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Kost GJ. Geospatial Science and Point-of-Care Testing: Creating Solutions for Population Access, Emergencies, Outbreaks, and Disasters. Front Public Health 2019; 7:329. [PMID: 32039125 PMCID: PMC6988819 DOI: 10.3389/fpubh.2019.00329] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: (a) To understand how to integrate geospatial concepts when implementing point-of-care testing (POCT); (b) to facilitate emergency, outbreak, and disaster preparedness and emergency management in healthcare small-world networks; (c) to enhance community resilience by using POCT in tandem with geographic information systems (GISs) and other geospatial tools; and (d) to advance crisis standards of care at points of need, adaptable and scalable for public health practice in limited-resource countries and other global settings. Content: Visual logistics help integrate and synthesize POCT and geospatial concepts. The resulting geospatial solutions presented here comprise: (1) small-world networks and regional topography; (2) space-time transformation, hubs, and asset mapping; (3) spatial and geospatial care paths™; (4) GIS-POCT; (5) isolation laboratories, diagnostics isolators, and mobile laboratories for highly infectious diseases; (6) alternate care facilities; (7) roaming POCT—airborne, ambulances, space, and wearables; (8) connected and wireless POCT outside hospitals; (9) unmanned aerial vehicles; (10) geospatial practice—demographic care unit resource scoring, geographic risk assessment, and national POCT policy and guidelines; (11) the hybrid laboratory; and (12) point-of-careology. Value: Small-world networks and their connectivity facilitate efficient and effective placement of POCT for optimal response, rescue, diagnosis, and treatment. Spatial care paths™ speed transport from primary encounters to referral centers bypassing topographic bottlenecks, process gaps, and time-consuming interruptions. Regional GISs position POCT close to where patients live to facilitate rapid triage, decrease therapeutic turnaround time, and conserve economic resources. Geospatial care paths™ encompass demographic and population access features. Timeliness creates value during acute illness, complex crises, and unexpected disasters. Isolation laboratories equipped with POCT help stop outbreaks and safely support critically ill patients with highly infectious diseases. POCT-enabled spatial grids can map sentinel cases and establish geographic limits of epidemics for ring vaccination. Impact: Geospatial solutions generate inherently optimal and logical placement of POCT conceptually, physically, and temporally as a means to improve crisis response and spatial resilience. If public health professionals, geospatial scientists, and POCT specialists join forces, new collaborative teamwork can create faster response and higher impact during disasters, complex crises, outbreaks, and epidemics, as well as more efficient primary, urgent, and emergency community care.
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Affiliation(s)
- Gerald J Kost
- Point-of-Care Testing Center for Teaching and Research (POCT·CTR™), University of California, Davis, Davis, CA, United States.,Knowledge Optimization®, Davis, CA, United States
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Alizadeh T, Nayeri S, Mirzaee S. A high performance potentiometric sensor for lactic acid determination based on molecularly imprinted polymer/MWCNTs/PVC nanocomposite film covered carbon rod electrode. Talanta 2019; 192:103-111. [DOI: 10.1016/j.talanta.2018.08.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/02/2018] [Accepted: 08/06/2018] [Indexed: 11/29/2022]
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Boobphahom S, Rattanawaleedirojn P, Boonyongmaneerat Y, Rengpipat S, Chailapakul O, Rodthongkum N. TiO2 sol/graphene modified 3D porous Ni foam: A novel platform for enzymatic electrochemical biosensor. J Electroanal Chem (Lausanne) 2019. [DOI: 10.1016/j.jelechem.2018.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lima-Oliveira G, Monneret D, Guerber F, Guidi GC. Sample management for clinical biochemistry assays: Are serum and plasma interchangeable specimens? Crit Rev Clin Lab Sci 2018; 55:480-500. [PMID: 30309270 DOI: 10.1080/10408363.2018.1499708] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The constrained economic context leads laboratories to centralize their routine analyses on high-throughput platforms, to which blood collection tubes are sent from peripheral sampling sites that are sometimes distantly located. Providing biochemistry results as quickly as possible implies to consolidate the maximum number of tests on a minimum number of blood collection tubes, mainly serum tubes and/or tubes with anticoagulants. However, depending on the parameters and their pre-analytical conditions, the type of matrix - serum or plasma - may have a significant impact on results, which is often unknown or underestimated in clinical practice. Importantly, the matrix-related effects may be a limit to the consolidation of analyses on a single tube, and thus must be known by laboratory professionals. The purpose of the present critical review is to put forward the main differences between using serum and plasma samples on clinical biochemistry analyses, in order to sensitize laboratory managers to the need for standardization. To enrich the debate, we also provide an additional comparison of serum and plasma concentrations for approximately 30 biochemistry parameters. Properties, advantages, and disadvantages of serum and plasma are discussed from a pre-analytical standpoint - before, during, and after centrifugation - with an emphasis on the importance of temperature, delay, and transport conditions. Then, differences in results between these matrices are addressed for many classes of biochemistry markers, particularly proteins, enzymes, electrolytes, lipids, circulating nucleic acids, metabolomics markers, and therapeutic drugs. Finally, important key-points are proposed to help others choose the best sample matrix and guarantee quality of clinical biochemistry assays. Moreover, awareness of the implications of using serum and plasma samples on various parameters assayed in the laboratory is an important requirement to ensure reliable results and improve patient care.
