Malaria is a potentially life-threatening disease requiring rapid diagnosis and treatment. Although microscopic examination of thick and thin blood films remains the gold standard for laboratory ...diagnosis, rapid antigen tests and nucleic acid amplification methods may also play a useful role in detection of acute infection. This review discusses the advantages and disadvantages of the commonly used diagnostic methods and provides important practice points for optimal malaria test utilization.
Objectives: Within mental health care, the use of routine outcome measure (ROMs) has increased. So far, clients' perspectives on ROMs in the context of long-term psychotherapy remain largely ...unexplored. The present study aimed to explore clients' perspectives on completing the CORE-OM throughout psychotherapy. Method: Eight clients attending a psychiatric outpatient clinic in Sweden were interviewed and the data were analyzed according to the principles of interpretative phenomenological analysis. Results: The results included three main themes. The clients described an uncertainty of the purpose and usage of the CORE-OM, which gave room for interpretations regarding possible consequences of the results. The theme self-reporting in a relational context describes the clients' reflections about the CORE-OM, both as a measure and as a means for communication requiring continuous feedback. The CORE-OM as part of the treatment indicated that completing the questionnaire was useful for clients by evoking feelings and increasing awareness of inner states. Conclusions: ROMs should be used with great care in the treatment process and openness about the purpose of the instrument might increase the validity of the results. The use of ROMs as both an outcome measure on group level and a therapeutic tool is discussed.
To examine how organizational routines serve as a source for balancing conflicting organizational goals, we use an inductive study of Alessi, an Italian design company, to trace how organizational ...members simultaneously achieved the conflicting organizational goals of design and efficiency in the new product development routine. Our analysis identified three types of regulatory actions (splicing, activating, and repressing) that participants took to flexibly enact these conflicting organizational goals through the same routine. We observed that the three regulatory actions facilitated new connections between new product development participants, allowing them to create a dynamic truce and accomplish the two conflicting goals in a new product’s origination, evaluation, and development phases. Routine regulation shifts our focus away from the routine as a stable truce to the truce as process, highlighting the role of actions performed by individuals throughout the organizational hierarchy, and moves the conversation away from eliminating goal conflict to elaborating the ongoing actions that people take to manage conflicting organizational goals. Our findings and theoretical insights produce a deeper conceptualization of routines as generative systems by demonstrating how action taken to enact a routine also has the capacity to regulate conflicting organizational goals.
Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions ...on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.
Gastrointestinal disease is a major cause of morbidity and mortality worldwide, especially among young children and immunocompromised patients. Diarrhea may result from infection with a variety of ...microbial pathogens, including bacteria, viruses, or parasites. Historically, the diagnosis of infectious diarrhea has been made using microscopy, antigen tests, culture, and real-time PCR. A combination of these traditional tests is often required due to the inability to distinguish between infectious etiologies based on the clinical presentation alone. Recently, several multiplex molecular assays have been developed for the detection of gastrointestinal pathogens directly from clinical stool samples. These panels allow for the detection and identification of up to 20 pathogens in as little as 1 h. This review will focus on the multiplex molecular panels that have received clearance from the FDA for the diagnosis of diarrheal disease and will highlight issues related to test performance, result interpretation, and cost-effectiveness of these new molecular diagnostic tools.
Fast and widespread diagnosis is crucial to fighting against the outbreak of COVID‐19. This work surveys the landscape of available and emerging biosensor technologies for COVID‐19 testing. Molecular ...diagnostic assays based on quantitative reverse transcription polymerase chain reaction are used in most clinical laboratories. However, the COVID‐19 pandemic has overwhelmed testing capacity and motivated the development of fast point‐of‐care tests and the adoption of isothermal DNA amplification. Antigenic and serological rapid tests based on lateral‐flow immunoassays suffer from low sensitivity. Advanced digital systems enhance performance at the expense of speed and the need for large equipment. Emerging technologies, including CRISPR gene‐editing tools, benefit from high sensitivity and specificity of molecular diagnostics and the easy use of lateral‐flow assays. DNA sequencing and sample pooling strategies are highlighted to bring out the full capacity of the available biosensor technologies and accelerate mass testing.
Biosensors for COVID‐19 testing. The landscape of molecular diagnostics for infectious diseases is evolving rapidly to respond to the COVID‐19 outbreak. The sensitivity, specificity and speed of the tests vary depending on the biomarker (viral RNA, viral protein or antibodies against the virus), sample type (swab or blood) and detection method. Emerging diagnostic tools aim to circumvent roadblocks encountered at each step.
Microbial whole genome sequencing (WGS) has many advantages over standard microbiological methods. However, it is not yet widely implemented in routine hospital diagnostics due to notable challenges.
...The aim was to extract managerial, financial and clinical criteria supporting the decision to implement WGS in routine diagnostic microbiology, across different operational models of implementation in the hospital setting.
This was a systematic review of literature identified through PubMed and Web of Science. English literature studies discussing the applications of microbial WGS without limitation on publication date were eligible. A narrative approach for categorization and synthesis of the sources identified was adopted.
A total of 98 sources were included. Four main alternative operational models for incorporating WGS in clinical microbiology laboratories were identified: full in-house sequencing and analysis, full outsourcing of sequencing and analysis and two hybrid models combining in-house/outsourcing of the sequencing and analysis components. Six main criteria (and multiple related sub-criteria) for WGS implementation emerged from our review and included cost (e.g. the availability of resources for capital and operational investment); manpower (e.g. the ability to provide training programmes or recruit trained personnel), laboratory infrastructure (e.g. the availability of supplies and consumables or sequencing platforms), bioinformatics requirements (e.g. the availability of valid analysis tools); computational infrastructure (e.g. the availability of storage space or data safety arrangements); and quality control (e.g. the existence of standardized procedures).
The decision to incorporate WGS in routine diagnostics involves multiple, sometimes competing, criteria and sub-criteria. Mapping these criteria systematically is an essential stage in developing policies for adoption of this technology, e.g. using a multicriteria decision tool. Future research that will prioritize criteria and sub-criteria that were identified in our review in the context of operational models will inform decision-making at clinical and managerial levels with respect to effective implementation of WGS for routine use. Beyond WGS, similar decision-making challenges are expected with respect to future integration of clinical metagenomics.
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