Biomedical subjects

M R Rea

Publications and source records attributed to M R Rea.

9 recordsLinked to original sources

PubMed1995

A grade-six reading level key for the multiple affect adjective check list-revised.

A scoring key containing adjectives from the Multiple Affect Adjective Check List-Revised (MAACL-R) at or below the Grade 6 reading level (MAACL-R6) was used to rescore data from two nonreferred samples (college students, ns = 52 and 78) and one referred sample of 202 from a community mental health center outpatient clinic. Reliability (measures of internal consistency and test-retest) and validity (correlations with five 5-point self-rating mood scales) were almost as high as those for the MAACL-R, and convergence among the MAACL-R6 scales was not increased. Means for the referred group were significantly higher.

Adolescent↗

PubMed1994

Situational obstacles to dietary adherence for adults with diabetes.

OBJECTIVE: To develop a taxonomy of everyday situations that create obstacles for adherence to dietary management in patients with diabetes. SUBJECTS: Twenty-six adults with diabetes (12 with insulin-dependent diabetes mellitus and 14 with non-insulin-dependent diabetes mellitus) were recruited from an outpatient diabetes clinic. MAIN OUTCOME MEASURES: Subjects were interviewed to identify problem situations that create obstacles for dietary adherence. The resulting 69 situations were judged for the presence or absence of 32 environmental features using a reliable coding system. STATISTICAL ANALYSIS: A hierarchical cluster analysis was used to identify homogeneous groups of dietary adherence obstacles. RESULTS: Twelve types of problem situations were identified: negative emotions, resisting temptation, eating out, feeling deprived, time pressure, tempted to relapse, planning, competing priorities, social events, family support, food refusal, and friends' support. CONCLUSIONS: The resulting taxonomy provides an outline for the detailed assessment of obstacles to dietary adherence. An individual's ability to cope with this array of obstacles to dietary adherence should be assessed so treatment can be individualized.

Adult↗

PubMed1987

Endogenous digoxin-like immunoreactive factors eliminated from serum samples by hydrophobic silica-gel extraction and enzyme immunoassay.

Elimination of endogenous digoxin-like immunoreactive factors (DLIF) that interfere with accurate measurement of digoxin requires use of a highly specific anti-digoxin antibody, or that DLIF be separated from digoxin before immunoassay. Several commercial digoxin-assay kits include a step for separating serum proteins and other substances from digoxin before immunoassay. We tested six different immunoassay methods (some having pretreatment steps) for their ability to detect DLIF in serum from patients in renal failure, pregnant women, and neonates, all of whom were not taking digoxin. Extracting digoxin on a column of derivatized silicagel eliminated detectable DLIF from serum as measured by enzyme immunoassay (EMIT; Syva Co.), but recovery of added digoxin was quantitative. In contrast, protein precipitation with 5-sulfosalicylic acid left significant amounts of DLIF in samples, most probably because the procedure (TDx assay; Abbott Labs.) disrupted protein-DLIF binding. A glass-bead radioimmunoassay (Immophase; Corning Medical) had the most digoxin-specific antisera. By preparative silica-gel-chromatography of serum we could eliminate or significantly minimize inaccurate digoxin measurements attributable to endogenous DLIF.

Blood Proteins↗

PubMed1987

Improved interassay correlation of digoxin results in patients with and without renal failure by elimination of digoxin-like immunoreactive factors.

Use of immunoassays that do not detect endogenous digoxin-like immunoreactive factors (DLIF) in serum significantly improves the between-assay correlation of digoxin results for patients. We investigated five different immunoassay methods (Abbott, Clinical Assays, Corning, Du Pont, and Syva), measuring digoxin by all five assays in sera from 38 patients in renal failure and in 40 patients with normal renal function, all taking digoxin. The mean standard error of the estimate (Sy X x) of digoxin results (compared for all five assays) were significantly lower for patients with normal renal function than for patients in renal failure (0.148 vs 0.293 microgram/L, P less than 0.001). Assays previously shown (Clin Chem 1987;33:401) to be the least sensitive to DLIF (Syva and Corning) gave the lowest mean scatter about the regression (Sy X x = 0.192 microgram/L, renal failure; 0.114 microgram/L, normal renal function) for all 10 assay correlations. Evidently, discrepancies between digoxin values as measured by different immunoassay kits for patients with renal disease can be attributed to DLIF. Moreover, because inaccurate digoxin results attributed to DLIF may not be limited exclusively to groups of patients with known increased concentrations of DLIF, the possibility of "latent" DLIF interference may be a problem in many other human subjects.