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Affiliation(s)
- Gabriel Lima-Oliveira
- a Section of Clinical Biochemistry, Department of Neurosciences , Biomedicine and Movement Sciences, University of Verona , Verona , Italy.,b Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) , Montevideo , Uruguay
| | - Denis Monneret
- c Department of Biochemistry and Molecular Biology , Lyon Sud Hospital Group, Hospices Civils de Lyon , Pierre Bénite , France
| | | | - Gian Cesare Guidi
- a Section of Clinical Biochemistry, Department of Neurosciences , Biomedicine and Movement Sciences, University of Verona , Verona , Italy.,b Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI) , Montevideo , Uruguay
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Biswas A, Bornhoeft LR, Banerjee S, You YH, McShane MJ. Composite Hydrogels Containing Bioactive Microreactors for Optical Enzymatic Lactate Sensing. ACS Sens 2017; 2:1584-1588. [PMID: 29043796 DOI: 10.1021/acssensors.7b00648] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Continuously monitoring specific biomarkers offer a promising method to interrogate disease status and progression. In this work we have demonstrated a composite hydrogel-based sensing platform that may be used for optical detection of lactate. The sensor design consists of microsized enzymatic sensors that are embedded in an outer hydrogel matrix. In these engineered microdomains, encapsulated lactate oxidase serves as the bioactive component, phosphorescent metalloporphyrin acts as the optical transducer, and polyelectrolyte multilayers coated on the enzymatic microsensors control the permeation of lactate into the microsensors. The response of the composite hydrogel-based lactate sensors was characterized by subjecting the sensors to lactate concentration challenges at low physiological oxygen levels. The analytical range and the mean sensitivity were determined to be 9.2 ± 0.83 mg/dL and 11 ± 0.90% dL mg-1, respectively. Repeated cyclic exposure to high levels of lactate revealed that these sensors were extremely stable, with no significant loss in sensor response after 20 cycles. These preliminary results support the premise that these composite hydrogels are capable of continuous lactate tracking and have the potential for use as fully implantable optical lactate sensors.
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Affiliation(s)
- Aniket Biswas
- Department of Biomedical Engineering, ‡Department of Biology, and §Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Lindsey R. Bornhoeft
- Department of Biomedical Engineering, ‡Department of Biology, and §Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Swayoma Banerjee
- Department of Biomedical Engineering, ‡Department of Biology, and §Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Yil-Hwan You
- Department of Biomedical Engineering, ‡Department of Biology, and §Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Michael J. McShane
- Department of Biomedical Engineering, ‡Department of Biology, and §Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
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Rathee K, Dhull V, Dhull R, Singh S. Biosensors based on electrochemical lactate detection: A comprehensive review. Biochem Biophys Rep 2015; 5:35-54. [PMID: 28955805 PMCID: PMC5600356 DOI: 10.1016/j.bbrep.2015.11.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/08/2015] [Accepted: 11/10/2015] [Indexed: 01/19/2023] Open
Abstract
Lactate detection plays a significant role in healthcare, food industries and is specially necessitated in conditions like hemorrhage, respiratory failure, hepatic disease, sepsis and tissue hypoxia. Conventional methods for lactate determination are not accurate and fast so this accelerated the need of sensitive biosensors for high-throughput screening of lactate in different samples. This review focuses on applications and developments of various electrochemical biosensors based on lactate detection as lactate being essential metabolite in anaerobic metabolic pathway. A comparative study to summarize the L-lactate biosensors on the basis of different analytical properties in terms of fabrication, sensitivity, detection limit, linearity, response time and storage stability has been done. It also addresses the merits and demerits of current enzyme based lactate biosensors. Lactate biosensors are of two main types – lactate oxidase (LOD) and lactate dehydrogenase (LDH) based. Different supports tried for manufacturing lactate biosensors include membranes, polymeric matrices-conducting or non-conducting, transparent gel matrix, hydrogel supports, screen printed electrodes and nanoparticles. All the examples in these support categories have been aptly discussed. Finally this review encompasses the conclusion and future emerging prospects of lactate sensors. Different enzymes used in lactate bio sensing have been studied. Support used for fabrication biosensors have been discussed. The linearity range, response time, detection limit, etc. have been studied. Merits and demerits of different supports are also discussed.
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Affiliation(s)
- Kavita Rathee
- Department of Biochemistry, Maharshi Dayanand University, Rohtak 124001, India
| | - Vikas Dhull
- Department of Bio & Nano Technology, Guru Jambheshwar University of Science & Technology, Hisar 125001, India
| | - Rekha Dhull
- Department of Biochemistry, Maharshi Dayanand University, Rohtak 124001, India
| | - Sandeep Singh
- Department of Biochemistry, Maharshi Dayanand University, Rohtak 124001, India
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Stadlbauer V, Wallner S, Stojakovic T, Smolle KH. Comparison of 3 different multianalyte point-of-care devices during clinical routine on a medical intensive care unit. J Crit Care 2011; 26:433.e1-11. [DOI: 10.1016/j.jcrc.2010.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/09/2010] [Accepted: 09/10/2010] [Indexed: 11/28/2022]
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Tatsuki M, Miyazawa R, Tomomasa T, Ishige T, Nakazawa T, Arakawa H. Serum magnesium concentration in children with functional constipation treated with magnesium oxide. World J Gastroenterol 2011; 17:779-83. [PMID: 21390149 PMCID: PMC3042657 DOI: 10.3748/wjg.v17.i6.779] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Revised: 12/01/2010] [Accepted: 12/08/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine whether hypermagnesemia recently reported in adult patients possibly develops in children with functional constipation taking daily magnesium oxide.
