Interpretive Comments Research Articles

Consensus statement on anaesthesia for day care surgeries.

The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.

Influence of antimicrobial susceptibility reporting on junior doctors' decision to prescribe antimicrobials inappropriately.

Inappropriate antimicrobial use drives antimicrobial resistance and is a global public health problem. This study examined whether withholding antimicrobial susceptibilities in combination with interpretive comments on microbiological reports influenced the decision to inappropriately prescribe antibiotics in a controlled survey. Seventy junior doctors attending educational sessions were given one of two surveys describing four clinical case vignettes (scenarios) in which antimicrobial treatment was not indicated. They were asked to select their preferred treatment from multiple choices. In the scenarios labelled 'A', the laboratory report did not report antibiotic susceptibilities, but included comments from the microbiologist. In the scenarios labelled 'B', the laboratory report included full organism identification and susceptibility results without additional comments. For scenarios 1, 2 and 3 there was a significantly higher probability ( P < 0.01) that the doctor selected an answer involving antibiotic treatment if he/she received the 'B' version of the scenario where reports included antimicrobial susceptibilities, but no interpretive comments. This was significant in both interns and more senior doctors. In scenario 4, of which there were two versions, there was no difference seen in the answers between the groups given scenario A or B. The results of this survey suggest that withholding antimicrobial susceptibility results in combination with interpretive comments on microbiology reports significantly influences the decision of junior doctors to prescribe antibiotics in low-acuity outpatient setting scenarios (represented in scenarios 1-3), but not in inpatient scenarios (represented in scenario 4).

Assuring the quality of interpretative comments in clinical chemistry.

The provision of interpretative advice on laboratory results is a post-analytic activity and an integral part of clinical laboratory services. It is valued by healthcare workers and has the potential to prevent or reduce errors and improve patient outcomes. It is important to ensure that interpretative comments provided by laboratory personnel are of high quality: comments should be patient-focused and answer the implicit or explicit question raised by the requesting clinician. Comment providers need to be adequately trained and qualified and be able to demonstrate their proficiency to provide advice on laboratory reports. External quality assessment (EQA) schemes can play a part in assessing and demonstrating the competence of such laboratory staff and have an important role in their education and continuing professional development. A standard structure is proposed for EQA schemes for interpretative comments in clinical chemistry, which addresses the scope and method of assessment including nomenclature and marking scales. There is a need for evidence that participation in an EQA program for interpretative commenting facilitates improved quality of comments. It is proposed that standardizing goals and methods of assessment as well as nomenclature and marking scales may help accumulate evidence to demonstrate the impact of participation in EQA for interpretative commenting on patient outcome.

Progress in the care of familial hypercholesterolaemia: 2016.

Familial hypercholesterolaemia (FH) is the most common autosomal dominant condition, with a prevalence of between one in 200 and one in 350 people in the general population. Untreated FH is associated with premature atherosclerotic cardiovascular disease (CVD). The prevalence of homozygous or compound heterozygous FH is now considered to be about one in 300 000 people. Treating children with FH reduces progression of atherosclerotic CVD and future CVD events. Most individuals with FH are undiagnosed, which together with the recent frequency data in the population and in individuals with premature coronary disease creates a public health challenge and mandates a key role for primary care. Childhood is the optimal period for detecting FH, since low-density lipoprotein cholesterol (LDL-c) concentrations better differentiate affected from unaffected individuals. In an Australian community setting, over 70% of adults with an LDL-c level ≥ 6.5 mmol/L have clinical FH; of these, 30% have a detectable mutation. The community laboratory has an important role in identifying FH, with interpretive comments leading to additional reductions in LDL-c concentrations, and a phone call from the pathologist to the general practitioner improving detection of cases. Cascade screening using DNA testing is cost-effective and acceptable to screenees. Next generation genetic sequencing may differentiate people with polygenic hypercholesterolaemia alone from those with FH. Smoking, hypertension, elevated lipoprotein(a) levels, chronic kidney disease and diabetes are additional atherosclerotic CVD risk factors in FH. Equations for assessing absolute risk of CVD in primary prevention underestimate risk in FH. The adult LDL-c goal is a greater than 50% reduction in LDL-c levels, followed by a target of <2.5 mmol/L, or <1.8 mmol/L for individuals with CVD or other CVD risk factors. Proprotein convertase subtilisin/kexin type 9 inhibitors significantly reduce LDL-c and lipoprotein(a) levels in people with FH. Registries are essential for improving the care of people with FH.

