journal
https://read.qxmd.com/read/38280802/nothing-basic-about-it-guiding-the-judicious-use-of-diagnostic-tests
#1
EDITORIAL
N Esther Babady, Jennifer Dien Bard
No abstract text is available yet for this article.
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280801/working-with-the-electronic-health-record-and-laboratory-information-system-to-maximize-ordering-and-reporting-of-molecular-microbiology-results
#2
REVIEW
Meghan W Starolis, Mark A Zaydman, Rachael M Liesman
Molecular microbiology assays have a higher cost of testing compared to traditional methods and need to be utilized appropriately. Results from these assays may also require interpretation and appropriate follow-up. Electronic tools available in the electronic health record and laboratory information system can be deployed both preanalytically and postanalytically to influence ordering behaviors and positively impact diagnostic stewardship. Next generation technologies, such as machine learning and artificial intelligence, have the potential to expand upon the capabilities currently available and warrant additional study and development but also require regulation around their use in health care...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280800/is-it-possible-to-test-for-viral-infectiousness-the-use-case-of-sars-cov-2
#3
REVIEW
Heba H Mostafa
Identifying and managing individuals with active or chronic disease, implementing appropriate infection control measures, and mitigating the spread of the COVID-19 pandemic highlighted the need for tests of infectiousness. The gold standard for assessing infectiousness has been the recovery of infectious virus in cell culture. Using cycle threshold values, antigen testing, and SARS-CoV-2, replication intermediate strands were used to assess infectiousness, with many limitations. Infectiousness can be influenced by host factors (eg, preexisting immune responses) and virus factors (eg, evolution)...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280799/the-report-says-what-how-the-medical-microbiologist-can-aid-in-the-interpretation-of-next-generation-sequencing-results
#4
REVIEW
Cristina Costales, Jennifer Dien Bard
The applications of next-generation sequencing (NGS) in the clinical microbiology laboratory are expanding at a rapid pace. The medical microbiologist thus plays a key role in translating the results of these emerging technologies to the practicing clinician. Here we discuss the factors to consider to successfully develop standardized reporting for microbial targeted or metagenomic NGS testing in the clinical laboratory.
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280798/diagnostic-stewardship-for-next-generation-sequencing-assays-in-clinical-microbiology-an-appeal-for-thoughtful-collaboration
#5
REVIEW
David C Gaston, Augusto Dulanto Chiang, Kevin Dee, Daniel Dulek, Ritu Banerjee, Romney M Humphries
Next-generation sequencing (NGS)-based assays are primarily available from reference laboratories for diagnostic use. These tests can provide helpful diagnostic data but also can be overused by ordering providers not fully understanding their limitations. At present, there are few best practice guidelines for use. NGS-based assays can carry a high cost to institutions and individual patients, requiring thoughtful use through application of diagnostic stewardship principles. This article provides an overview of diagnostic stewardship approaches as applied to these assays, focusing on principles of collaboration, differential diagnosis formation, and seeking the best patient, syndrome, sample, timing, and test for improved patient care...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280797/diagnostic-stewardship-for-multiplex-respiratory-testing-what-we-know-and-what-needs-to-be-done
#6
REVIEW
Jose Lucar, Rebecca Yee
Syndromic respiratory panels are now widely available in clinical microbiology laboratories and health care institutions. These panels can rapidly diagnose infections and detect antimicrobial resistance genes allowing for more rapid therapeutic optimization compared to standard microbiology approaches. However, given reimbursement concerns and limitations of multiplex molecular testing and results interpretation, maximum clinical utility and positive clinical outcomes depend on active diagnostic stewardship...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280796/preanalytical-challenges-of-molecular-microbiology-tests
#7
REVIEW
Anisha Misra, Eleanor A Powell