METHODS: We enrolled 120 patients (57 male and 63 female) aged 1-14 years old (median: 4.7 years) with functional constipation from 13 hospitals and two private clinics. All patients fulfilled the Rome III criteria for functional constipation and were treated with daily oral magnesium oxide for at least 1 mo. The median treatment dose was 600 (500-800) mg/d. Patients were assessed by an interview and laboratory examination to determine possible hypermagnesemia. Serum magnesium concentration was also measured in sex- and age-matched control subjects (n = 38).
RESULTS: In the constipation group, serum magnesium concentration [2.4 (2.3-2.5) mg/dL, median and interquartile range] was significantly greater than that of the control group [2.2 (2.0-2.2) mg/dL] (P < 0.001). The highest value was 3.2 mg/dL. Renal magnesium clearance was significantly increased in the constipation group. Serum magnesium concentration in the constipation group decreased significantly with age (P < 0.01). There was no significant correlation between the serum level of magnesium and the duration of treatment with magnesium oxide or the daily dose. None of the patients had side effects associated with hypermagnesemia.
CONCLUSION: Serum magnesium concentration increased significantly, but not critically, after daily treatment with magnesium oxide in constipated children with normal renal function.
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Point of Care Testing. APOLLO MEDICINE 2009. [DOI: 10.1016/s0976-0016(11)60042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND Modern blood gas analyzers are often coupled to electrolyte and metabolite analyzers. We evaluated a Stat Profile Critical Care Xpress analyzer (STP CCX) for the rapid point-of-care measurement of blood gases (pH, pCO2, pO2, sO2), hematocrit (Hct), total hemoglobin (tHb), sodium (Na+), potassium (K+), chloride (Cl-), glucose (Glu), lactate (Lac), urea (BUN), ionized calcium (iCa) and ionized magnesium (iMg). METHODS The analyzer was evaluated in terms of imprecision and recovery using the STP CCX control. Fresh blood samples were also measured to determine the between-day imprecision. Correlation was assessed by clinical sample comparison with the Nova Stat Profile Ultra C and Dimension RxL systems for Cl- and BUN. We used Deming regression, correlation coefficients, mean differences, and the Wilcoxon signed-rank test for data analysis. RESULTS The coefficients of variation for all analytes were within desirable limits, ranging from 0.1% to 4.3%, and the recovery was 100%+/-3%. Between-day imprecision using fresh blood samples showed good results, ranging from 0.2% to 3.4%. The comparison results showed high to very high correlation. However, statistically significant mean differences with large bias were found for pCO2, pO2 and Cl-. CONCLUSIONS This analyzer is suitable as a simple and fast diagnostic tool in the laboratory and the critical care unit. However, users should be aware of biases that may lead to clinically significant errors in the assessment of acid-base status.
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Affiliation(s)
- Somlak Vanavanan
- Division of Clinical Chemistry, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Amperometric lactate biosensors and their application in (sports) medicine, for life quality and wellbeing. Mikrochim Acta 2007. [DOI: 10.1007/s00604-007-0834-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shanklin DR. Cellular magnesium acquisition: an anomaly in embryonic cation homeostasis. Exp Mol Pathol 2007; 83:224-40. [PMID: 17532318 DOI: 10.1016/j.yexmp.2007.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 03/14/2007] [Accepted: 03/15/2007] [Indexed: 12/22/2022]
Abstract
The intracellular dominance of magnesium ion makes clinical assessment difficult despite the critical role of Mg(++) in many key functions of cells and enzymes. There is general consensus that serum Mg(++) levels are not representative of the growing number of conditions for which magnesium is known to be important. There is no consensus method or sample source for testing for clinical purposes. High intracellular Mg(++) in vertebrate embryos results in part from interactions of cations which influence cell membrane transport systems. These are functionally competent from the earliest stages, at least transiently held over from the unfertilized ovum. Kinetic studies with radiotracer cations, osmolar variations, media lacking one or more of the four biological cations, Na(+), Mg(++), K(+), and Ca(++), and metabolic poison 0.05 mEq/L NaF, demonstrated that: (1) all four cations influence the behavior of the others, and (2) energy is required for uptake and efflux on different time scales, some against gradient. Na(+) uptake is energy dependent against an efflux gradient. The rate of K(+) loss is equal with or without fluoride, suggesting a lack of an energy requirement at these stages. Ca(++) efflux took twice as long in the presence of fluoride, likely due in part to intracellular binding. Mg(++) is anomalous in that early teleost vertebrate embryos have an intracellular content exceeding the surrounding sea water, an isolated unaffected yolk compartment, and a clear requirement for energy for both uptake and efflux. The physiological, pathological, and therapeutic roles of magnesium are poorly understood. This will change: (1) when (28)Mg is once again generally available at a reasonable cost for both basic research and clinical assessment, and (2) when serum or plasma levels are determined simultaneously with intracellular values, preferably as part of complete four cation profiles. Atomic absorption spectrophotometry, energy-dispersive x-ray analysis, and inductively coupled plasma emission spectroscopy on sublingual mucosal and peripheral blood samples are potential methods of value for coordinated assessments.
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Affiliation(s)
- D Radford Shanklin
- Department of Pathology and Laboratory Medicine, University of Tennessee, Memphis, 930 Madison Avenue, Suite 599, Memphis, TN 38163, USA.
