Valuing Simplicity: Developing a Good Point of Care Diagnostic.
Valuing Simplicity: Developing a Good Point of Care Diagnostic.
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DOI：
10.3389/fsoc.2020.00037
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发表时间：
2020
影响因子：
2.5
通讯作者：
Krumeich A
中科院分区：
文献类型：
--
作者：
Engel N;Krumeich A
在不容易进入实验室的环境中，或者在处理测试需要太长时间或太昂贵的情况下，护理点测试承诺基于实验室的精确度。开发人员和全球卫生行为者强调简单、快速和准确等价值观和规范，以实现在护理点起作用并与护理点设置的特定要求保持一致的诊断创新。本文利用参与结核病和艾滋病毒诊断开发和实施的诊断制造商、科学家、捐助者、民间社会成员、行业顾问、国际组织、监管者、政策制定者、项目官员、实验室技术人员和临床医生的实地工作，检查良好的医疗诊断的规范和价值如何通过自上而下和自下而上的动态在实践中运作。它指出了诊断方法的设计、证据和采用之间的联系，以及不同行为者如何解释支撑新做法的价值观。该分析借鉴了科学技术研究和医学社会学中关于评估实践、证据制作和技术设计的文献。研究结果揭示了这些价值观如何构成全球和地方(印度)地区的创新、实施和评估实践，对卫生基础设施、能力和培训资源的资金筹措产生重要影响，以解决一些现有的结构性不平等问题。目前定义护理点诊断的主导价值观有可能加剧那些拥有和没有必要的社会和财政资源以获得装备更好和功能更好的医疗设施的人之间的健康不平等，特别是在资源有限的情况下。
Point-of-care testing promises laboratory-based precision in settings that do not have easy access to laboratories or where processing tests takes too long or is too costly. Developers and global health actors stress values and norms such as simplicity, rapidity and accuracy for realizing diagnostic innovations that work at point of care and are aligned to the specific requirements of point-of-care settings. This paper uses fieldwork among diagnostic manufacturers, scientists, donors, members of civil society, industry consultants, international organizations, regulators, policymakers, programme officers, lab technicians, and clinicians involved in development and implementation of tuberculosis and HIV diagnostics, to examine how norms and values of what constitutes a good point-of-care diagnostic are operating in practice through both top-down and bottom-up dynamics. It draws the link between design, evidence and adoption of diagnostics and how the different actors interpret the values underpinning the new practice. The analysis draws on literature on valuation practices, evidence-making and technology design in science and technology studies and medical sociology. The findings reveal how these values constitute innovation, implementation, and evaluation practices across global and local (India) sites, with important consequences for funding of health infrastructure, capacity, and training resources for addressing some of the existing structural inequalities. Dominant values currently defining point of care diagnostics risk exacerbating health inequalities between those who do and do not have the necessary social and financial resources to access better equipped and functioning healthcare facilities, especially in resource constrained settings.
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影响因子：
2.8
作者：
Hutchinson E;Chandler C;Clarke S;Lal S;Magnussen P;Kayendeke M;Nabirye C;Kizito J;Mbonye A
通讯作者：
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通讯作者：
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