As infectious disease diagnostics increasingly incorporates molecular techniques, there are unique preanalytical concerns that must be considered. First, noninvasive specimen types that may be inadequate for culture-based diagnostics may be acceptable when using molecular tests. Second, specimen containers must be evaluated for the presence of substances that may interfere with amplification or sequencing reactions. Finally, the capacity of transport, storage, and processing conditions to maintain nucleic acid integrity and avoid contamination must be assessed...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280795/point-of-care-molecular-testing-current-state-and-opportunities-for-diagnostic-stewardship
#8
REVIEW
Caitlin Otto, Dan Chen
Inappropriate ordering practices, either under or over ordering of diagnostic tests, are recognized problems with possible negative downstream consequences. As the menu of clinical tests, especially molecular tests grows, it is becoming increasingly important to provide guidance to providers on the appropriate utilization. Diagnostic stewardship programs have been established at many institutions to help direct the appropriate utilization of laboratory testing to ultimately guide patient management and treatment decisions...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280794/home-and-clinical-laboratory-improvement-amendments-waived-testing-for-infectious-diseases-how-do-these-fit-in-the-testing-landscape
#9
REVIEW
Jacky Lu, Susan M Butler-Wu
Though testing for infectious diseases has long been performed in traditional clincial laboratory settings, more widespread availability of waived testing is expanding accessibility of patients to rapid test results. This is being further expanded to home testing. Nevertheless, with this greater democratization and availability of clinical testing there are important limitations that need to be balanced. In this article, we review the current test landscape for infectious diseases waived testing and opportunities for assuring optimal quality testing...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280793/present-and-future-non-culture-based-diagnostics-stewardship-potentials-and-considerations
#10
REVIEW
Arryn Craney, Steve Miller
The medical microbiologist plays a key role in the transition from culture-based to molecular test methods for diagnosis of infectious diseases. They must understand the scientific and technical bases underlying these tests along with their associated benefits and limitations and be able to educate administrators and patient providers on their proper use. Coordination of testing practices between clinical departments and the spectrum of public health and research laboratories is essential to optimize health care delivery...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/38280792/taking-center-stage-clinical-laboratory-leading-diagnostic-stewardship-efforts
#11
REVIEW
Christopher D Doern, Chelsea Kidd
This article will discuss diagnostic stewardship from the perspective of those who are just starting, or have recently started, a diagnostic stewardship effort. This document will provide guidance on how to identify opportunities for intervention and tools that can be used to affect change. Specifically, we will discuss key components of a diagnostic stewardship committee, referral laboratory testing, prior authorization, miscellaneous test orders, establishing a laboratory test formulary, and conclude with some specific examples of interventions that can be considered...
March 2024: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865512/advances-in-myelodysplastic-syndromes
#12
EDITORIAL
Alexa J Siddon
No abstract text is available yet for this article.
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865511/treatment-considerations-of-myelodysplastic-syndromes-neoplasms-for-pathologists
#13
REVIEW
Yazan F Madanat, Amer M Zeidan
The diagnosis of myelodysplastic syndromes/neoplasms (MDS) has evolved over the years with the incorporation of genetic abnormalities to establish a diagnosis, their impact on risk stratification, prognostication, and therapeutic options. Hematopathologists are the cornerstone to establish an accurate diagnosis and ensure patients receive the best available treatment option. Hematopathologists and clinicians must work closely together to establish the best disease subclassification, by combining pathologic findings with the clinical presentation...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865510/transfusion-support-of-patients-with-myelodysplastic-syndromes
#14
REVIEW
Juliana Guarente, Christopher Tormey
Patients with MDS often suffer from anemia, and less often thrombocytopenia, and thus are a frequently transfused population. Red blood cell (RBC) transfusion may be used to improve functional capacity and quality of life in this population, while platelet transfusion is typically used to decrease bleeding risk. Despite the frequency of transfusion in patients with MDS, there are few well-defined guidelines for RBC and platelet transfusion support in this patient population. Transfusion is not without risk-patients with MDS who are frequently transfused may develop alloantibodies to RBC antigens, which can lead to hemolytic transfusion reactions and delays in obtaining compatible RBCs...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865509/acute-myeloid-leukemia-arising-from-myelodysplastic-syndromes