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Hoshino K, Ogawa K, Hishitani T, Isobe T, Etoh Y. Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome. Pediatr Int 2006; 48:112-7. [PMID: 16635167 DOI: 10.1111/j.1442-200x.2006.02177.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Administration of magnesium sulfate (MgSO4) is an effective and safe treatment for torsades de pointes (TdP) associated with acquired long QT syndrome (LQTS) in adults. As for children, there are few reports focusing on it. The authors discuss the efficacy of MgSO4 for TdP in children with congenital and acquired LQTS. The authors also discuss the optimal administration dosage and serum magnesium (SMg) concentration during MgSO4 therapy. METHODS The authors studied seven consecutive LQTS children undergoing MgSO4 therapy for TdP. Of the seven children, five were congenital LQTS and two were acquired LQTS. A bolus injection of MgSO4 was given intravenously over 1-2 min followed by continuous infusion for the next 2-7 days. RESULTS Of the seven patients, six responded completely to the initial bolus. The bolus dosage was 5.9 +/- 3.8 mg/kg (range, 2.3-12 mg/kg) in these six, and the other remaining one (neonate with congenital LQTS) required a total of 30 mg/kg until complete abolishment. The continuous infusion was given at rates of 0.3-1.0 mg/kg per h and patients did not show recurrence of TdP. The SMg concentration was 3.9 +/- 1.0 mg/dL (2.9-5.4 mg/dL) immediately after bolus injection. The mean corrected QT (QTc) interval before and after bolus injection did not show significant difference. CONCLUSION Intravenous infusion of MgSO4 was effective for TdP in children with LQTS, and MgSO4 abolished TdP without shortening the QTc interval. The optimal bolus dosage, infusion rates and SMg concentration were 3-12 mg/kg, 0.5-1.0 mg/kg per h and 3-5 mg/dL, respectively.
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Affiliation(s)
- Kenji Hoshino
- Department of Pediatric Cardiology, Saitama Children's Medical Center, Iwatsuki City, Saitama, Japan.
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Kost GJ, Tran NK. Point-of-Care Testing and Cardiac Biomarkers: The Standard of Care and Vision for Chest Pain Centers. Cardiol Clin 2005; 23:467-90, vi. [PMID: 16278118 DOI: 10.1016/j.ccl.2005.08.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Point-of-care testing (POCT) is defined as testing at or near the site of patient care. POCTdecreases therapeutic turnaround time (TTAT), increases clinical efficiency, and improves medical and economic outcomes. TTAT represents the time from test ordering to patient treatment. POC technologies have become ubiquitous in the United States, and, therefore,so has the potential for speed, convenience, and satisfaction, strong advantages for physicians, nurses, and patients in chest pain centers. POCT is applied most beneficially through the collaborative teamwork of clinicians and laboratorians who use integrative strategies, performance maps, clinical algorithms, and care paths (critical pathways). For example, clinical investigators have shown that on-site integration of testing for cardiac injury markers (myoglobin, creatinine kinase myocardial band [CKMB],and cardiac troponin I [cTnI]) in accelerated diagnostic algorithms produces effective screening, less hospitalization, and substantial savings. Chest pain centers, which now total over 150 accredited in the United States, incorporate similar types of protocol-driven performance enhancements. This optimization allows chest pain centers to improve patient evaluation, treatment, survival, and discharge. This article focuses on cardiac biomarker POCT for chest pain centers and emergency medicine.
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Affiliation(s)
- Gerald J Kost
- Point-of-Care Testing Center for Teaching and Research, Department of Pathology and Laboratory Medicine,UCD Health System, School of Medicine, University of California, Davis, CA 95616, USA.
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Sakamoto T, Takasu A, Saitoh D, Kaneko N, Yanagawa Y, Okada Y. Ionized magnesium in the cerebrospinal fluid of patients with head injuries. ACTA ACUST UNITED AC 2005; 58:1103-9. [PMID: 15995455 DOI: 10.1097/01.ta.0000169950.51735.c4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In head injury patients, a decrease in the serum ionized magnesium (iMg) concentration is considered to be related to the severity of the injury, however, this phenomenon is still not completely understood. The cerebrospinal fluid (CSF) iMg concentration has not been well documented under such conditions and, moreover, its normal value has not yet been established. We hereby intended to investigate the role of the iMg concentration and other parameters in both the serum and CSF of head injury patients and identify any relationship with other parameters. MATERIALS AND METHODS The subjects consisted of head injury patients without any other serious injuries. Ten healthy volunteers were selected as control subjects. Arterial blood and CSF specimens were simultaneously obtained and measured. We measured the Glasgow Coma Scale scores (GCS), the intracranial pressure (ICP), pH, po2, pco2, sodium, potassium, iCa, iMg, glucose, lactate, urea nitrogen. All data are expressed as the mean+/-SD and the units of iMg and iCa (corrected under pH 7.40) are given in mmol/L. RESULTS In the healthy subjects, the iMg concentration in the serum/CSF was 0.48 +/- 0.02 / 0.66 +/- 0.14, and iCa was 1.14 +/- 0.05 / 0.94 +/- 0.07. The GCS of the 15 head injury subjects at examination was 8.7 +/- 4.5. When the subjects were divided into 3 groups according to the GCS level (3 and 4, 5-8, and > or =9) at the time of examination, the serum iMg concentration was thus found to be related to the severity of injury based on the GCS level (p = 0.028), but not the CSF iMg concentration (p = 0.89). No relationship was observed between the iMg concentration in the serum and CSF when all specimens were compared, but an extremely close correlation was seen in the group with GCS 3 and 4 (p < 0.0001, r = 0.995), although no such correlation was seen in the other 2 groups (p = 0.12, r = -0.56 in the group with GCS 5-8, and p = 0.26, r = -0.35 in the group with GCS > or = 9). There was a significant correlation between the serum iMg and iCa (p = 0.0093, r = 0.47), and also between the CSF iMg and iCa concentrations (p < 0.0001, r = 0.67). CONCLUSION The serum iMg concentration has been suggested to possibly affect the neurologic state through CSF iMg in patients with the most severe head injury. In patients with moderate or mild head injuries, however, the ionized magnesium concentration is also probably associated with the degree of neurologic deficit based on the ionized calcium level. The CSF and serum ionized magnesium dissociation may thus result from the slow movement of ionized magnesium through the blood brain barrier.
