Immunology Laboratory Testing
CLINICS IN LABORATORY MEDICINE (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 26, 2019 Category: Laboratory Medicine Authors: Vinay S. Mahajan Source Type: research

Copyright
Elsevier (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 26, 2019 Category: Laboratory Medicine Source Type: research

Contributors
MILENKO JOVAN TANASIJEVIC, MD, MBA (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 26, 2019 Category: Laboratory Medicine Source Type: research

Contents
Vinay S. Mahajan (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 26, 2019 Category: Laboratory Medicine Source Type: research

Forthcoming Issues
Direct to Consumer Testing: The Role of  Laboratory Medicine (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 26, 2019 Category: Laboratory Medicine Source Type: research

Antinuclear Antibody Tests
This article discusses the most commonly used diagnostic modalities for detecting and quantitating the presence of ANA: indirect immunofluorescence assay, enzyme-linked immunosorbent assay, and multiplex bead technology, which serve as useful screening tests. We also review testing for autoantibodies to ENAs, which are often helpful to confirm the diagnosis of a specific connective tissue disease. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 4, 2019 Category: Laboratory Medicine Authors: Morris Ling, Mandakolathur Murali Source Type: research

Laboratory Evaluation of Antiphospholipid Syndrome
Antiphospholipid syndrome (APS) is as an autoimmune disease characterized by thrombosis and/or specific pregnancy-related morbidity associated with persistent antiphospholipid antibodies, namely, lupus anticoagulant and IgG and IgM antibodies to cardiolipin and beta2 glycoprotein I. Optimal antibody detection plays a central role in diagnosis and classification. This review discusses antiphospholipid antibodies helpful for diagnosing APS. It includes the criteria and noncriteria antiphospholipid antibodies, methods for their detection, and challenges for clinical reporting and interpretation. The significance of using spec...
Source: Clinics in Laboratory Medicine - October 4, 2019 Category: Laboratory Medicine Authors: Anne E. Tebo Source Type: research

Testing Immune-Related Adverse Events in Cancer Immunotherapy
Immune-targeted therapeutics are being used in cancer. Immune “checkpoint inhibition” provides promise for prolonged disease-free patient survival. Use of immune checkpoint inhibitors in cancer has coincided with the onset of immune-related adverse events (irAEs). irAEs are caused by a break in host self-tolerance, which can be deadly. Acute management of irAEs is complicated by difficulty making a prompt clinical diagnosis. The goal is to maximize anticancer benefit while minimizing irAE risk. We currently lack diagnostic tools to assess pretreatment irAE risk and facilitate diagnosis. Current immunologic unde...
Source: Clinics in Laboratory Medicine - October 4, 2019 Category: Laboratory Medicine Authors: Jocelyn R. Farmer Source Type: research

Serologic Diagnosis of Rheumatoid Arthritis
This article discusses the serologic basis f or the diagnosis of RA, how these biomarkers have framed conceptualization of the pathogenesis of RA, and the inherent limitations in their use. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Hugues Allard-Chamard, Gilles Boire Source Type: research

Antineutrophil Cytoplasmic Antibodies Testing and Interpretation
This article traces landmarks in the development of ANCA tests, describes common pitfalls arising during ANCA interpretation, and discusses new technologies to improve the future of ANCA testing. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Hugues Allard-Chamard, Patrick Liang Source Type: research

Analysis of the Complement System in the Clinical Immunology Laboratory
This article describes the pathways involved in complement activation and function, the regulation of these various pathways, and the interpretation of laboratory testing performed for the diagnosis of diseases of complement deficiency, exuberant complement activation, and complement dysregulation. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Morris Ling, Mandakolathur Murali Source Type: research

Laboratory Assays of Immune Cell Function in Immunodeficiencies
Laboratory assays of immune cell function are essential for understanding the type and function of immune defects. These assessments should be performed in conjunction with a detailed history and physical examination, which should guide the evaluation of patients with a suspected immune deficiency. Laboratory assays of immune cell function are critical for assessing and demonstrating the functional impact of genetic mutations. Advances in diagnostic techniques continue to expand the ability of clinicians and researchers to understand the complex immune pathophysiology that underlies these disorders. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Sara Barmettler Source Type: research

