scholarly journals Syndromic Panel-Based Testing in Clinical Microbiology

2017 ◽  
Vol 31 (1) ◽  
Author(s):  
Poornima Ramanan ◽  
Alexandra L. Bryson ◽  
Matthew J. Binnicker ◽  
Bobbi S. Pritt ◽  
Robin Patel
Keyword(s):  
Paradigm Shift ◽  
Clinical Microbiology ◽  
Turnaround Time ◽  
Test Interpretation ◽  
Central Nervous System Infections ◽  
Number Of Microorganisms ◽  
Definition Of ◽  
Optimal Ordering ◽  
Respiratory Specimens ◽  
Improve Health

SUMMARY The recent development of commercial panel-based molecular diagnostics for the rapid detection of pathogens in positive blood culture bottles, respiratory specimens, stool, and cerebrospinal fluid has resulted in a paradigm shift in clinical microbiology and clinical practice. This review focuses on U.S. Food and Drug Administration (FDA)-approved/cleared multiplex molecular panels with more than five targets designed to assist in the diagnosis of bloodstream, respiratory tract, gastrointestinal, or central nervous system infections. While these panel-based assays have the clear advantages of a rapid turnaround time and the detection of a large number of microorganisms and promise to improve health care, they present certain challenges, including cost and the definition of ideal test utilization strategies (i.e., optimal ordering) and test interpretation.

Reporting altered test results in hemolyzed samples: is the cure worse than the disease?

2017 ◽  
Vol 55 (8) ◽  
pp. 1112-1114 ◽  
Author(s):  
Giuseppe Lippi ◽  
Gianfranco Cervellin ◽  
Mario Plebani
Keyword(s):  
Laboratory Data ◽  
Turnaround Time ◽  
Reliable Data ◽  
Test Results ◽  
The Past ◽  
Laboratory Test Results ◽  
Performance Specifications ◽  
Life Threatening ◽  
The Many ◽  
Definition Of

AbstractThe management of laboratory data in unsuitable (hemolyzed) samples remains an almost unresolved dilemma. Whether or not laboratory test results obtained by measuring unsuitable specimens should be made available to the clinicians has been the matter of fierce debates over the past decades. Recently, an intriguing alternative to suppressing test results and recollecting the specimen has been put forward, entailing the definition and implementation of specific algorithms that would finally allow reporting a preanalytically altered laboratory value within a specific comment about its uncertainty of measurement. This approach carries some advantages, namely the timely communication of potentially life-threatening laboratory values, but also some drawbacks. These especially include the challenging definition of validated performance specifications for hemolyzed samples, the need to producing reliable data with the lowest possible uncertainty, the short turnaround time for repeating most laboratory tests, the risk that the comments may be overlooked in short-stay and frequently overcrowded units (e.g. the emergency department), as well as the many clinical advantages of a direct communication with the physician in charge of the patient. Despite the debate remains open, we continue supporting the suggestion that suppressing data in unsuitable (hemolyzed) samples and promptly notifying the clinicians about the need to recollect the samples remains the most (clinically and analytically) safe practice.

scholarly journals Comparison of the Genedia MTB Detection Kit and the Cobas TaqMan MTB Assay for Detection of Mycobacterium tuberculosis in Respiratory Specimens

2015 ◽  
Vol 53 (3) ◽  
pp. 1012-1014 ◽  
Author(s):  
Hee Jae Huh ◽  
Hyeon Jeong Kwon ◽  
Chang-Seok Ki ◽  
Nam Yong Lee
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Turnaround Time ◽  
Cobas Taqman ◽  
Respiratory Specimens

The performance of the Genedia MTB detection kit was compared with that of the Cobas TaqMan MTB test using respiratory specimens. The Genedia and Cobas assays showed comparable sensitivities (81.8% and 78.8%, respectively) and specificities (99.8% and 99.5%, respectively), while the Genedia assay produced fewer invalid results and required less turnaround time and labor.

