Search Results (8)

Recent initiatives have discouraged the treatment of asymptomatic bacteriuria in specific patient populations due to its lack of clinical benefit, no improvement in morbidity or mortality, and its contribution to antibiotic overuse. This study aimed to evaluate whether an intervention at order entry, combined with DCLS laboratory consultation for urine cultures and urinalyses, could reduce unnecessary lab tests and inappropriate antibiotic use, thereby improving patient outcomes. Our research design was a quasi-experimental study with a retrospective and prospective chart review on non-pregnant adult patients 18 years of age and older from July 2021 to September 2022. Data collected for both reviews included patient demographics, provider demographics, patient signs and symptoms, laboratory test results, test order type, test order utilization and antibiotic prescriptions. Our study included 6372 patients, with 3408 in the retrospective review and 2964 in the prospective review. Before the intervention, 60% (n = 2053) of test orders were inappropriate, which decreased to 20% (n = 591) post-intervention. In asymptomatic patients, reflexed urine cultures decreased from 51% to 13% post-intervention. Lastly, in asymptomatic patients, antibiotic therapy at discharge dropped from 54% to 25% after the intervention. Post-intervention ordering practices improved, decreasing the number of inappropriate orders across all patient and provider types. Overall, this initiative showed a significant reduction in the treatment of asymptomatic bacteriuria, which has been linked to the overuse of antibiotic therapy. Full article

Background: With advancements in molecular diagnostics, including Highly Multiplexed Microbiological/Medical Countermeasure Diagnostic Devices (HMMDs) and the impending integration of Next-Generation Sequencing (NGS) into clinical microbiology, interpreting the flood of nucleic acid data in a clinically meaningful way has become a crucial challenge. This study focuses on the Luminex xTAG Gastrointestinal Pathogen Panel (GPP) for Salmonella detection, evaluating the impact of MFI threshold adjustments on diagnostic accuracy and exploring the need for an “indeterminate” result category to enhance clinical utility in molecular diagnostics. Methods: A retrospective review of Salmonella-positive cases detected via the Luminex xTAG GPP was conducted from June 2016 to November 2023. Key metrics included patient symptoms, stool culture results, and potential infection sources. Results were analyzed using the assay’s MFI cutoffs in Versions 1.11 and 1.12. Statistical comparisons between culture-confirmed and non-confirmed cases were performed using Kruskal–Wallis tests to assess MFI value distributions. Results: Among 2573 tests, 212 were Salmonella-positive under Version 1.11, while 185 were positive under Version 1.12. Adjusting the MFI threshold in Version 1.12 reduced false positives from 40.6% to 38.4% but led to one culture-confirmed positive case being missed. Statistically significant MFI differences were observed between culture-positive and culture-negative cases, suggesting that fixed binary cutoffs may not always yield clinically accurate interpretations. Discussion: The MFI threshold adjustment decreased false positives without fundamentally improving diagnostic accuracy, highlighting the limitations of binary interpretations in HMMDs. Introducing an “indeterminate” category, especially for cases with low MFI values, could aid clinicians in integrating molecular results with patient context. This approach offers a framework for future NGS integration, where nuanced interpretation will be essential to differentiate clinically significant findings from incidental data. Conclusions: Implementing an “indeterminate” interpretation category for HMMDs could enhance clinical decision-making and refine public health surveillance by focusing on clinically relevant findings. As NGS moves toward clinical application, establishing similar interpretive standards will be essential to manage the complexity and volume of molecular data effectively. Full article

The ecclesiastical discourse in Britian over homosexuality has included a significant focus on the narratives and experience of LGBTQ+ people. However, the relationship between and respective authority given to human experience and the Bible within church debates remains a matter of contention, especially among evangelicals committed to ‘biblicism’. This study considers how even those unconvinced about experience as a ‘source’ of theology might still engage with queer narratives as an invitation for personal and cultural reflexivity and how the plausibility of theological claims might be tested whilst still prioritising Scripture. I examine testimony through a three-stage study. First, I conduct a narrative analysis of audiovisual recordings of my own prior practice of testimony as a celibate gay evangelical. Second, I offer up new, autoethnographic, thick descriptions of three pivotal crisis moments. Third, I theologically reflect upon these in relation to Romans 12.1–2 and the meta-theme of identity formation. I argue that LGBTQ+ testimonies have the potential to illuminate and thus transform heteronormative cultural patterns within the church; I argue that Christian identity formation must include the central integration of God’s identification of a person in Christ; and I attempt to model how Christians might cautiously discern God’s activity within a practice of testimony. Full article

