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Biomedical subjects

A Maturen

Publications and source records attributed to A Maturen.

At least 19 recordsLinked to original sources
PubMed1998

Use of beta-hydroxybutyric acid levels in the emergency department.

UNLABELLED: The impact of a new test on the market, the beta-hydroxybutyric acid (BOH) assay, on clinical decision-making in the emergency department (ED) has not been well studied. In this retrospective analysis, we studied the potential benefit of this new test in the ED decision-making process in diabetic patients. BOH levels were measured on all patients who had glucose and acetone levels ordered by the emergency physician during a 3-month period in the ED of a university tertiary referral center. Two groups were analyzed: group 1 was acetone-positive and BOH-positive (n = 13); group 2 was acetone-negative BOH-positive (n = 31). There was no difference between the two groups in terms of gender (p = 0.55) or age (p = 0. 47). The length of stay (p = 0.97) and number of complications (p = 0.89) were also similar between the two groups. CONCLUSION: This study suggests that in those diabetic patients with a negative acetone test and a positive BOH test, the addition of the positive result on the BOH test may provide additional prognostic information for predicting hospital length of stay and number of in-hospital complications.

3-Hydroxybutyric Acid↗
PubMed1997

Multicenter study of Abbott AxSYM Digoxin II assay and comparison with 6 methods for susceptibility to digoxin-like immunoreactive factors.

Performance characteristics of the Abbott nonpretreatment AxSYM Digoxin II assay were evaluated for quantification of digoxin at four independent sites. Correlation of digoxin measurements with the Abbott pretreatment AxSYM, Baxter Stratus II, Abbott TDx/ TDxFLx II, Abbott IMx, Emit 2000, and Beckman Synchron CX digoxin assays showed acceptable agreement, as indicated by: slope values > 0.84, r > 0.90, y-intercepts for all comparisons at or below the assay detection limit, and Sy/x ranging between 7.5% and 15.4% of the average digoxin value. Susceptibility to interference from digoxin-like immunoreactive factors (DLIFs) was examined in 233 samples from renal patients, liver disease patients, cord blood, and third-trimester pregnancies; the AxSYM Digoxin II assay demonstrated the least DLIFs interference. DLIF susceptibility for four of the methods was significantly greater (P < 0.05) than in the AxSYM Digoxin II assay; susceptibilities of the Stratus II and Emit 2000 methods were similar to the AxSYM Digoxin II assay.

Autoanalysis↗
PubMed1991

Digoxin-like immunoreactive substance in renal transplant patients.

Digoxin-like immunoreactive substance (DLIS) has been detected in several patient populations that were not receiving digoxin, including those patients with end-stage renal disease. The structure and physiologic significance of this compound are unknown, and the fate of DLIS after renal transplantation has not been studied. The authors prospectively evaluated 163 patients (not receiving digoxin) before and after transplantation for the presence of DLIS. Three different assays were used: radioimmunoassay (RIA), affinity mediated immunoassay (ACA), and fluorescence polarization immunoassay (TDX I). Depending on the assay method used, 11% (RIA), 6% (ACA), and 9% (TDX) of patients had detectable DLIS pretransplant. Using all 3 assays, a total of 34 patients (21%) were found to have DLIS. The mean serum digoxin concentration was 0.41 +/- 0.13 ng/mL (range: 0.2-1.2 ng/mL) and DLIS was detectable by greater than 1 assay method in seven patients. DLIS persisted longer in patients who had delayed allograft function (13.7 +/- 7 days) than in those who did not (3 +/- 1.9 days), P less than .05. In summary, detection of DLIS in renal transplant recipients appears to be an infrequent occurrence when using a single digoxin assay method. When detected, the concentration of DLIS is often below the usual therapeutic range for digoxin and disappears once allograft function is established. The authors conclude that the presence of DLIS is unlikely to be clinically significant in the renal transplant population.

Adult↗
PubMed1990

Screening hospital admissions from the emergency department for occult carbon monoxide poisoning.

Because cases of unrecognized carbon monoxide (CO) poisoning have been described among patients admitted to the hospital with other diagnoses, screening hospital admissions with carboxyhemoglobin testing has the potential for preventing morbidity among patients as well as among their cohabitants. Carboxyhemoglobin levels were obtained on 753 patients admitted to the hospital from the emergency department over a 3-month period during the winter. Patients in whom CO poisoning was diagnosed in the emergency department prior to admission were excluded. The mean carboxyhemoglobin level was 2.52% +/- 1.85%; there was no significant difference in mean carboxyhemoglobin among patients with medical, surgical, neurological, and psychiatric admission diagnoses (F = 1.17; df = 3,746; P = .32). Two patients (0.3%; 95% confidence limits, 0.04% to 1.1%) from the entire admission cohort, and one of 20 patients (5%; 95% confidence limits, 0.3% to 26.9%) admitted with seizures, had carboxyhemoglobin levels greater than 10%. The carboxyhemoglobin levels of the two patients were only marginally elevated, with levels of 10.9% and 11.3%. The cost of the carboxyhemoglobin screening program was $2.26 per patient result, or approximately $2,100 over a 3-month winter heating season. A program for screening emergency department admissions with carboxyhemoglobin testing, although feasible in terms of cost, detected few cases of unrecognized CO poisoning.