Interpretative comments specifically suggesting specialist referral increase the detection of familial hypercholesterolaemia

Familial hypercholesterolaemia (FH) is an under-diagnosed inherited condition characterised by elevated low density lipoprotein (LDL)-cholesterol and premature coronary artery disease. The requesting general practitioner of individuals with extremely elevated LDL-cholesterol measured by St John of God Pathology receives an interpretative comment on the lipid results highlighting possible FH. We sought to determine whether specifically recommending referral to the regional Lipid Disorders Clinic (LDC) increased referral and FH detection rates. A prospective case-control study of individuals with LDL-cholesterol ≥6.5 mmol/L was conducted. All individuals received an interpretative comment highlighting the possibility of FH. The cases comment also suggested LDC referral, and a subset of cases received the LDC's fax number (fax-cases) in addition. There were 231 individuals with an LDL-cholesterol ≥6.5 mmol/L; 96 (42%) controls and 135 (58%) cases, of which 99 were fax-cases. Twenty-four (18%) cases were referred to clinic compared with eight (8%) controls (p= 0.035). After specialist review and genetic testing, four probable and four definite FH individuals were detected amongst controls, compared with seven possible, eight probable and nine definite FH amongst cases. Genetic testing was performed in 31 (94%) individuals, 13 (42%) had a causative mutation identified. Interpretative commenting specifically recommending specialist review augments the detection of FH in the community.

Quality assurance program review for somatic cancer modules

The RCPAQAP Molecular Genetics Discipline offers quality assurance modules in the Australasian region for the molecular genetic analysis of inherited and somatic diseases.The discipline has expanded the scope of quality assurance modules and participation in these modules has steadily increased over the last three years to >30 for some oncology modules. This report presents the survey outcomes for the Oncology Program, which includes the EGFR, KRAS and BRAF modules. The outcomes of a NRAS pilot module, which was established in 2014 will also be discussed.The EGFR, KRAS and BRAF modules were NATA accredited in 2013. The modules were designed to assess laboratory performance in the detection of genetic mutations from patient-derived formalin-fixed paraffin-embedded (FFPE) tumour tissue samples, together with interpretive comments provided to the referring clinician.In 2016, multigene modules for Lung Cancer, Colorectal Cancer and Melanoma will be introduced and laboratories will be given the opportunity to incorporate several genes into their testing and analysis.An overview of the results obtained, methods employed and areas for improvement will be presented.The RCPAQAP would like to acknowledge the Australian Government, Department of Health Quality use of Pathology Program (QUPP) for their funding assistance in this project. The RCPAQAP Molecular Genetics Discipline offers quality assurance modules in the Australasian region for the molecular genetic analysis of inherited and somatic diseases. The discipline has expanded the scope of quality assurance modules and participation in these modules has steadily increased over the last three years to >30 for some oncology modules. This report presents the survey outcomes for the Oncology Program, which includes the EGFR, KRAS and BRAF modules. The outcomes of a NRAS pilot module, which was established in 2014 will also be discussed. The EGFR, KRAS and BRAF modules were NATA accredited in 2013. The modules were designed to assess laboratory performance in the detection of genetic mutations from patient-derived formalin-fixed paraffin-embedded (FFPE) tumour tissue samples, together with interpretive comments provided to the referring clinician. In 2016, multigene modules for Lung Cancer, Colorectal Cancer and Melanoma will be introduced and laboratories will be given the opportunity to incorporate several genes into their testing and analysis. An overview of the results obtained, methods employed and areas for improvement will be presented. The RCPAQAP would like to acknowledge the Australian Government, Department of Health Quality use of Pathology Program (QUPP) for their funding assistance in this project.

Laboratory testing of extravascular body fluids in Croatia: a survey of the Working group for extravascular body fluids of the Croatian Society of Medical Biochemistry and Laboratory Medicine.