In this study, both performance and polymedia serve as important conceptual lenses to examine how university students in the Global South handle the social media landscape in enacting cultural identity. Based on 17 focus groups with 105 students from Bolivian universities, we argue that in performing their multiplex identities, this group of Bolivian young people navigate social media as polymedia environments, taking advantage of its possibilities and testing its constraints. The research generated three key findings: (1) students mainly reported examples of cosmopolitan and national identity performances; (2) performances of national belonging showed an ambiguous mixture of self-glorification and self-reflexivity; (3) indigenous identities were rarely performed on the platforms used. Full article

A urinary tract infection is amongst the most common bacterial infections in the community and hospital setting and accounts for an estimated 1.6 to 2.14 billion in national healthcare expenditure. Despite its financial impact, the diagnosis is challenging with urine cultures and antibiotics often inappropriately ordered for non-specific symptoms or asymptomatic bacteriuria. In an attempt to limit unnecessary laboratory testing and antibiotic overutilization, several diagnostic stewardship initiatives have been described in the literature. We conducted a systematic review with a focus on the application of molecular and microbiological diagnostics, clinical decision support, and implementation of diagnostic stewardship initiatives for urinary tract infections. The most successful strategies utilized a bundled, multidisciplinary, and multimodal approach involving nursing and physician education and feedback, indication requirements for urine culture orders, reflex urine culture programs, cascade reporting, and urinary antibiograms. Implementation of antibiotic stewardship initiatives across the various phases of laboratory testing (i.e., pre-analytic, analytic, post-analytic) can effectively decrease the rate of inappropriate ordering of urine cultures and antibiotic prescribing in patients with clinically ambiguous symptoms that are unlikely to be a urinary tract infection. Full article

Stool culture is the gold standard method to diagnose enteric bacterial infections; however, many clinical laboratories are transitioning to syndromic multiplex PCR panels. PCR is rapid, accurate, and affordable, yet does not yield subtyping information critical for foodborne disease surveillance. A metagenomics-based stool testing approach could simultaneously provide diagnostic and public health information. Here, we evaluated shotgun metagenomics to assess the detection of common enteric bacterial pathogens in stool. We sequenced 304 stool specimens from 285 patients alongside routine diagnostic testing for Salmonella spp., Campylobacter spp., Shigella spp., and shiga-toxin producing Escherichia coli. Five analytical approaches were assessed for pathogen detection: microbiome profiling, Kraken2, MetaPhlAn, SRST2, and KAT-SECT. Among analysis tools and databases compared, KAT-SECT analysis provided the best sensitivity and specificity for all pathogens tested compared to culture (91.2% and 96.2%, respectively). Where metagenomics detected a pathogen in culture-negative specimens, standard PCR was positive 85% of the time. The cost of metagenomics is approaching the current combined cost of PCR, reflex culture, and whole genome sequencing for pathogen detection and subtyping. As cost, speed, and analytics for single-approach metagenomics improve, it may be more routinely applied in clinical and public health laboratories. Full article

Recent studies in the field of cognitive science of religion have proposed a connection between religious beliefs, theory of mind, and prosocial behaviour. Theory of mind appears to be related to empathy and compassion, and both to a special sensitivity towards unjust suffering, which could trigger a religious crisis, as has often happened and is revealed in the “theodicy question”. To test such relationships, adolescents were surveyed by an exploratory questionnaire. The collected data point to a more complex, less linear interaction, which depends more on cultural factors and reflexive elaboration than cognitive structures. In general, compassion and outrage before unjust suffering appear to be quite related; compassion is related to religious practice and even more to spiritual perception. Full article

Two cases of cryptococcal meningitis went undetected by a cryptococcal antigen (CrAg) lateral flow assay on blood in a reflex CrAg screen-and-treat programme in South Africa, although Cryptococcus neoformans was identified by culturing the cerebrospinal fluid specimens. Further investigations into these discordant diagnostic results included multilocus sequence typing (which showed no mutations in the CAP59 gene) and transmission electron microscopy using a capsule-staining protocol (which revealed a >50% reduction in capsular material in both cases, relative to a control culture). A multi-disciplinary approach for resolving discordant diagnostic test results is recommended. Full article