scholarly journals The Tail Wagging the Dog (or the Challenges Faced When the Financing of Medicine Gets Ahead of the Science of Medicine)

2018 ◽  
Vol 56 (10) ◽  
Author(s):  
David W. Kimberlin
Keyword(s):  
Case Series ◽  
Molecular Testing ◽  
Labor Costs ◽  
Specific Test ◽  
Potential Harm ◽  
Viral Culture ◽  
Diagnostic Decision ◽  
Simplex Virus ◽  
Diagnostic Decision Making ◽  
Made In

ABSTRACTIn their article in this issue of theJournal of Clinical Microbiology, S. R. Dominguez et al. (J Clin Microbiol 56:e00632-18, 2018,https://doi.org/10.1128/JCM.00632-18) describe the performance of PCR detection of herpes simplex virus (HSV) DNA versus viral culture in skin and mucosal samples from 7 neonates with HSV disease. This is a significant contribution to our understanding of the optimal diagnostic approach in babies being evaluated for neonatal HSV disease. Many diagnostic laboratories already have made the change to molecular diagnostics for skin and mucosal swab testing, however, in large part due to the labor costs associated with viral cultures. Thus, important studies such as this one are being conducted to support a decision that has already been made in many locations on mostly economic grounds. This small case series supports the decision to use molecular testing for samples from skin and mucosal sites, but larger studies are needed to more fully define the performance characteristics of PCR in this population. Since a false-positive result would commit a baby to months of management that would be unnecessary and have potential harm, it is critical to base diagnostic decision making on data that support the use of a specific test.

scholarly journals Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

2019 ◽  
Vol 69 (689) ◽  
pp. e809-e818 ◽  
Author(s):  
Sophie Chima ◽  
Jeanette C Reece ◽  
Kristi Milley ◽  
Shakira Milton ◽  
Jennifer G McIntosh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Decision Support ◽  
Cost Effectiveness ◽  
Cancer Diagnosis ◽  
Decision Support Tools ◽  
Diagnostic Decision ◽  
Support Tools ◽  
Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

scholarly journals EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e44-e45 ◽  
Author(s):  
Hana Mijovic ◽  
Yossef Al-Nasser ◽  
Ghada Al-Rawahi ◽  
Ashley Roberts
Keyword(s):  
Case Series ◽  
Pericardial Fluid ◽  
Diagnosis And Treatment ◽  
Molecular Testing ◽  
Retrospective Case ◽  
Detection Rates ◽  
Endemic Setting ◽  
Number Of Patients ◽  
Small Patient Population ◽  
Extra Pulmonary

Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.

scholarly journals Phases 1–3 Clinical Trials Using Adult Stem Cells in Osteonecrosis and Nonunion Fractures

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Jean-Philippe Hauzeur ◽  
Valérie Gangji
Keyword(s):  
Stem Cells ◽  
Bone Marrow ◽  
Adult Stem Cells ◽  
Bone Marrow Aspirate ◽  
Direct Injection ◽  
Case Series ◽  
Autologous Bone Marrow ◽  
Bone Necrosis ◽  
Concentrated Bone Marrow ◽  
Made In

Nonunion fractures and aseptic bone necrosis are two pathological conditions having some impairment of the cellular part of the repair: a reduction of MSC and of the osteoblastic activation. Both are good candidates for cell-based therapies using stem cells. We made a review of the published human trials. Only autologous bone marrow aspirate implantation was until now used. In Nonunion, a direct injection—15 to 150 ml—was made in 4 case series studies. In another, the bone marrow aspirate was concentrated before injection. The results were good. In bone necrosis, only one level 1 study was published. The results at 24 months were positive in terms of reduction of the necrosis and appearance of collapse. In 3 case series studies, a treatment with concentrated bone marrow aspirates was deemed useful with good results in 76 to 96%. These results are interesting but need confirmation by controlled studies.

Diagnostic Decision-Making Processes

2019 ◽  
pp. 79-85
Author(s):  
Julia Hodgson ◽  
Kevin Moore ◽  
Trisha Acri ◽  
Glenn Jordan Treisman
Keyword(s):  
Decision Making ◽  
Diagnostic Decision ◽  
Decision Making Processes ◽  
Diagnostic Decision Making

scholarly journals Identification of duration construction of combined foundation

2018 ◽  
Vol 5 (4) ◽  
Author(s):  
Iakov Pronozin ◽  
Denis Volosiuk
Keyword(s):  
Labor Costs ◽  
Work Time ◽  
Common Time ◽  
Actual Duration ◽  
Concrete Mix ◽  
Time Standards ◽  
Time Parameters ◽  
Working Out ◽  
Sufficient Precision ◽  
Made In

The method for determining the duration of a combined foundation device, which is constructed in several stages, is considered in the article. The main stages include the construction of structures and the regulation of the stress-strain state of the soil base, which is carried out by pressing it. Pressurization is carried out during the construction of the building. On an example of construction of the linear schedule the mutual coordination of works of each stage during building of a building is resulted. The possibility of varying the time parameters of the network model is presented depending on the parameters of the crimping process. Between the late and early beginnings of work there is a common time reserve, which is part of the technological break. The authors present empirical data on the actual duration of concreting of grillage of combined foundations. The study of time parameters of technological processes was based on such methods of observation as timekeeping, photo-timing and video and photo-fixation. The measurements were carried out during the construction of the residential complex «Neighbors» in Tyumen. The scope of research included the study of labor costs of the team, consisting of seven concrete workers. The investigated technological process of concreting consistently included the reception and direction of the concrete mix, laying, leveling and compacting the mixture, smoothing and smoothing the grillage surface. Based on the data obtained, the dependencies of the average duration of concrete work on the volume of the concrete mix laid in the cells (shells) are revealed. The comparison of work durations on both foundations is made. Actual work is determined and work time standards are established, allowing to organize concrete works with sufficient precision when drawing up calendar plans within the framework of working out of projects for the production of works. This article is made in the framework of the dissertation research by co-author Volosiuk D.V.

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