A Laboratory Medicine Best Practices Systematic Review and Meta-analysis of Nucleic Acid Amplification Tests (NAATs) and Algorithms Including NAATs for the Diagnosis of Clostridioides (Clostridium) difficile in Adults.

The evidence base for the optimal laboratory diagnosis of Clostridioides (Clostridium) difficile in adults is currently unresolved due to the uncertain performance characteristics and various combinations of tests. This systematic review evaluates the diagnostic accuracy of laboratory testing algorithms that include nucleic acid amplification tests (NAATs) to detect the presence of C. difficile The systematic review and meta-analysis included eligible studies (those that had PICO [population, intervention, comparison, outcome] elements) that assessed the diagnostic accuracy of NAAT alone or following glutamate dehydrogenase (GDH) enzyme immunoassays (EIAs) or GDH EIAs plus C. difficile toxin EIAs (toxin). The diagnostic yield of NAAT for repeat testing after an initial negative result was also assessed. Two hundred thirty-eight studies met inclusion criteria. Seventy-two of these studies had sufficient data for meta-analysis. The strength of evidence ranged from high to insufficient. The uses of NAAT only, GDH-positive EIA followed by NAAT, and GDH-positive/toxin-negative EIA followed by NAAT are all recommended as American Society for Microbiology (ASM) best practices for the detection of the C. difficile toxin gene or organism. Meta-analysis of published evidence supports the use of testing algorithms that use NAAT alone or in combination with GDH or GDH plus toxin EIA to detect the presence of C. difficile in adults. There is insufficient evidence to recommend against repeat testing of the sample using NAAT after an initial negative result due to a lack of evidence of harm (i.e., financial, length of stay, or delay of treatment) as specified by the Laboratory Medicine Best Practices (LMBP) systematic review method in making such an assessment. Findings from this systematic review provide clarity to diagnostic testing strategies and highlight gaps, such as low numbers of GDH/toxin/PCR studies, in existing evidence on diagnostic performance, which can be used to guide future clinical research studies.

Are medical school students ready for e-readers?

College textbook publishers are planning to make college and professional education textbooks available online to be downloaded to personal communication devices (e.g., smartphones), digital audio players (e.g., iPods), and digital readers (e.g., Kindles). The current literature on the attitudes of current students to this technological change, especially as it relates to medical school students is reviewed. A short survey attempted to determine how ready the first-year medical students at the University of Louisville are to accept this change in their study habits.

Use of laptop computers in an academic medical library.

Who borrows laptop computers in an academic health sciences library? Why do they choose to check out laptops? In a survey, laptop computer users responded that the laptops were used most frequently to do class-related work. Laptops were most often checked out because they could be taken to a quiet area of the library or to where the user had more room to work. The majority of such borrowers were satisfied or very satisfied with the laptops and the service from the library. The majority of those completing the survey were medical school students and graduate students. The circulation of laptop computers at this academic health sciences library is a very successful and popular program.

Retraction policies of high-impact biomedical journals.

PURPOSE: The purpose is to review the issue of retraction in the scientific literature and to examine the policies on retraction of major biomedical journals. METHOD: The historical background of this issue was investigated through a literature search. The Instructions to Authors of 122 major biomedical journals were reviewed for evidence of a policy on the retraction of articles. Editors of those journals with no mention of retraction in their Instructions to Authors were contacted by email and/or postal mail. RESULTS: Sixty-two percent of the journals investigated did not post or report having a policy on issuing retractions. Only twenty-one (18%) did. The remainder did not post any policy and did not respond to inquiries. DISCUSSION: Including policies in Instructions to Authors relating to the principled conduct of research and publication will improve the ethical environment in which the scientific community works.

Case studies from morning report: librarians' role in helping residents find evidence-based clinical information.

In primary care specialties, Morning Report is a traditional vehicle for expanding medical residents' training in diagnosis and treatment. At one academic medical center, residents and faculty in the Department of Family and Community Medicine use case-based teaching, centered around planning and reviewing patient management, to review intriguing cases from patient encounters in the department's hospital service. Seeking to improve the level of evidence-based information exchanged at Morning Report, department leaders invited reference librarians from the health sciences library to attend weekly Morning Report. The librarians saw this as an opportunity not only to improve residents' information-seeking skills, but also to improve librarians' teaching skills and understanding of the needs of users in clinical settings. This paper describes the evolution of librarians' involvement in Morning Report, examples of the kinds of contributions librarians have made in this setting, and changes made in Morning Report sessions to facilitate this activity.

Emerging ethical issues in instructions to authors of high-impact biomedical journals.

Public interest in issues concerning the maintenance of high ethical standards in the conduct of scientific research and its publication has been increasing. Some of the developments in these issues as reflected in the publication of the medical literature are traced here. This paper attempts to determine whether public interest is reflected in the specific requirements for authors for manuscript preparation as stated in the "Instructions to Authors" for articles being prepared for submission to 124 "high-impact" journals. The instructions to authors of these journals were read on the Web for references to ethical standards or requirements. The ethical issues that the instructions most often covered were specifically related to the individual journal's publication requirements. The results suggest that while the editors and publishers of the biomedical literature are concerned with promoting and protecting the rights of the subjects of the experiments in the articles they publish, and while these concerns are not yet paramount, they are evolving and growing.