IntroductionWe hypothesized that extravascular body fluid (EBF) analysis in Croatia is not harmonized and aimed to investigate preanalytical, analytical and postanalytical procedures used in EBF analysis in order to identify key aspects that should be addressed in future harmonization attempts.Materials and methodsAn anonymous online survey created to explore laboratory testing of EBF was sent to secondary, tertiary and private health care Medical Biochemistry Laboratories (MBLs) in Croatia. Statements were designed to address preanalytical, analytical and postanalytical procedures of cerebrospinal, pleural, peritoneal (ascites), pericardial, seminal, synovial, amniotic fluid and sweat. Participants were asked to declare the strength of agreement with proposed statements using a Likert scale. Mean scores for corresponding separate statements divided according to health care setting were calculated and compared.ResultsThe survey response rate was 0.64 (58 / 90). None of the participating private MBLs declared to analyse EBF. We report a mean score of 3.45 obtained for all statements evaluated. Deviations from desirable procedures were demonstrated in all EBF testing phases. Minor differences in procedures used for EBF analysis comparing secondary and tertiary health care MBLs were found. The lowest scores were obtained for statements regarding quality control procedures in EBF analysis, participation in proficiency testing programmes and provision of interpretative comments on EBF’s test reports.ConclusionsAlthough good laboratory EBF practice is present in Croatia, procedures for EBF analysis should be further harmonized to improve the quality of EBF testing and patient safety.

Utilization of cardiac troponin assays in adult and pediatric populations: Guideline recommendations vs. reality

ObjectivesWe hypothesized significant gaps remained for cardiac troponin (cTn) utilization in the United States, despite an emerging evidence base and guideline recommendations. We tested this hypothesis and investigated differences and trends between the use of cTn in adult versus pediatric hospitals. Design and methodsIndividuals were identified by a targeted distribution through personal contact and professional society email lists. Participants completed an online survey (Qualtrics) from 07/15/13 to 07/26/13. The 31-item questionnaire used skipped logic and collected data about the respondent and their institutional cTn clinical practices. Data tabulation and analysis were conducted using Qualtrics and Microsoft Excel. ResultsA total of 159 unique laboratories responded to the survey, representing primarily adult (81%) versus pediatric (19%) institutions. 59% of laboratories utilize the guideline recommended 99th percentile as the upper reference limit (URL) for cTn, with large variability in reporting practices among users of the same assay. 73% of laboratories reported simultaneous ordering of other cardiac biomarkers with cTn, a majority which included CK-MB. Interpretive comments were used with cTn in 71 laboratories with a significant amount of heterogeneity. Pediatric hospitals reported a lower frequency of cTn orders and were less likely to consider elevated cTn a critical value. ConclusionsGaps in current utilization and reporting of cTn exist, along with practices inconsistent with clinical guideline recommendations. Implementation of the 99th percentile and serial sampling protocols will be critical to adoption of high-sensitivity cTn assays. Differences in chest pain etiology are the most likely reason for the notable differences between cTn use in adults versus pediatric hospitals.

Sleep and menopause: a narrative review.

Our overall aim-through a narrative review-is to critically profile key extant evidence of menopause-related sleep, mostly from studies published in the last decade. We searched the database PubMed using selected Medical Subject Headings for sleep and menopause (n = 588 articles). Using similar headings, we also searched the Cochrane Library (n = 1), Embase (n = 449), Cumulative Index to Nursing and Allied Health Literature (n = 163), Web of Science (n = 506), and PsycINFO (n = 58). Articles deemed most related to the purpose were reviewed. Results were articulated with interpretive comments according to evidence of sleep quality (self-reported) and sleep patterns (polysomnography and actigraphy) impact as related to reproductive aging and in the context of vasomotor symptoms (VMS; self-reported), vasomotor activity (VMA) events (recorded skin conductance), depressed mood, and ovarian hormones. Predominantly, the menopausal transition conveys poor sleep beyond anticipated age effects. Perceptions of sleep are not necessarily translatable from detectable physical sleep changes and are probably affected by an emotional overlay on symptoms reporting. Sleep quality and pattern changes are mostly manifest in wakefulness indicators, but sleep pattern changes are not striking. Likely contributing are VMS of sufficient frequency/severity and bothersomeness, probably with a sweating component. VMA events influence physical sleep fragmentation but not necessarily extensive sleep loss or sleep architecture changes. Lack of robust connections between perceived and recorded sleep (and VMA) could be influenced by inadequate detection. There is a need for studies of women in well-defined menopausal transition stages who have no sleep problems, accounting for sleep-related disorders, mood, and other symptoms, with attention to VMS dimensions, distribution of VMS during night and day, and advanced measurement of symptoms and physiologic manifestations.

