘The portfolio of such apps seems to be unlimited. In the USA, a first prototype to measure blood sugar concentrations without taking blood was introduced in February 2015 in the shape of a tattoo that can be applied to the skin. The continu- ously measured glucose concentra- tion levels are wirelessly transmitted to the smartphone and then docu- mented. The boom in these medical apps is mostly occurring in the USA and Asia, but we must assume that this rapid growth will soon also reach Europe. Security Should we not scrutinise the issues of data security, patient protection, ethical and legal problems and many more at this point? ‘Yes, correct! These apps are often heavily promoted, but with how much reliability the provider deliv- ers the diagnostics, or other ser- vices, remains a bit of a grey area. Can we also trust them to safeguard our personal data? This requires more than a mere call for more legal guidelines. ‘On the other hand, certain apps really can be very useful for spe- cial applications and situations. Specialists in tropical diseases, for instance, have been working for years on using smartphones with special camera add-ons as micro- scopes. There is currently a field trial in Tanzania, where a modi- fied smartphone is being used as a detection system for parasites, and particularly worms, in stool sam- ples. The earlier mentioned detec- tion of HIV, but also of Malaria and other diseases, could be a major argument for the use of such apps in third world countries or other areas with a lack of infrastructure.’ So, there’s a plea in favour of apps after all? ‘Users and manufacturers of these apps should definitely work togeth- er with medical specialists and diag- nosticians on the development of “useful” apps. Furthermore, interdis- ciplinary teams should develop sen- sible workflows from the capture and transmission of measurements to the resulting diagnostic and ther- apeutic consequences.’ Pros and cons Point of care diagnostics Are medical apps a waste of time? This market will boom Among 28.8 million mobile telephones sold in Germany in 2014, 82% were smartphones. For this reason, the medical apps market has also increased exponentially. A survey by health insurer IKK showed that 22% of Germans already use these apps and a further 24% intend to install them on their smartphones or tablets. We asked Professor Norbert Gässler, Head of the Centre for Laboratory Diagnostics at the St. Bernward Hospital, Hildesheim, whether medical apps on private smartphones are worth having Prof. Norbert Gässler, Centre for Laboratory Diagnostics at the St. Bernward Hospital, Hildesheim, Germany The turnover in POCT diagnostics will continue to increase substan- tially according to participants in an ‘In Vitro Diagnostic Products’ meet- ing held in Toronto, Canada last October. Sponsored by the German Institute for Standardisation, the event included participation by the DIN Standards Committee Medicine (NAMed; NA 063) and the Working Committee on Point of Care Testing (POCT) (NA 063-03-11 AA). In 2013 in the USA, turnover for products used to diagnose glucose levels, infections, heart disease and cancers, to name the most impor- tant conditions, was around US$25.2 billion. The forecast for 2018 is estimated at US$27.5 billion, an increase of around 9.3%. Robert L Michel (Editor-in-Chief of The Dark Report) spoke of the particularly poignant diabetes occurrence in the US. 29.1 million Americans are diabetics, i.e. roughly 9.3% of the population. 21 million people were found to have diabetes following a specific diagnosis. 8.1 million people had no diagnosis. 75 million people are estimated to have pre-diabetic symptoms already. The number of POCT tests and their applications is growing expo- nentially. Many experts in Toronto particularly saw technological pro- gress leading to distinct changes. Classic areas of application, such as chemistry, toxicology, haematCol- ogy and microbiology, are using more and specific test proceduo- eres for Point-of-Care. For example, the latest trends include additional modules for smartphones, such as those used for glucose and thyroid stimulating hormone (TSH) diag- nosis. The number of Point-of-Care DNA tests being used, some highly complex, is also increasing. Another interesting trend revolves around ‘smart’ nappies with an integrated, specific urine test for babies and other patients. B a s e d on exam- ples from Australia and Canada (more specifically from the Ontario region) diagnostic networks to treat HIV, and also car- diac disease, were intro- duced at the event. This emphasised the clear advan- tage of comprehensive POCT diagnostics, particularly regarding their analytical quality. Ana Stankovic, Vice President of Becton Dickinson (BD) opened the event with a detailed overview of POC diag- nostics workflow, emphasising the issue of potential error sources and relevance of timing for these tests. In conclusion, the importance and usability of POC tests can no longer be questioned. Frequently, they are on a par with tests used in conventional laboratory diagnostics, whilst clearly easier to use – and faster. Provided the critical points, such as error sources, are given enough consideration, this form of testing will continue to boom and grow. Source:BectonDickinson Source:BectonDickinson Source:iMedicalApps Source:NYU

EH 2_2015

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