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Abstract
An amperometric sol-gel derived sensor that both releases nitric oxide (NO) and measures physiologically relevant concentrations of oxygen (PO2) is described. The sensor consists of a platinum electrode coated with an aminosilane/ethyltrimethoxysilane hybrid xerogel film. Hydrophilic polyurethane (HPU) is doped into the hybrid film to reduce sensor hydration time and increase oxygen permeability. Diazeniumdiolate NO donors are formed within the polymer matrix by exposing the cured film to high pressures of NO. These coatings release up to 7.2 pmol s(-1) cm(-2) of NO over the first 12 h and maintain detectable levels of NO release through 48 h. Sensors modified with HPU-doped, NO-releasing xerogels exhibit a linear response to O2 within 30 min of polarization at -0.65 V vs. Ag/AgCl, and have a sensitivity of approximately 6 nA/mmHg O2. The xerogel coating is stable in buffer solution with minimal fragmentation over 48 h. In vitro biocompatibility studies indicate that these materials effectively reduce platelet adhesion.
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Affiliation(s)
- Stephanie M Marxer
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3290, USA
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Hoshino K, Ogawa K, Hishitani T, Isobe T, Eto Y. Optimal Administration Dosage of Magnesium Sulfate for Torsades de Pointes in Children with Long QT Syndrome. J Am Coll Nutr 2004; 23:497S-500S. [PMID: 15466950 DOI: 10.1080/07315724.2004.10719388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intravenous administration of magnesium sulphate (MgSO(4)) is a very effective and safe treatment for torsades de pointes (TdP) associated with acquired long QT syndrome (LQTS) in adults. Discussed here is the efficacy of MgSO(4) for TdP in children with congenital and acquired LQTS. METHODS The optimal MgSO(4) dosage and serum magnesium (SMg) was determined in six consecutive children with TdP; four had congenital LQTS and two had acquired LQTS. A bolus injection of MgSO(4) was given intravenously over 1 to 2 minutes followed by continuous infusion for the next 2 to 7 days. RESULTS Of the six patients, five responded completely to the initial bolus of 6.1 +/- 4.2 mg/kg (range, 2.3-12 mg/kg). One (a neonate with congenital LQTS) required a total of 30 mg/kg until complete TdP elimination. Continuous infusion was given at rates of 0.3 to 1.0 mg/kg/hr with no recurrence of TdP. SMg concentration was 3.9 +/- 1.0 mg/dL (2.9-5.4 mg/dL) immediately after bolus injection. CONCLUSION Intravenous MgSO(4) infusion effectively treated TdP in children with LQTS. Optimal bolus dosage, infusion rates and SMg concentration were 3 to 12 mg/kg, 0.5 to 1.0 mg/kg/hr and 3 to 5 mg/dL, respectively.
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Affiliation(s)
- Kenji Hoshino
- Pediatric Cardiology, Saitama Children's Medical Center, 2100 Magome, Iwatsuki City, Saitama 339-8551, Japan.
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Boldt J, Kumle B, Suttner S, Haisch G. Point-of-care (POC) testing of lactate in the intensive care patient. Accuracy, reliability, and costs of different measurement systems. Acta Anaesthesiol Scand 2001; 45:194-9. [PMID: 11167165 DOI: 10.1034/j.1399-6576.2001.450210.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Point-of-care (POC) monitoring may facilitate diagnostic and therapeutic interventions in the critically ill. In a prospective study reliability and costs of two POC lactate testing devices were compared to the central laboratory lactate monitoring method. METHODS From arterial whole blood and capillary blood samples of 40 intensive care unit (ICU) patients lactate concentrations were measured using either a battery-powered hand-held lactate analyser (Accusport) or a bench-top blood gas analyser (Chiron 865 series) and compared with lactate measured by the hospital's central laboratory ('reference' method). Measurements were carried out on the day of inclusion in the study ('baseline'), 8 h later, and in the morning of the 1st, 2nd, and 3rd days thereafter. Costs for blood lactate measurements were analysed for each method. RESULTS A total of 197 lactate measurements were done with each system. Lactate measured from arterial blood using the Accusport and the central laboratory showed excellent agreement (bias: -0.15 mmol/l; relative error: -2.74%). Lactate measured by the blood gas analyser had also excellent agreement with the reference method (bias: 0.09 mmol/l; relative error: 2.24%) and the hand-held device (bias: -0.24 mmol/l; relative error: -5.06%). Time from blood sampling to availability of data was significantly longer for the central laboratory (85+/-35 min [range: 45-168 min]) than for both POC systems (range: 1-10 min). Total cost for measuring blood lactate was lowest using the Accusport device. CONCLUSION The trend towards miniaturizing laboratory monitoring devices will continue, resulting in greater flexibility of management of the critically ill. Blood lactate can rapidly, easily, accurately, and economically be measured at the bedside with the hand-held monitor apparatus Accusport and the bench-top blood gas analyser.