Food Allergy Testing
Although the gold standard for diagnosis of immunoglobulin E (IgE)-mediated food allergy is an oral food challenge, clinically relevant biomarkers of IgE sensitization, including serum-specific IgE and skin prick testing, can aid in diagnosis. Clinically useful values have been defined for individual foods. More recently, specific IgE to particular protein components has provided additional diagnostic value. In summary, food allergy diagnostics to evaluate IgE sensitization are clinically useful and continue to evolve to improve evaluation of IgE-mediated food allergies. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Nicole A. LaHood, Sarita U. Patil Source Type: research

Immunologic Risk Assessment and Approach to Immunosuppression Regimen in Kidney Transplantation
The outcomes of kidney transplantation show a steady improvement with an increasing number of transplantations and decreasing incidence of acute rejection episodes. Successful transplantation begins with a comprehensive immunologic risk assessment and judicious choice of therapeutic agents. In this review, we discuss the trends in transplant immunosuppression practices and outcomes in the United States. We discuss practical testing algorithms for clinical decision making in induction therapy and fine-tuning maintenance immunosuppression. We introduce assessment tools for immune monitoring after transplantation and speculat...
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: John Choi, Anil Chandraker Source Type: research

Laboratory Testing in the Context of Biologics and Cellular Therapies
“With the increasing application of biotechnology to the realm of pharmacology and therapeutics, the types of biological treatments available have significantly expanded. Currently, recombinant proteins, humanized antibodies, or rationally engineered monoclonal antibodies are used on a regular bas is in the clinical setting. Moreover, cell-based therapeutics with molecularly rewired antigenic specificities are becoming increasingly common in oncology and are actively being developed for a broad range of diseases. Nonetheless, there has been a significant lag between the development of these t echnologies and the emer...
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Hugues Allard-Chamard Source Type: research

The Future of Clinical Immunology Laboratory Testing
For decades, autoantibody detection has comprised the bulk of clinical laboratory immunology. However, most immune disorders are caused by imbalances in both humoral and cellular immunity. Our knowledge of the immune system has grown exponentially, resulting in new treatment paradigms in immunology. Extensive functional characterization of lymphocyte subsets is routinely carried out in a research laboratories, facilitated by the emergence of high-dimensional analysis technologies for low cell numbers. It will not be long before these approaches enter the diagnostic realm. This chapter outlines emerging trends in laboratory...
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Hugues Allard-Chamard, Vinay S. Mahajan Source Type: research

Update on Clinical Immunology Laboratory Testing
The recent explosion in our knowledge of the molecular basis of immune regulatory mechanisms has paved the way for rapid developments in immunosuppression, immunotherapy, allergy, autoimmunity, and immunodeficiencies, all of which have impacted the practice of clinical laboratory immunology. The advent of immune checkpoint inhibitors and cell therapies in recent years has led to a surge of interest in clinical immunology. Advancements in lasers, microfluidics, and advanced electronics have resulted in the proliferation of robust and affordable flow cytometry or cell-sorting instruments that can withstand the demands of a c...
Source: Clinics in Laboratory Medicine - October 3, 2019 Category: Laboratory Medicine Authors: Vinay S. Mahajan Tags: Preface Source Type: research

Diagnostic Pitfalls in Immunology Testing
Immunology testing is relevant for the diagnosis of many autoimmune conditions. However, diagnostic pitfalls arise owing to incorrect interpretation of results and incomplete understanding of the underlying technique or immune-mediated condition. Here, we review the diagnostic considerations related to commonly used immunology tests. Specifically, we summarize the caveats pertinent to the interpretation of rheumatoid factor, antinuclear antibodies, antiphospholipid antibodies, antineutrophil cytoplasmic antibodies, and serum IgG4 testing. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - September 10, 2019 Category: Laboratory Medicine Authors: Lewena Maher, Cory Perugino Source Type: research

Flow Cytometry as a Diagnostic Tool in Primary and Secondary Immune Deficiencies
Flow cytometry is an incredibly powerful diagnostic tool in the evaluation of primary and secondary immune deficiencies. Assay design and setup involves a methodological consideration of specimen collection, marker and fluorochrome selection, antibody titration, instrumentation, compensation, gating, reference range development, and cross validation. Commonly used analyses for lymphocytes are the lymphocyte subset, T-cell subset, B-cell and T-cell naive/memory, double-negative T-cell, and plasmablast panels. Flow cytometry has direct clinical applicability to the workup of severe forms of primary immune deficiency disorder...
Source: Clinics in Laboratory Medicine - September 10, 2019 Category: Laboratory Medicine Authors: Jocelyn R. Farmer, Michelle DeLelys Source Type: research