Opening the Ears that Science Closed: Transforming Qualitative Data Using Oral Coding

The purpose of this article is to describe an alternative method for transcribing and transforming (analyzing and interpreting) oral data collected from interviews. Rather than record and then immediately transcribe data, the “oral coding” approach relies on a Three-Phase Approach. Phase One involves extended and reflective listening to the original interview data. This extended time with data in its original oral form enables researchers to construct both propositional and tacit knowledge in relation to the phenomenon being investigated. Intensive encounters with the original data are continued during the Second Phase of analysis and interpretation by re-recording on another device those segments that are thought to be potentially thematic as well the researcher’s own reflective and interpretive comments in relation to these segments. Finally, in Phase Three, using a combination of keyboarding and optionally voice recognition software, both in vivo quotes and researcher reflections are transcribed to text and organized by research question. This entire Three Phase process is intended to transform raw data into understandable accounts by allowing researchers to “hang on” to the original oral data for an extended time thus delaying reduction to text and thereby enabling researchers to capture participant nuances conveyed through tone, inflection, volume, pause, and emphases. Consequently, this method may have the potential to promote a higher degree of credibility and trustworthiness. Experience to date provides limited support for this process based on a previously published article (Bernauer, Semich, Klentzin, &amp; Holdan, 2013) that used both traditional and oral coding and another article (Bernauer, 2015) that used only oral coding. It is hoped that colleagues try out this method and “transform” it based on their own creative insights.

Two Against Freud: Pinsky’s “Essay on Psychiatrists” in a Philosophical Context

This article offers a reading of Robert Pinsky’s “Essay on Psychiatrists” in the context of a contemporary theoretical work by Gilles Deleuze and Félix Guattari, Anti-Oedipus . I do not use the philosophy of Deleuze and Guattari to make interpretive comments about poetry, to identify or articulate meanings. Rather I read Pinsky’s poem in the context of the philosophy, noting points of agreement between the two texts, areas where the poetry works as a supplement to the insights of the philosophy, places where the poetry offers grounds for criticisms of the philosophy and times where there might be irreconcilable differences in the two forms of critical response. Part of my intention in taking this approach to Pinsky, Deleuze and Guattari is to show, at a time when Freud’s worth is often strenuously doubted and his work more comfortably disparaged than at any time since its creation, the value of Freud as a cultural interlocutor.

Reporting and interpreting red blood cell morphology: is there discordance between clinical pathologists and clinicians?

Clinical pathologists (CPs) report RBC morphologic (RBC-M) changes to assist clinicians in prioritizing differential diagnoses. However, reporting is subjective, semiquantitative, and potentially biased. Reporting decisions vary among CPs, and reports may not be interpreted by clinicians as intended. The aims of this study were to survey clinicians and CPs about RBC-M terms and their clinical value, and identify areas of agreement and discordance. Online surveys were distributed to small animal clinicians via the Veterinary Information Network and to CPs via the ASVCP listserv. A quiz assessed understanding of RBC-M terms among respondent groups. Descriptive statistics were used to analyze responses to survey questions, and quiz scores were compared among groups. Analyzable responses were obtained from 1662 clinicians and 82 CPs. Both clinicians and CPs considered some terms, e.g., agglutination, useful, whereas only CPs considered other terms, e.g., ghost cells, useful. All groups interpreted certain terms, e.g., Heinz bodies, correctly, whereas some clinicians misinterpreted others, e.g., eccentrocytes. Responses revealed that CPs often do not report RBC-M they consider insignificant, when present in low numbers. Twenty-eight percent of clinicians think CPs review all blood smears while only 19% of CPs report reviewing all smears. Important differences about the clinical relevance of certain RBC-M terms exist between clinicians and CPs. Inclusion of interpretive comments on CBC reports is the clearest way to ensure that RBC-M changes are interpreted as intended by the CP. Reporting practices should be examined critically to improve communication, transparency, and ultimately medical decisions.