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Affiliation(s)
- J Boldt
- Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Germany.
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22
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Kost GJ, Nguyen TH, Tang Z. Whole-blood glucose and lactate. Trilayer biosensors, drug interference, metabolism, and practice guidelines. Arch Pathol Lab Med 2000; 124:1128-34. [PMID: 10923071 DOI: 10.5858/2000-124-1128-wbgal] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the effects of 30 of the most commonly used critical care drugs on measurements obtained with trilayer electrochemical biosensors on a reference analyzer (ABL625-GL), to determine metabolic changes in glucose and lactate in vitro, and to formulate guidelines for whole-blood analysis of these 2 analytes. DESIGN Serial measurements were taken of changes in glucose and lactate levels caused by metabolism in whole blood in vitro over time. A parallel control study of drug interference with measurements of glucose and lactate in whole blood and of dose-response relationships in whole-blood samples and in plasma samples also was conducted. RESULTS At room temperature, whole-blood metabolism decreased glucose levels -2.3% at 15 minutes, -4.6% at 30 minutes, and -6.4% at 45 minutes. Metabolism increased lactate levels 11.4% at 15 minutes, 20.6% at 30 minutes, and 26.7% at 45 minutes in vitro. Paired differences between drug-spiked and control samples were calculated to determine interference (corrected for metabolism). The threshold for determination of interference was +/-2 SD from within-day precision, equal to +/-0.18 and +/-0.10 mmol/L for glucose and lactate, respectively. Only mannitol (C(6)H(14)O(6)) interfered with glucose and lactate measurements. At a concentration of 24 mg/mL, mannitol decreased whole-blood glucose levels by an average of 0.711 mmol/L (12.8 mg/dL) and whole-blood lactate levels by 0.16 mmol/L (1.4 mg/dL). Mannitol interference with measurements may have resulted from suppression of hydrogen peroxide formation in the enzymatic reactions in the biosensors, repartitioning of water between erythrocytes and plasma, or from other mechanisms. CONCLUSIONS Most critical care drugs had no significant effects on the trilayer electrochemical biosensors. Whole-blood analysis should be performed within 15 minutes for lactate and within 30 minutes for glucose because of metabolism in vitro. Mannitol effects on glucose measurements may be clinically significant in mannitol-induced acute renal failure and therefore should be considered for appropriate diagnosis and treatment of critically ill patients.
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Affiliation(s)
- G J Kost
- Medical Pathology and Clinical Chemistry, University of California, Davis, School of Medicine 95616, USA
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23
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Kost GJ, Vu HT, Inn M, DuPlantier R, Fleisher M, Kroll MH, Spinosa JC. Multicenter study of whole-blood creatinine, total carbon dioxide content, and chemistry profiling for laboratory and point-of-care testing in critical care in the United States. Crit Care Med 2000; 28:2379-89. [PMID: 10921568 DOI: 10.1097/00003246-200007000-00033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To introduce a creatinine biosensor and a total carbon dioxide content (TCO2) method for whole-blood measurements, to evaluate the clinical performance of a new transportable analyzer that simultaneously performs these two and six other tests (Na+, K+, Cl-, glucose, urea nitrogen, and hematocrit), and to assess the potential of the new analyzer for point-of-care testing in critical care by comparing results obtained by nonlaboratory personnel and by medical technologists. DESIGN Multicenter sites compared whole-blood measurements with the transportable analyzer to plasma measurements from the same specimens with local reference instruments. One site compared whole-blood results produced by nonlaboratory personnel vs. medical technologists and evaluated day-to-day and within-day precision at the point of care. SETTINGS AND PATIENTS Four medical centers in the United States. Venous and arterial specimens from 710 critically ill patients with a variety of diagnoses. Point-of-care testing in the emergency room and operating room. RESULTS The linear regression analyses at the four medical centers showed the following: creatinine (a) slope, 0.91 to 1.22, (b) y intercept, -0.07 to 0.15 mg/dL, and (c) r2, 0.77 to 1.00; and TCO2: (a) slope, 0.64 to 1.00, (b) y intercept, 1.36 to 9.6 mmol/L, and (c) r2, 0.52 to 0.72 (yi, whole-blood analyses; xi, plasma reference measurements). Bland-Altman plots also were used to assess multicenter creatinine and TCO2 results. Of the other analytes, K+, glucose, and urea nitrogen had the highest r2-values. For the eight chemistry profile tests performed at the point of care (yi, nonlaboratory personnel results; xi, medical technologist results), the average value of r2 was 0.96 (SD 0.08) in the operating room and 0.96 (SD 0.06) in the emergency room, and mean paired differences (yi - xi) were not statistically or clinically significant. Precision was acceptable. CONCLUSIONS The performance of the creatinine biosensor and the TCO2 method was acceptable for whole-blood samples. Comparisons of whole-blood results from the transportable analyzer and plasma results from the local reference instruments revealed analyte biases that may be attributed to differences between direct whole-blood analyses and indirect-diluted plasma measurements and other factors. Performance of nonlaboratory personnel and medical technologists was equivalent for point-of-care testing in critical care settings. The whole-blood analyzer should be useful when patient care demands immediate results.