Molecular Diagnosis of Inherited Immune Disorders
Primary immunodeficiency diseases are a heterogeneous group of rare inherited disorders of innate or adaptive immune system function. Patients with primary immunodeficiencies typically present with recurrent and severe infections in infancy or young adulthood. More recently, the co-occurrence of autoimmune, benign lymphoproliferative, atopic, and malignant complications has been described. The diagnosis of a primary immunodeficiency disorder requires a thorough assessment of a patient ’s underlying immune system function. Historically, this has been accomplished at the time of symptomatic presentation by measuring im...
Source: Clinics in Laboratory Medicine - September 6, 2019 Category: Laboratory Medicine Authors: Jocelyn R. Farmer, Vinay S. Mahajan Source Type: research

Total Laboratory Automation
This article discusses commercially available automated systems in the United States; why automation is needed; and quality improvements, efficiency, and cost savings associated with automation. After learning how these systems are used, gains and losses experienced, and how one can afford the most expensive equipment ever purchased for clinical microbiology laboratories, the question is, how can one afford not to purchase one of these microbiology automation systems? (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: Richard B. Thomson, Erin McElvania Source Type: research

Next-Generation Sequencing in Clinical Microbiology
Next-generation sequencing (NGS) applications have been transitioning from research tools to diagnostic methods and are becoming more commonplace in clinical microbiology laboratories. These applications include (1) whole-genome sequencing, (2) targeted next-generation sequencing methods, and (3) metagenomic next-generation sequencing. The introduction of these methods into the clinical microbiology laboratory has led to the theoretic question of “Will NGS-based methods supplant traditional methods for strain typing, identification, and antimicrobial susceptibility prediction?” The authors address this question...
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: Stephanie L. Mitchell, Patricia J. Simner Source Type: research

Distributed Microbiology Testing
We describe strengths, weaknesses, opportunities, and threats to the development of point-of-care diagnostics in the near (1 –10 years) and more distant (10–20 years) future. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: David R. Peaper, Thomas Durant, Sheldon Campbell Source Type: research

Direct-from-Specimen Pathogen Identification
This article describes the current state of the art with regards to commercially available syndromic panels for blood stream infections, gastrointestinal pathogen detection, respiratory tract infections, and central nervous system infections, while providing a provocative and speculative look into the future of syndromic panel testing for infectious diseases. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: Marc Roger Couturier, Jennifer Dien Bard Source Type: research

Predicting Bacterial Versus Viral Infection, or None of the Above
Sepsis and pneumonia cause significant morbidity and mortality worldwide. Despite improvements in diagnostic methodologies for organism identification, the early recognition and further risk stratification of these infections can be challenging. Although traditional clinical scoring systems are beneficial for the management of sepsis and pneumonia, biomarkers supporting the diagnosis and management of these infectious diseases are needed. Many biomarkers have been identified and there is no lack of studies and meta-analyses assessing the utility of biomarkers. Focusing primarily on sepsis and pneumonia, this article discus...
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: Stefan Riedel Source Type: research

Our Pathogens Are Not Standing Still and Neither Can We
In 1 or 2 generations, we have gone from a world in which there were no cures for most infections to a declaration that the war against infectious disease was won. That period of ephemeral confidence was followed by the inexorable march toward increasingly resistant pathogens that quickly learned to evade each new advance and our own race, sometimes successful, sometimes faltering, to produce new antimicrobials and vaccines. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: James E. Kirby Tags: Preface Source Type: research

Advances and Trends in Clinical Microbiology: The Next 20 Years
CLINICS IN LABORATORY MEDICINE (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Authors: James E. Kirby Source Type: research

Copyright
Elsevier (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Source Type: research

Contributors
MILENKO JOVAN TANASIJEVIC, MD, MBA (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Source Type: research

Contents
James E. Kirby (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Source Type: research

Forthcoming Issues
Immunology Laboratory Testing (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - August 3, 2019 Category: Laboratory Medicine Source Type: research

What the Clinical Microbiologist Should Know About Pharmacokinetics/Pharmacodynamics in the Era of Emerging Multidrug Resistance
As a class, β-lactamase inhibitors have proved successful in extending the clinical utility of β-lactam antibiotics by circumventing β-lactamase–mediated resistance. However, the rapid evolution of these β-lactamases calls for a critical reevaluation of the relationships between susceptibility, drug expos ures, and bacterial response. The existing paradigm for in vitro susceptibility testing and development of β-lactam/β-lactamase inhibitor combinations may not optimally facilitate clinical use. Thus, alternative approaches for pairing these combinations and evaluating in vitro...
Source: Clinics in Laboratory Medicine - July 6, 2019 Category: Laboratory Medicine Authors: Henrietta Abodakpi, Audrey Wanger, Vincent H. Tam Source Type: research