Adolescent↗
PubMed1990

Occult carbon monoxide poisoning in patients with neurologic illness.

To investigate occult carbon monoxide poisoning in patients with neurologic illness, we prospectively studied 168 patients who presented to the emergency department between December 1987 and February 1988 with neurologic symptoms for evidence of carbon monoxide exposure. Patients with known carbon monoxide poisoning were excluded. The mean carboxyhemoglobin level was 3.1 percent; there were no significant differences in carboxyhemoglobin between categories of neurologic illness (F(5,162) = 1.35; p less than 0.25). Five patients (3 percent) had a carboxyhemoglobin greater than 10 percent, with levels ranging from 11.7 percent to 29.5 percent. After controlling for the effects of active and passive exposure to cigarette smoke, problems with the home heating system (odds ratio 9.6; p less than 0.03) and the presence of cohabitants with concurrent headache or dizziness (odds ratio 21.6; p less than 0.0001) were associated with an increased risk of a carboxyhemoglobin greater than 10 percent. A rule for obtaining carboxyhemoglobin tests only on patients who used gas stoves for heat or who had symptomatic cohabitants would have correctly identified all patients with carboxyhemoglobins greater than 10 percent, correctly excluded 77 percent of patients with lower levels, and eliminated the need for testing in 75 percent of cases. We conclude that unrecognized carbon monoxide poisoning occurs in a small but important fraction of patients with wintertime neurologic illness and can be identified by a characteristic risk factor profile.

Adult↗
PubMed1989

Carbon monoxide and myonecrosis: a prospective study.

Myonecrosis has been reported to occur in patients with carbon monoxide (CO) poisoning, and last year we reported a case of non-traumatic rhabdomyolysis in a patient with CO poisoning secondary to smoke inhalation. We prospectively studied the association between CO poisoning and rhabdomyolysis by obtaining serum creatine kinase (CPK) levels on 65 of 81 consecutive patients (range 20-1315 IU/L) who presented to the University of Illinois Hospital Emergency Room during a 3-month period with CO levels greater than 5.0% (range 5.0%-63.9%). Thiocyanate levels were obtained on 45 patients (range 0-3.5 mg/dl). We found no statistically significant correlation by linear regression analysis between CO level and CPK level in these patients. A subjective complaint of weakness was obtained in 4 patients and physical evidence of weakness was found in 1 of these (this was felt to be secondary to a cerebrovascular accident). In none of these 4 patients was an elevated CPK level noted. We did, however, note an association between thiocyanate level and CPK level by linear regression analysis (p less than 0.02). A power curve was a better fit for this data (r2 = 0.7). This data suggests that serum CPK levels should not be routinely obtained on patients with CO poisoning and that cyanide may play a more important role in non-traumatic rhabdomyolysis associated with toxic inhalation than had previously been suspected.

Carbon Monoxide↗
PubMed1988

Occult carbon monoxide poisoning: validation of a prediction model.

Headache and dizziness are early symptoms of carbon monoxide poisoning, occurring at carboxyhemoglobin levels of greater than 10 percent. Previously, it was shown that among patients presenting to an emergency department during the winter with headache or dizziness, an algorithm for obtaining carboxyhemoglobin levels on patients who used gas stoves for heating purposes or who had similarly affected cohabitants correctly identified all patients with carboxyhemoglobin levels greater than 10 percent. To test the validity of this retrospectively derived rule, 65 patients were studied who were unaware of any carbon monoxide exposure and who presented during the winter of 1986-1987 with headache or dizziness. The algorithm correctly identified three of four patients with carboxyhemoglobin levels greater than 10 percent (sensitivity = 75 percent) and correctly excluded 45 of 61 patients with lower levels (specificity = 74 percent). The presence of symptomatic cohabitants alone was an equally sensitive (75 percent) but more specific (90 percent) marker for elevated carboxyhemoglobin levels. When data from the two cohorts were combined, stepwise multiple regression identified number of cigarettes smoked daily (F = 8.66) and concurrently symptomatic cohabitants (F = 34.71) as significant predictors of the carboxyhemoglobin level. It is concluded that a retrospectively derived rule correctly identified most cases of occult carbon monoxide poisoning when applied prospectively, and that the presence of similarly affected cohabitants was the most reliable marker for a carbon monoxide-mediated illness.