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Affiliation(s)
- G J Kost
- University of California, Davis, Health System and the Point-of-Care Testing Center for Teaching and Research, USA
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24
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Schoenfisch MH, Mowery KA, Rader MV, Baliga N, Wahr JA, Meyerhoff ME. Improving the thromboresistivity of chemical sensors via nitric oxide release: fabrication and in vivo evaluation of NO-releasing oxygen-sensing catheters. Anal Chem 2000; 72:1119-26. [PMID: 10740848 DOI: 10.1021/ac991370c] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The development and in vivo analytical performance of a nitric oxide (NO)-releasing amperometric oxygen sensor with greatly enhanced thromboresistivity are reported. Gas permeable coatings formulated with cross-linked silicone rubber (SR) containing NO-generating compounds (diazeniumdiolates) are shown to release NO for extended periods of time (> 20 h) while reducing platelet adhesion and activation. Oxygen-sensing catheters prepared by dip-coating the NO-releasing films over the outer SR tubes of the implantable devices display similar analytical response properties in vitro (sensitivity, selectivity, response times) when compared to analogous sensors prepared without the NO release coatings. Superior analytical accuracy (relative to blood PO2 values measured in vitro) and greatly reduced thrombus formation on the outer surface of the sensors are observed in vivo (in canine model) with the NO release PO2 sensors compared to control sensors (without NO release) implanted simultaneously within the same animals. Based on these preliminary studies, the use of NO release polymers to fabricate catheter-style chemical sensors may be a potential solution to lingering biocompatibility and concomitant performance problems encountered when attempting to employ such devices for continuous intravascular measurements of blood gases and electrolytes.
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Affiliation(s)
- M H Schoenfisch
- Department of Chemistry, University of Michigan, Ann Arbor 48109, USA
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25
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Barrera R, Fleischer M, Miletic J, Groeger J. Ionized magnesium supplementation in critically ill patients: comparing ionized and total magnesium. J Crit Care 2000; 15:36-40. [PMID: 10757197 DOI: 10.1053/jcrc.2000.0150036] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE The purpose of this study was to assess the effect of magnesium supplementation on total magnesium, ionized magnesium, ionized calcium, potassium, and pH in critically ill cancer patients and to compare the validity of the measurements. MATERIALS AND METHODS Thirty-three consecutive critically ill patients receiving magnesium supplementation were placed in this prospective observational study at the Comprehensive Cancer Center, University Hospital. One gram (4.1 mmol) magnesium in 50 mL D5W was administered to critically ill patients, and the following were measured: total magnesium, ionized magnesium, ionized calcium, potassium, albumin, pH, BUN, creatinine, creatinine. RESULTS Total magnesium and ionized magnesium increased by a mean of .11 +/- .02 and .05 +/- .01 mmol/L, respectively, after supplementation with 4.1 mmol of magnesium sulfate (P = .0001). Total magnesium, ionized magnesium, albumin, ionized calcium, potassium, and pH did not change significantly by the administration of 1 g of magnesium sulfate. CONCLUSION The mean ionized magnesium (IMg+2) relationship to total magnesium (TMg) cannot be predicted before the supplementation with the available technology. After supplementation of 4.1 mmol/L the ionized magnesium level increased by .05 +/- .01 mmol/L. Magnesium supplementation had no significant effect on ionized calcium, potassium, and pH. TMg and IMg+2 should be followed independently.
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Affiliation(s)
- R Barrera
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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26
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Affiliation(s)
- M Mor
- Unit of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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27
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Kost GJ, Ehrmeyer SS, Chernow B, Winkelman JW, Zaloga GP, Dellinger RP, Shirey T. The laboratory-clinical interface: point-of-care testing. Chest 1999; 115:1140-54. [PMID: 10208220 DOI: 10.1378/chest.115.4.1140] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
POC testing provides an opportunity for clinicians and laboratorians to work together to consider how best to serve the patients within an individual institution. Each health system has unique characteristics relative to patient population, as well as a unique laboratory structure. If physicians, nurses, laboratorians, and pathologists work collaboratively, the best interests of patients will be served. In some institutions that cater to specific patient groups, POC testing may offer clear and distinct advantages. In other institutions with sophisticated transport systems and established rapid response capabilities, the quality resulting from central laboratory testing may outweigh any advantages of bedside testing. Clearly, attention to regulatory issues, QC issues, the importance of proper documentation, proficiency testing, performance enhancement, and cost-effectiveness is requisite. As the technology for diagnostic testing advances through more microcomputerization, microchemistry, and enhanced test menus, the concept of POC testing will need perpetual revisiting. We hope that the information provided here will aid clinicians, laboratorians, and administrators in their quest to best serve their patients.
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Affiliation(s)
- G J Kost
- University of California, Davis, USA
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28
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Kricka LJ, Parsons D, Coolen RB. Healthcare in the United States and the practice of laboratory medicine. Clin Chim Acta 1997; 267:5-32. [PMID: 9469242 DOI: 10.1016/s0009-8981(97)00175-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
US healthcare and the impact of the changes in the healthcare system on the current and future practice of laboratory medicine are analyzed. Factors considered include--population and government, healthcare expenditure, organization of healthcare delivery (institutions, personnel, healthcare industry, knowledge-personnel production, financing), the impact of managed care, and political and public health issues. The effect of the changing healthcare scene on laboratories and the consequent cost-containment measures for laboratory medicine are examined, including centralization, consolidation, supplier relationships, reengineering and automation (total lab automation), expert systems, CQI, and the move to point-of-care testing.