The Strategic Imperative and the Paradigm Shift in Economics

2021 ◽  
Vol 2021 (1) ◽  
pp. 1-14
Author(s):  
Jacques Sapir
Keyword(s):  
Free Trade ◽  
Paradigm Shift ◽  
Balance Of Power ◽  
Strategic Thinking ◽  
Company Strategy ◽  
New Approach ◽  
Science And Art ◽  
Radical Uncertainty ◽  
Strategic Imperative ◽  
Definition Of

The very idea of strategic thinking is quite opposed to the tradition of linking the choices of agents, individual or collective, to the process of maximization under constraints. The theory of general equilibrium has closed the door to the notion of strategy, just as the theory of generalized free trade has closed that of sovereignty. But this paradigm is falling apart. With a new approach of radical uncertainty, something made even more obvious with the COVID-19 pandemic, we are relearning the science and art of strategy, the more so because we are living in a world of a balance of power. But what would be the definition of strategy? Quite clearly we must distinguish between state and company strategy. This debate is also at the very center of the controversy over the role and meaning of institutions in economics. There is also a variety of strategies and those having a distinct appetite for risk must seriously consider whether to practice the art of strategy or not.

Mixed mould species in laboratory cultures of respiratory specimens: how should they be reported, and what are the indications for susceptibility testing?: Table 1

2011 ◽  
Vol 64 (6) ◽  
pp. 543-545 ◽  
Author(s):  
J Purcell ◽  
J McKenna ◽  
P Critten ◽  
D W Denning ◽  
I A Hassan
Keyword(s):  
Clinical Microbiology ◽  
Susceptibility Testing ◽  
Positive Culture ◽  
Invasive Disease ◽  
Clinical Samples ◽  
Transplant Recipients ◽  
Patient Case ◽  
Tertiary Centre ◽  
Risk Patients ◽  
Respiratory Specimens

AimsTo investigate how clinical microbiology laboratories should report and interpret mixed mould isolates including Aspergillus species from clinical samples and the criteria for susceptibility testing of the isolates.MethodsRetrospectively collected data from our laboratory information system of moulds isolated between January 2005 and December 2007. Patient case notes were also reviewed.ResultsA total of 502 isolates (from 273 patients) were found. 20 patients with clinical diagnosis of a probable fungal infection had mixed Aspergillus species.ConclusionsIn most instances, the isolation of Aspergillus species from non-sterile sites does not represent clinical disease, but only colonisation/contamination. However, for high-risk patients including transplant recipients, a positive culture is associated with invasive disease. Our tertiary centre routinely reports single fungal isolates and mixed cultures with appropriate comments, and those considered significant will also have susceptibility testing carried out. The correlation of culture results with clinical features can differentiate between invasive disease and contamination.

scholarly journals Metagenomics to Assist in the Diagnosis of Bloodstream Infection

2019 ◽  
Vol 3 (4) ◽  
pp. 643-653 ◽  
Author(s):  
Alexander L Greninger ◽  
Samia N Naccache
Keyword(s):  
Bloodstream Infection ◽  
Clinical Microbiology ◽  
Culture Media ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Turnaround Time ◽  
Detection Algorithm ◽  
Molecular Testing ◽  
Clinical Microbiology Laboratory ◽  
Infectious Disease Diagnostics

Abstract Background Metagenomic next-generation sequencing (mNGS) has emerged as a promising technology that enables pan-pathogen detection from any source. However, clinical utility and practical integration into the clinical microbiology work flow and a bloodstream infection detection algorithm are currently uncharted. In the context of bloodstream infections, the challenges associated with blood culture, including sensitivity, postantibiotic treatment, attaining sufficient volumes sufficient volumes, and turnaround time, are well-known. Molecular assays have helped expedite turnaround time, especially when performed directly from positive culture media bottles. mNGS offers an unbiased but more complex version of molecular testing directly from sample, but it is unclear how and if it should be implemented in the clinical microbiology laboratory today. Content Here we map out the potential utility and application of mNGS tests to infectious disease diagnostics from blood sources, including intrinsic limitations of the methodology in diagnosing bloodstream infections and sepsis vs DNAemia, current barriers to integration into routine workup, and milestones that may need to be met before implementation. Summary Polymerases and pores move faster than bugs divide, so the thermodynamics of mNGS adoption for bloodstream infection is favorable. Nonetheless, considerable activation barriers exist that will slow this likely diagnostic transition. We eagerly await the manufacturer who designs an integrated sample-to-answer box to do for mNGS what has been done for other aspects of molecular detection.