Blood Proteins↗

PubMed1987

Criteria for evaluating nonquantitative assays: application to serum choriogonadotropin.

We present guidelines for assessing the performance of nonquantitative (qualitative) assay methods. Criteria to be evaluated include analytical sensitivity, imprecision near limits of detection, analytical specificity, accuracy over a wide range of analyte concentrations, potential interferents, and technical ease of performance. A protocol was developed to evaluate several nonquantitative assay kits for detection of human choriogonadotropin (hCG) in serum. These include Tandem Icon HCG (Hybritech), Quest Pregnancy Test (Quidel), Concep-7 beta hCG (Leeco), and Beta Quik V (Pacific Biotech). Quantitative measurement of beta-hCG by RIA (Immophase beta hCG, Corning Medical) was used as the reference method. Results of this evaluation are discussed. The guidelines established and utilized in this report are adaptable to the evaluation of assay kits that measure other analytes by qualitative techniques.

Chorionic Gonadotropin↗

PubMed1986

Implementation of a screening program for diagnosing open neural tube defects: selection, evaluation, and utilization of alpha-fetoprotein methodology.

We evaluated and compared three different commercial kit immunoassays for alpha-fetoprotein (AFP) before we implemented our neural tube defect screening program. Each kit can be used with either serum or amniotic fluid. Analytical recovery ranges for AFP reference sera within each kit's standard curve limits (in kilo-int. units/L) were 97-108% (7.5-180) for the Kallestad kit, 77-101% (21.8-436) for Amersham, and 92-100% (0-177) for Hybritech. CVs, within each manufacturer's standard-curve limits, for combined intra-assay (amniotic fluid pools) and inter-assay (kit serum controls) averaged 3.6-7.3% (Kallestad), 2.4-9.3% (Amersham (y) kit results showed a correlation of r = 0.97, y = 1.05x + 5.5 kilo-int. units per liter of maternal serum (n = 66; range, 2.0-98.5). Gestational age did not influence these assay correlations. The Kallestad AFP assay demonstrated a maternal serum positivity rate of 2.9% at greater than or equal to 2.5 (n = 655) and 8.9% at less than 0.5 (n = 423) multiples of the median. All kits performed well analytically.

Amniotic Fluid↗

PubMedDate not supplied

Situational obstacles to adherence for adolescents with diabetes.

Twenty adolescents with insulin-dependent diabetes mellitus were interviewed to obtain samples of problem situations that create obstacles to dietary adherence. The resulting 57 situations were analyzed using a reliable coding system to determine the presence or absence of 28 stimulus features. A hierarchical cluster analysis was used to identify 10 relatively homogeneous categories of obstacles to dietary adherence: being tempted to stop trying; negative emotional eating; facing forbidden foods; peer interpersonal conflict; competing priorities; eating at school; social events and holidays; food cravings; snacking when home, alone, or bored; and social pressure to eat. Diabetes educators should consider an individual's ability to cope with this array of obstacles to adherence when individualizing treatment. Dietary intervention then can be personalized to address specific situational obstacles.

Adolescent↗

PubMedDate not supplied

Whose patient is it anyway? Coordinating nursing and case management services.

This article discussed ways for nurses and case managers to address the challenges of providing care to medically complex patients. By focusing on early identification of patient needs, appropriate referrals can be made by nursing personnel to case management. Nurses are able to impact the outcomes of the patients on a daily basis. However, time and resource constraints often leave nurses with limited ability to provide discharge and follow-up services necessary for complex medical patients. Ideally, nursing and case management can work together to address the entire continuum of care needed by these complex patients. Recognizing how and when to integrate these two professionals in caring for specific types of patients can be challenging. The case studies presented in this article should assist the reader in identifying role expectations and potential patient outcomes. The reader is encouraged to share these case studies with others in the organization struggling to develop and/or integrate nursing and case management services in a seamless process. By recognizing and supporting each other, nursing personnel and case management staff are able to become the advocates that patients need and deserve in order to obtain optimal care.

Aged↗

PubMedDate not supplied

Redesigning care delivery in the community hospital.

In 1991, Augusta Hospital Corporation implemented a patient care delivery redesign project in an effort to enhance overall quality of care while improving cost effectiveness. Preliminary findings suggest success in both of these endeavors.

Delivery of Health Care↗