PubMed · 12260253
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1977. Trial for improved rhythm method.. https://pubmed.ncbi.nlm.nih.gov/12260253/
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The routine reporting of suspected measles cases and laboratory testing of samples from these cases is the backbone of measles surveillance. The Global Measles Laboratory Network (GMLN) has developed standards for laboratory confirmation of measles and provides training resources for staff of network laboratories, reference materials and expertise for the development and quality control of testing procedures, and accurate information for the Measles Mortality Reduction and Regional Elimination Initiative. The GMLN was developed along the lines of the successful Global Polio Laboratory Network, and much of the polio laboratory infrastructure was utilized for measles. The GMLN has developed as countries focus on measles control activities following successful eradication of polio. Currently more than 100 laboratories are part of the global network and follow standardized testing and reporting procedures. A comprehensive laboratory accreditation process will be introduced in 2002 with six quality assurance and performance indicators.
Patients and society expect physicians to base their approach to any type of clinical problem on informed diagnostic reasoning. Informed diagnostics means that clinicians understand and readily apply the principles of diagnostic decision making, which include an estimate of the pre-test probability (prevalence) of diseases and information about the characteristics and discriminatory power of the applied investigations. Despite the crucial importance of the appropriate use of diagnostic tools in clinical decision-making, many diagnostic tests have not been subjected to rigorous evaluation to establish the diagnostic accuracy and clinical utility of laboratory investigations using modern standards of clinical epidemiology. The lack of good quality research in the field not only contributes to inappropriate utilization of laboratory services but also to wasting significant resources. Evidence-based laboratory medicine tries to combat this problem by combining methods from epidemiology, biostatistics, clinical and social sciences with basic sciences to evaluate the role of investigations in clinical decision making and outcomes for patients. Evidence-based laboratory medicine aims to advance clinical diagnosis and management of diseases through systematic researching and disseminating generalisable new knowledge which meets the standards of critical review on clinically effective practice of laboratory investigations. The main phases of practicing evidence-based laboratory medicine are 1. question formulation, 2. systematic literature search, 3. critical appraisal of literature, 4. implementation of evidence into practice, and 5. evaluation of impact in a clinical audit cycle. The use of evidence in laboratory medicine requires systematically compiled databases of standardised and critically appraised information on the test characteristics and diagnostic accuracy of laboratory investigations. Such an approach is the Bayes Library that provides information on the global and specific measures of test performance in different patient groups and settings, in addition to prevalence data of common diseases. The Bayes Library will support informed diagnostic decisions and improve patient outcome by integrating evidence-based medicine into the diagnostic service, education and training of laboratories. The process of constant questioning and reviewing the evidence for rational diagnosis of diseases provides a practical tool to identify gaps in our knowledge and thus it generates new research ideas in laboratory medicine.
OBJECTIVE: To describe the outbreak of severe acute respiratory syndrome in Hong Kong. DESIGN: Descriptive case series. SETTING: Hong Kong, Special Administrative Region, China RESULTS: The outbreak started with a visitor from southern China on 21 February. At the hospitals where the first cases were treated the disease spread quickly among healthcare workers, and then out into the community as family members became infected. By 1 April, 685 cases had been reported with 16 deaths. Symptoms include high fever and one or more respiratory symptoms (including cough, shortness of breath, and difficulty breathing). Changes in lung tissue suggest that part of the lung damage is due to cytokines induced by the microbial agent, which has led to empirical treatment with corticosteroids, broad spectrum antiviral agent, and antibacterial cover. There is strong evidence that a novel coronavirus is the pathogen. Precautions for droplet infection should be instituted, including the wearing of masks and rigorous disinfection and hygiene procedures. On 27 March the Department of Health announced drastic measures, including vigorous contact tracing and examination, quarantine of contacts in their homes, and closure of all schools and universities. CONCLUSION: The rapidity of the spread of the disease and the morbidity indicate that the agent responsible is highly infectious and virulent. Strict infection control measures for droplet and contact transmission by healthcare workers, a vigilant healthcare profession, and public education are essential for disease prevention.