scholarly journals Quality Is in the Eye of the Beholder—A Focus Group Study from the Perspective of Ambulance Clinicians, Physicians, and Managers

Healthcare ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 41 ◽  
Author(s):  
Andreas Rantala ◽  
Lina Behm ◽  
Helena Rosén
Keyword(s):  
Focus Group ◽  
Response Time ◽  
Paradigm Shift ◽  
Patient Involvement ◽  
Ambulance Service ◽  
Group Method ◽  
Focus Group Study ◽  
Definition Of ◽  
Patients Experience ◽  
Focus Group Method

Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients’ experience of the care is just as important as various time measures.

High Heat Flux Cooling of Electronics: The Need for a Paradigm Shift

2013 ◽  
Vol 135 (11) ◽  
Author(s):  
Heinz Herwig
Keyword(s):  
Heat Flux ◽  
Paradigm Shift ◽  
High Heat ◽  
High Heat Flux ◽  
German Research Foundation ◽  
Cooling Strategies ◽  
German Research ◽  
Definition Of ◽  
Cooling Of Electronics

In a discussion initiated by the German Research Foundation (DFG) about cooling of electronics, two aspects turned out to be important: The need for a paradigm shift from an “add on” to an “integrated multidisciplinary” solution and the definition of generic demonstrators for cooling strategies.

scholarly journals Representasi Homoseksualitas dalam Film Indonesia Kontemporer

ATAVISME ◽  
2007 ◽  
Vol 10 (1) ◽  
pp. 59-73
Author(s):  
Maimunah Maimunah
Keyword(s):  
Paradigm Shift ◽  
New Order ◽  
Sexual Diversity ◽  
Queer Cinema ◽  
Sexual Orientations ◽  
Rock N Roll ◽  
Definition Of ◽  
Second Category ◽  
Representation Of Sexuality ◽  
Male To Female

This paper examines the emergence of non-normative sexual orientations in contemporary Indonesian films. Unlike the representation of sexuality in New Order Indonesian films, which centred on the female reproductive role and presented the nation as constructed of heterosexual families rather than individual citizens, a number of 200()s Indonesian films can be seen as negotiations of new understandings of sexual diversity and individual subjectivity. These films represent a challenge to monolithic and essentialist constructions of sexuality in Indonesia, and portray characters and situations in ways that seem to fulfil the five selection criteria which Griffin and Benshoff (2006) apply to the definition of 'queer' cinema. As such, they are indicative of a paradigm shift in Indonesian cinema, which needs to be studied in association with broader patterns of social and political change. The paper describes three categories in the representation of sexual minorities in contemporary Indonesian films. The first category is represented by films such as Arisanl and , Gie, which portray characters and situations deal with male homosexual subjectivity or homoeroticism. The second category concerns films of this type that portray female characters, such as Detik Terakhirand TentangDia. In the third category are films which depict waria (male to female transgender characters) and transsexuals, represented by Panggil Aku Puspa and Realita Cinta dan Rock n Roll. The paper examines these films in the light of Boellstorff's (2005) study of gay and lesbi communities and subjectivities in Indonesia, as a way of situating them in a larger cultural picture. It suggests that the makers of these films are attempting to change the perception of their audiences about non-normative sexualities, and investigates the strategic devices used by the film makers to subvert censorship codes and social taboos in a country where homosexual behaviour is accommodated, but homosexual identities remain outside the range of socially and culturally-sanctioned subjectivities.

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