#15
REVIEW
Adelaide Kwon, Olga K Weinberg
Myelodysplastic syndromes (MDS) are a group of myeloid neoplasms characterized by clonal hematopoiesis and abnormal maturation of hematopoietic cells, resulting in cytopenias. The transformation of MDS to acute myeloid leukemia (AML) reflects a progressive increase in blasts due to impaired maturation of the malignant clone, and thus MDS and many AML subtypes form a biological continuum rather than representing two distinct diseases. Recent data suggest that, in addition to previously described translocations, NPM1 mutations and KMT2A rearrangements are also AML-defining genetic alterations that lead to rapid disease progression, even if they present initially with less than  20% blasts...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865508/childhood-myelodysplastic-syndrome
#16
REVIEW
Karen M Chisholm, Sandra D Bohling
Myelodysplastic syndrome (MDS) in children is rare, accounting for < 5% of all childhood hematologic malignancies. With the advent of next-generation sequencing, the etiology of many childhood MDS (cMDS) cases has been elucidated with the finding of predisposing germline mutations in one-quarter to one-third of cases; somatic mutations have also been identified, indicating that cMDS is different than adult MDS. Herein, cMDS classification schema, clinical presentation, laboratory values, bone marrow histology, differential diagnostic considerations, and the recent molecular findings of cMDS are described...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865507/germline-predisposition-to-myeloid-neoplasms-diagnostic-concepts-and-classifications
#17
REVIEW
Ifeyinwa E Obiorah, Kalpana D Upadhyaya, Katherine R Calvo
Molecular and sequencing advances have led to substantial breakthroughs in the discovery of new genes and inherited mutations associated with increased risk of developing myeloid malignancies. Many of the same germline mutated genes are also drivers of malignancy in sporadic cancer. Recognition of myeloid malignancy associated with germline mutations is essential for proper therapy, disease surveillance, informing related donor selection for hematopoietic stem cell transplantation, and genetic counseling of the patient and affected family members...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865506/diagnosis-and-classification-of-myelodysplastic-syndromes-with-mutated-tp53
#18
REVIEW
Alexa J Siddon, Olga K Weinberg
The genetic underpinnings of myeloid neoplasms are becoming increasingly well understood. The accessibility to sequencing technology, in particular next-generation sequencing (NGS), has highlighted the importance of gene mutations in myelodysplastic syndromes (MDS) in conjunction with traditional cytogenetics. With the relatively recent influx of molecular information to complement known cytogenetic abnormalities, the diagnosis, classification, and prognosis of MDS and acute myeloid leukemia (AML) have been increasingly refined, which has also led to therapeutic advancements...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865505/significance-of-sf3b1-mutations-in-myeloid-neoplasms
#19
REVIEW
David C Gajzer, Cecilia C S Yeung
Myelodysplastic neoplasm with low blasts and SF3B1 mutation (MDS-LB-SF3B1) has undergone significant classification changes in the past year with the publication of the 5th edition of the World Health Organization Classification of Tumors of Haematopoietic and Lymphoid Tissues and the International Consensus Classification. This article reviews the basic biology of SF3B1, iron metabolism, and dysfunction that leads to the formation of ring sideroblasts. It highlights neoplastic and non-neoplastic considerations to the differential diagnoses...
December 2023: Clinics in Laboratory Medicine
https://read.qxmd.com/read/37865504/morphologic-characteristics-of-myelodysplastic-syndromes
#20
REVIEW
Lisa D Yuen, Robert P Hasserjian
Morphologic characterization remains a cornerstone in the diagnosis and classification of myelodysplastic syndromes (MDS) in the updated International Consensus Classification (ICC) and 5th edition World Health Organization Classification of Myeloid Neoplasms (Arber, Orazi, & Hasserjian, 2022; Khoury & Solary, 2022). The presence of dysplasia is one of the key diagnostic criteria required for establishing a diagnosis of MDS, and the percentage of myeloblasts in the blood and bone marrow impacts both disease classification and prognostication...
December 2023: Clinics in Laboratory Medicine
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