Adult↗
PubMed1988

Toxidrome recognition to improve efficiency of emergency urine drug screens.

We correlated clinical symptom complexes of drugs (toxidromes) to results of 204 consecutive toxicological screens ordered in our emergency department. The toxidromes were divided into eight categories: sedative hypnotic, narcotic, stimulant, coma-apnea-seizure, hallucinogenic, anticholinergic, unknown, and "no drugs." Emergency medicine nurses, clinical pharmacists, and medical residents were asked to choose one or more of the above toxidromes independently when ordering the toxicology screen. The nurses achieved the highest symptom complex recognition of the drug (55 of 61, 88%) followed by medical residents (76 of 90, 84%) and clinical pharmacists (27 of 34, 79.4%), but the differences were not statistically significant. We conclude that the major determinant in selecting correct toxidromes is clinical experience of the practitioners. Given the percentages of toxidrome recognition, it should be possible to increase efficiency of laboratory use by ordering tests only for the drugs clinically suspected in a particular toxic patient.

Diagnostic Tests, Routine↗
PubMed1987

Predictors of occult carbon monoxide poisoning in patients with headache and dizziness.

Headache and dizziness occur at carboxyhemoglobin levels of greater than 10%. We studied 89 patients with headache or dizziness for evidence of carbon monoxide exposure. The mean carboxyhemoglobin level was 2.87%. Number of cigarettes smoked per day (r = 0.471; p less than 0.00002), use of gas kitchen stoves for heating purposes (r = 0.252, p less than 0.02), problems with the home heating system (r = 0.278, p less than 0.01), and cohabitants with concurrent headache or dizziness (r = 0.427, p less than 0.01) correlated with carboxyhemoglobin levels. Multiple regression analysis identified number of cigarettes smoked daily, use of stoves for heat, and concurrently symptomatic cohabitants as significant predictors of carboxyhemoglobin level (F = 13.939 [3, 85]; p less than 0.01). Obtaining carboxyhemoglobin levels from patients who used stoves for heat or had similarly affected cohabitants identified 4 of 4 patients with levels greater than 10% (sensitivity, 100%) and excluded 47 of 85 patients with lower levels (specificity, 55.3%). The 4 patients with carboxyhemoglobin levels in excess of 10% may represent occult carbon monoxide poisoning in this population.

Adult↗
PubMed1987

Pharmacologic role of rubidium in psychiatric research.

Rubidium appears to exert several biologic and pharmacologic effects that are similar if not identical to those of many of the classic antidepressant drugs. This mineral element, if given orally as rubidium chloride, appears to be nontoxic and therapeutically effective in several types of depressive disorders. Currently, however, it is unclear whether or not rubidium will serve as an invaluable pharmacologic agent of a direct clinical nature. Further pharmacometric studies and clinical evaluations are needed to elucidate its mechanism of action and to ascertain its future therapeutic role as an antidepressant drug in clinical psychiatry.

Antidepressive Agents↗
PubMed1981

Uniform admissions system for a medical laboratory sciences program.

A system for selection of medical technology students has been developed that features numerical ranking of applicants according to a uniform point system. Each applicant is quantitatively evaluated on achievement of academic and non-academic criteria identified as predictors of success in the student program and in clinical practice. This admissions system has been statistically evaluated by comparing admissions data for 59 graduates with subsequent measures of success during the program and in their first professional employment. The academic and non-academic predictors used in this system describe separate sets of applicant characteristics and appear to be effective as predictors of success. Academic and non-academic predictors are found to function independently of each other as predictors of success in the academic aspects of the program and in the clinical, non-cognitive aspects of both the student program and subsequent professional practice, respectively.

Educational Measurement↗
PubMed1981

Academic rank and salary status of medical laboratory sciences faculty.

The combined emergence of medical laboratory science as a body of knowledge and the emphasis of decreasing the use of health care funds for education have occasioned the development of medical technology programs as academic programs and the employment of qualified laboratory practitioners in university faculty positions. Establishment and maintenance of strong educational programs in the university setting requires that faculty salaries compare favorably with those available in clinical practice and that faculty members meet their institutions's criteria for appointment/promotion at each academic rank. Twenty institutions of higher education with medical technology programs organized as academic departments were surveyed in 1978 and 1980 to determine faculty size, salaries by rank and increases over two years, and criteria for appointment/promotion at each academic rank. Salary data are compared with clinical practice and with other academic disciplines. Data presented will be of value to existing and planned programs and to individuals considering an academic position.

Academic Medical Centers↗