We Cannot Do It Alone
Infectious diseases by definition spread and therefore have impact beyond local hospitals and institutions where they occur. With increasingly complex and worrisome infectious disease evolution including emergence of multidrug resistance, regional, national, and international agencies and resources must work hand in hand with local clinical microbiology laboratories to address these global threats. Described are examples of such resources, both existing and aspirational, that will be needed to address the infectious disease challenges ahead. The authors comment on several instances of entrenched policy that are nonproducti...
Source: Clinics in Laboratory Medicine - July 6, 2019 Category: Laboratory Medicine Authors: Rose A. Lee, James E. Kirby Source Type: research

Clinical Microbiology in Underresourced Settings
The article discusses the environment of laboratory diagnostic bacteriology testing in several underresourced settings experienced by the author. The major global infectious diseases are usually managed with government or donor-supported systems, whereas basic laboratory testing for bacterial infections has no formal global programs. The causes of many of those diseases can be detected using simple manual bacteriologic methods available in most resource-limited environments; however, the challenges of building laboratory capacity in those settings are many. Positive and negative aspects of developing such capacities in sel...
Source: Clinics in Laboratory Medicine - July 2, 2019 Category: Laboratory Medicine Authors: Ellen Jo Baron Source Type: research

Mapping the Road to the Future
Rapidly changing technology in the clinical microbiology laboratory requires a highly skilled workforce. The current clinical microbiology workforce is aging with a wave of retirements currently unfolding. Key competencies that will be needed for the next generation of microbiologists include strong analytical skills, adaptability, and the willingness to be life-long learners. Experiential learning is a key component of the initial learning environment for medical laboratory scientists and technicians. Continuing education in clinical microbiology must reflect the changes in technology whereby learners are more comfortable...
Source: Clinics in Laboratory Medicine - July 2, 2019 Category: Laboratory Medicine Authors: Peter H. Gilligan, Martha H. McGee Source Type: research

Matrix-Assisted Laser Desorption/Ionization Time-of-Flight
This article summarizes recent advances in the application of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) to new areas of infectious diseases diagnostics. We discuss progress toward routine identification of mycobacteria and filamentous fungi and direct identification of pathogens from clinical specimens. Of greatest interest is the use of MALDI-TOF MS for identifying organisms from positive blood cultures and from clinical specimens such as urine. Last, We highlight some exciting new possibilities for MALDI-TOF MS phenotypic susceptibility testing for bacteria and yeast. (So...
Source: Clinics in Laboratory Medicine - July 2, 2019 Category: Laboratory Medicine Authors: Alexandra L. Bryson, Emily M. Hill, Christopher D. Doern Source Type: research

What Is the Future of Clinical Microbiology?
Clinical microbiology has advanced tremendously in the past 10  years. In this comic, the role of technology, the need for skilled microbiologists, and the meaning of progress in clinical microbiology are considered. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - June 21, 2019 Category: Laboratory Medicine Authors: Alexander J. McAdam Source Type: research

Rapid Susceptibility Testing Methods
With emerging antimicrobial resistance, rapid antimicrobial susceptibility testing (AST) is needed to provide early definitive therapeutic guidance to optimize patient outcome. Genotypic methods are fast, but can identify only a subset of known resistance elements. Phenotypic methods determine clinically predictive minimal inhibitory concentrations and include very sensitive optical and biophysical methods to detect changes in replication or physiology of pathogens in response to antibiotics. For the potential of rapid AST to be fully realized, results must be linked with robust decision support solutions that will impleme...
Source: Clinics in Laboratory Medicine - June 12, 2019 Category: Laboratory Medicine Authors: Kenneth P. Smith, James E. Kirby Source Type: research

When One Drug Is Not Enough
Antibacterial combinations have long been used to accomplish a variety of therapeutic goals, including prevention of resistance and enhanced antimicrobial activity. In  vitro synergy testing methods, including the checkerboard array, the time-kill study, diffusion assays, and pharmacokinetic/pharmacodynamic models, are used commonly in the research setting, but are not routinely performed in the clinical microbiology laboratory because of test complexity and unce rtainty about their predictive value for patient outcomes. Optimized synergy testing techniques and better data on the relationship between in vitro res...
Source: Clinics in Laboratory Medicine - June 12, 2019 Category: Laboratory Medicine Authors: Thea Brennan-Krohn, James E. Kirby Source Type: research