Detecting familial hypercholesterolaemia in the community: Impact of a telephone call from a chemical pathologist to the requesting general practitioner

ObjectiveTo determine whether a telephone call from a chemical pathologist to the requesting general practitioner (GP) of individuals at high risk of familial hypercholesterolaemia (FH) increases specialist referral and detection of FH. MethodIndividuals with an LDL-cholesterol ≥6.5 mmol/L without secondary causes were identified from a community laboratory; 100 cases and 96 historical controls.All laboratory reports (cases and controls) received interpretative comments highlighting FH. In addition, the cases' GPs received a telephone call from the chemical pathologist to highlight their patient's risk of FH and suggest specialist referral, whereas with the controls' GPs were not telephoned. ResultsAfter 12 months follow-up, 27 (27%) cases were referred to clinic compared with 4 (4%) controls (p < 0.0001). 25 cases were reviewed at clinic, 12 (48%) had definite FH and 18 (72%) had probable or definite FH according to the Dutch Lipid Clinic Network Criteria, 2 cases did not attend their clinic appointments. Genetic testing was performed in 23 individuals: 7 (30%) had pathogenic FH mutations. Genotypic cascade screening of 4 kindreds from the intervention group detected an additional 7 individuals with FH and excluded 5 mutation-negative family members. ConclusionsA telephone call from a chemical pathologist to the requesting GP of patients at high risk of FH was associated with significantly higher rates of FH detection and specialist referral. Over 70% of individuals with an LDL-cholesterol ≥6.5 mmol/L were diagnosed with FH. However, further investigation is required to improve the relatively low referral rate.

The Common Core State Standards: School Reform at Three Suburban Middle Schools

The Common Core State Standards (CCSS) present public education with perhaps the largest shift in educational paradigm since No Child Left Behind in 2001. This study investigated the importance of principal leadership and how information regarding the CCSS reform flowed to the principal and from the principal to the teachers. Furthermore, this study assessed the assertion that principals are key to reform interpretation and implementation. The research reported here is a multicase study developed through qualitative methods over a period of 7 months. Primary data collection was accomplished through a series of three interviews with three public suburban middle school principals in a Midwestern state. The first stage of this study examined each principal’s background and educational experience. It aimed to create a profile of the principal and to identify any relationship between principal experience and perception of the CCSS reform. The second stage investigated how these three principals received information and built professional knowledge about the CCSS. The last stage sought to identify how these principals organized and disseminated CCSS information for teachers within their buildings and how they prepared their staff for adaptive change. This study also included a review of the documents that these principals used to garner information about the CCSS and to disseminate information to staff members. Additionally, this study yields secondary data for the analysis and triangulation with primary data. Transcriptions of interview data and field notes, along with interpretive comments of the researcher, were checked for validity with each participant. This study was completed as part of the dissertation requirements for Michigan State University. It is important to state that the study in its entirety was modified to a journal format to be concise and direct.

External Quality Assessment/Proficiency Testing and Internal Quality Control for the PFA-100 and PFA-200: An Update

Platelet function testing is an essential component of comprehensive hemostasis evaluation within the framework of bleeding and/or bruising investigations, and it may also be performed to evaluate antiplatelet medication effects. Globally, the platelet function analyzer (PFA)-100 (Siemens Healthcare, Marburg, Germany) is the most used primary hemostasis-screening instrument and has also been recently remodeled/upgraded to the PFA-200. The PFA-100 is sensitive to a wide range of associated disorders, including platelet function defects and von Willebrand disease (VWD), as well as to various antiplatelet medications. The PFA-100 is also useful in therapy monitoring, especially in VWD. External quality assessment (EQA) (or proficiency testing) and internal quality control (IQC) are critical to ensuring quality of test practice, inclusive of all hemostasis tests. However, both EQA and IQC for platelet function testing, including the PFA-100, is logistically challenging, given theoretical requirements for production, storage, and shipment of large volumes of "stabilized" normal and pathological blood/platelets covering both normal function plus a wide variety of potential defects. We accordingly describe the development and testing of novel feasible approaches to both EQA and IQC of PFA-100/PFA-200 instruments, whereby a range of formulated "platelet function antagonist" materials are utilized. For EQA purposes, these are distributed to participants, and citrated normal whole blood collected on site is then added locally, thereby creating test material that can be locally evaluated. Several exercises have been conducted by the Royal College of Pathologists of Australasia Quality Assurance Program (RCPAQAP) over the past 6 years. A total of 26 challenges, with most designed to mimic moderate to severe primary hemostasis defects, have been tested in 26 to 50 laboratories depending on the year of dispatch. Numerical results for PFA-100/PFA-200 closure times (CTs) and interpretive comments supplied by participants are analyzed by the RCPAQAP. During this period, reported CTs for each challenge were within limits of expectation and good reproducibility was evidenced by repeated challenges. Coefficients of variation (CVs) generated for challenges using the two major PFA-100/PFA-200 cartridge types (collagen/adenosine diphosphate and collagen/epinephrine) are always similar to those obtained using native whole blood, and in general range from 15 to 25%. Interpretations are also in general consistent with expectations and test data provided by laboratories. The EQA created material has also been assessed within the context of possible IQC material. In conclusion, EQA and IQC processes for the PFA-100/PFA-200 have been developed that include highly reproducible test challenge processes, not only supporting the concept that EQA/IQC is possible for platelet function testing but also providing a valuable mechanism for monitoring and improving laboratory performance in this area.