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Affiliation(s)
- L J Kricka
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia 19104, USA
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29
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Chernow B, Jackson E, Miller JA, Wiese J. Blood conservation in acute care and critical care. AACN CLINICAL ISSUES 1996; 7:191-7. [PMID: 8718381 DOI: 10.1097/00044067-199605000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Blood conservation has evolved into an important issue in hospital-based medicine. Increased awareness of and worry about transfusion-associated diseases have prompted a focus on this important area. New technologies, including continuous intraarterial monitoring devices, microchemical technologies, new drug development (recombinant human erythropoietin and aprotinin) and intraoperative salvage techniques have made the concept of clinically important blood conservation possible. In this article, the authors review clinically important areas regarding blood conservation, which are subsequently detailed in this issue of AACN Clinical Issues. Emphasis is placed on the need for blood conservation in acute and critical care practice and the technologies available to achieve this goal.
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30
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Espadas-Torre C, Bakker E, Barker S, Meyerhoff ME. Influence of nonionic surfactants on the potentiometric response of hydrogen ion-selective polymeric membrane electrodes. Anal Chem 1996; 68:1623-31. [PMID: 8815748 DOI: 10.1021/ac951017g] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The influence of poly(ethylene oxide)-based nonionic surfactants (i.e., Triton X-100 and Brij 35) in the sample phase on the response properties of hydrogen ion-selective polymeric membrane electrodes containing mobile (lipophilic amines) or covalently bound (aminated-poly-(vinyl chloride)) hydrogen ion carriers is reported. In the presence of these nonionic surfactants, membrane electrode response toward interfering cation activity (e.g., Na+) in the sample phase is increased substantially and the pH measuring range shortened. The degree of cation interference for pH measurements is shown to correlate with the basicity of the hydrogen ion carrier doped within the membrane phase. The observed deterioration in selectivity arises from the partitioning of the surfactant into the membrane and concomitant extraction of metal cations by the surfactants in the organic phase. The effect of nonionic surfactants on pH electrodes prepared with aminated-PVC membranes is shown to be more complex, with additional large shifts in EMF values apparently arising from multidentate interactions between the surfactant molecules and the polymeric amine in the membrane, leading to a change in the apparent pKa values for the amine sites. The effects induced by nonionic surfactants on the EMF response function of hydrogen ion-selective polymeric membrane electrodes are modeled, and experimental results are shown to correlate well with theoretical predictions.
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Affiliation(s)
- C Espadas-Torre
- Department of Chemistry, University of Michigan, Ann Arbor 48109-1055, USA
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31
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Burritt MF, Santrach PJ, Hankins DG, Herr D, Newton NC. Evaluation of the i-STAT portable clinical analyzer for use in a helicopter. Scand J Clin Lab Invest Suppl 1996; 224:121-8. [PMID: 8865426 DOI: 10.3109/00365519609088630] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We evaluated the performance of the i-STAT Portable Clinical Analyzer (PCA) for use in a helicopter with the analyses performed by the flight nurses. Imprecision and initial split-sample comparative studies were performed in the Hospital Laboratory and Clinical Chemistry Laboratory. Day-to day imprecision (CV) ranged from 0.5 to 6.7% in the clinical laboratories and 0.5 to 5.3% in the helicopter with urea nitrogen and glucose determinations giving the highest values. Comparison studies between the PCA and the Kodak Ektachem E700 and the Beckman Astra 8 gave acceptable results, although urea nitrogen did show a bias in the high range (mean difference 4.91 and 3.69 mmol/L respectively). It was not considered medically significant for the anticipated patient population of the PCA in our hospitals. Comparison studies of patient specimens between the PCA in the helicopter and the clinical laboratories showed no significant differences, with the exception of glucose. Lower glucose values were obtained in the laboratory due to the time lag between specimen collection in the helicopter and analysis in the laboratory.
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Affiliation(s)
- M F Burritt
- Department of Laboratory Medicine and Pathology, Mayo Clinic/Mayo Foundation, Rochester, Mn., USA
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32
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Sands VM, Auerbach PS, Birnbaum J, Green M. Evaluation of a portable clinical blood analyzer in the emergency department. Acad Emerg Med 1995; 2:172-8. [PMID: 7497029 DOI: 10.1111/j.1553-2712.1995.tb03190.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess the potential effects of rapid bedside blood analysis on patient management in the ED. METHODS A prospective, nonrandomized clinical study was conducted over a consecutive ten-month period (August 1992 to May 1993). Blood samples drawn from a convenience sample of 960 patients for analysis of Na+, K+, Cl-, BUN, glucose, and/or hematocrit (Hct) were simultaneously analyzed by portable clinical analyzer (PCA) and by routine methods in the central laboratory. Caregivers were blinded to the PCA values; patient care was based solely on central laboratory results. Physicians were surveyed after the completion of patient care. RESULTS The PCA results were available 31 minutes (mean) sooner than were the central laboratory results for Hct, 43 minutes faster for Na+, K+, and Cl-, and 44 minutes faster for BUN and glucose. Except for Hct and glucose, the values obtained from the PCA were not significantly different from the central clinical blood analyzer laboratory values. When surveyed, the physicians caring for the patients reported that had the PCA results been available, a different or an earlier therapeutic approach would have resulted in 9.5% of the cases. The decision to release or admit the patient was based on one or more of the laboratory values for 10.7% of patients sampled. In no case in this series did a physician report that final ED clinical outcome would have been affected. CONCLUSIONS In our ED, the PCA yielded faster reporting of laboratory values. These earlier results might have reduced the length of stay in the ED for 17.3% of patients studied. Selective use of a handheld portable analyzer might decrease time to therapeutic interventions and time to disposition.
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Affiliation(s)
- V M Sands
- Department of Surgery, Stanford University Medical Center, USA
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