Operational Aspects of a Clinical Decision Support Program
Clinical decision support tools that involve improving test utilization should be jointly overseen by a laboratory stewardship committee and the hospital informatics team. The roles of these groups vary by institution and may overlap. This is a team effort and collaboration is a must. The effectiveness of these efforts in an institution depends on the receptiveness of leadership and providers, as well as the effectiveness of the associated committees. Examples of the challenges and successes of laboratory stewardship interventions that have been operationalized at the Cleveland Clinic that use clinical decision support too...
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Authors: Gary W. Procop, Allison L. Weathers, Anita J. Reddy Source Type: research

Clinical Decision Support: Tools, Strategies, and Emerging Technologies
CLINICS IN LABORATORY MEDICINE (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Authors: Anand S. Dighe Source Type: research

Copyright
Elsevier (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Source Type: research

Contributors
MILENKO JOVAN TANASIJEVIC, MD, MBA (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Source Type: research

Contents
Anand S. Dighe (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Source Type: research

Forthcoming Issues
Advances and Trends in Clinical Microbiology: The Next 20 Years (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - April 27, 2019 Category: Laboratory Medicine Source Type: research

Decision Support Tools within the Electronic Health Record
Laboratory tests are an integral part of the electronic health record (EHR). Providing clinical decision support (CDS) for the ordering, collection, reporting, viewing, and interpretation of laboratory testing is a fundamental function of the EHR. The implementation of a sustainable, effective laboratory CDS program requires a commitment to standardization and harmonization of the laboratory dictionaries that are the foundation of laboratory-based CDS. In this review, the authors provide an overview of the tools available within the EHR to improve decision making throughout the entire laboratory testing process, from test ...
Source: Clinics in Laboratory Medicine - March 28, 2019 Category: Laboratory Medicine Authors: Joseph W. Rudolf, Anand S. Dighe Source Type: research

Decision Support and Patient Safety
In recent years, clinical decision support (CDS) systems have become recognized as increasingly important in assuring patient safety and supporting all phases of the clinical decision-making process. In Laboratory Medicine, CDS systems are usually used to drive test ordering and diagnostic prediction while combining IT components and staff skills. However, educational initiatives, user and provider feedback, and expert consultations should also be considered integral to CDS. The aim of this paper is to provide an overview of some important developments in CDS in supporting the clinical decision-making process and guarantee...
Source: Clinics in Laboratory Medicine - March 28, 2019 Category: Laboratory Medicine Authors: Mario Plebani, Ada Aita, Andrea Padoan, Laura Sciacovelli Source Type: research

Decision Support to Enhance Automated Laboratory Testing by Leveraging Analytical Capabilities
This article addresses the historical, current, and future state of laboratory analytics using examples and offering a framework to organize thinking around analytical capabilities. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - March 28, 2019 Category: Laboratory Medicine Authors: J. Mark Tuthill Source Type: research

Decision Support in Transfusion Medicine and Blood Banking
Clinical decision support (CDS) can greatly enhance patient blood management through optimizing ordering and providing patient-specific information. At present, modeling and prediction have small roles in inventory management; they will likely have increasing applications to help guide donor center collections based on real-time demand to meet more dispersed needs. Transfusion side-effects management for both donor and recipients is an area ripe for intervention by CDS to enable proactive actions. Last, CDS and broader prediction will 1 day function alongside and seamlessly along many of our major processes to create a hum...
Source: Clinics in Laboratory Medicine - March 28, 2019 Category: Laboratory Medicine Authors: Neil K. Shah Source Type: research

Technical, Biological, and Systems Barriers for Molecular Clinical Decision Support
This article reviews the substantial technical progress that has been made in the past decade and finds that the underlying biological limitations of genomics as well as systemic barriers to adoption of molecular CDS have been comparatively underestimated. A hybrid consultative CDS system, which integrates a genomics consultant into an active CDS system, may provide an interim path forward. (Source: Clinics in Laboratory Medicine)
Source: Clinics in Laboratory Medicine - March 28, 2019 Category: Laboratory Medicine Authors: Niklas Krumm, Brian H. Shirts Source Type: research