LAMENTATIONS 1:8A IN THE WORDINGS OF THE MASORETIC TEXT AND 4QLAM

This study takes as its point of departure the view that 4QLam, one of the manuscripts of Lamentations from Qumran, holds great significance for both textcritics and exegetes who study Lamentations. To illustrate the significance of the manuscript, this study analyses the wordings of Lamentations 1:8 in 4QLam and the Masoretic text text-critically and provides interpretive comments on the differences between the two Hebrew textual representatives. In this regard, the study focuses on the variant readings dwnl and hdynl.

Impact of interpretative commenting on lipid profiles in people at high risk of familial hypercholesterolaemia

BackgroundFamilial hypercholesterolaemia (FH) is an autosomal dominant condition characterised by increased low density lipoprotein cholesterol (LDL-c), xanthomata and premature cardiovascular disease. However, it is currently underdiagnosed and undertreated in Australasia. We sought to investigate whether interpretative commenting on lipid profiles could improve FH detection and treatment. MethodsA case–historical control study of individuals with serum LDL-c concentrations ≥6.5mmol/L; 96 cases receiving an interpretative comment suggesting FH compared with 100 controls not receiving a comment. ResultsSerum LDL-c was repeated in 63 (66%) cases and 70 (70%) controls within 12months. LDL-c decreased in 59 (94%) cases and in 61 (87%) controls. In individuals with a repeat LDL-c, a mean LDL-c reduction of 2.3mmol/L (32%; p<0.0001) was demonstrated in controls, compared with 3.0mmol/L (42%; p<0.0001) in cases; significantly greater than that of controls (p<0.005). Interpretative comments suggesting specialist review were associated with a higher referral rate compared with controls (11.5% vs 1%, p<0.05). ConclusionInterpretative commenting was associated with a significant additional LDL-c reduction and increased specialist referrals compared with controls. However, only a minority of individuals received a specialist referral. Interpretative commenting may play an important role in the detection and management of FH.

Oor die Teologiese Inhoud van die Belydenis van Belhar

The essay argues that the theological content is indeed the most important contribution of Reformed confessional documents, but that the theological content can only be understood against the specific historical, which most often means socio-political, circumstances in which these confessions were originally adopted. Regarding the Confession of Belhar , the theological content consists in three confessional claims (each including allusions to the false teaching that is implicitly thereby unmasked and rejected) within the broader framework of an introduction and conclusion, involving key theological claims as well, respectively about the nature of the church and the lordship of Jesus Christ. After some interpretive comments on all five of these structural aspects – the introduction and conclusion and the three claims – brief consideration is given to the nature of reception of confessional documents in the Reformed tradition and some implications for the reception of the theological content of the Confession of Belhar . Article text in Afrikaans

Clinical microbiology laboratory should pay attention to the changes in CLSI document M100

Recent major changes and updates of Clinical and Laboratory Standards Institute(CLSI) document M100 for performance standards for antimicrobial susceptibility testing were introduced in the article, which include changes of interpretive criteria and comments, antimicrobial susceptibility testing of infrequently isolated or fastidious bacteria, changes of appendixes and others.Brief comments were made for these changes.（Chin J Lab Med,2012,35:673-675） Key words: Anti-bacterial agents; Microbial sensitivity tests; Reference standards

Summary of major changes in CLSI document M100-S22

Major changes and updates of Clinical and Laboratory Standards Institute (CLSI) document M100-S22 for performance standards for antimicrobial susceptibility testing were introduced in the article, which includes (1) general changes; (2) changes of drugs recommended for testing and reporting; (3) changes of interpretive criteria (breakpoints) and comments; (4) changes of quality control and others; and (5) changes of appendixes and glossaries.（Chin J Lab Med,2012,35:676-678） Key words: Antimicrobial agents; Microbial sensitivity tests; Publications