Multi-center evaluation of analytical performance of the Beckman Coulter AU5822 chemistry analyzer.

OBJECTIVES: Our three academic institutions, Indiana University, Northwestern Memorial Hospital, and Wake Forest, were among the first in the United States to implement the Beckman Coulter AU5822 series chemistry analyzers. We undertook this post-hoc multi-center study by merging our data to determine performance characteristics and the impact of methodology changes on analyte measurement. DESIGN AND METHODS: We independently completed performance validation studies including precision, linearity/analytical measurement range, method comparison, and reference range verification. Complete data sets were available from at least one institution for 66 analytes with the following groups: 51 from all three institutions, and 15 from 1 or 2 institutions for a total sample size of 12,064. RESULTS: Precision was similar among institutions. Coefficients of variation (CV) were <10% for 97%. Analytes with CVs >10% included direct bilirubin and digoxin. All analytes exhibited linearity over the analytical measurement range. Method comparison data showed slopes between 0.900-1.100 for 87.9% of the analytes. Slopes for amylase, tobramycin and urine amylase were <0.8; the slope for lipase was >1.5, due to known methodology or standardization differences. Consequently, reference ranges of amylase, urine amylase and lipase required only minor or no modification. CONCLUSION: The four AU5822 analyzers independently evaluated at three sites showed consistent precision, linearity, and correlation results. Since installations, the test results had been well received by clinicians from all three institutions.

Assisting students at risk: using computer NCLEX-RN review software.

In response to a decline in the success rate on the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination, the authors developed a program to identify and assist students at risk for failure. The use of a computerized NCLEX-RN practice examination and an individualized student review and study process is described.

Physical therapists' perceptions of family involvement in the rehabilitation process.

The purpose of this qualitative study was to describe how physical therapists working in rehabilitation settings involved families in the patient's rehabilitation program and what factors facilitated or impeded this involvement. Forty physical therapists practicing in the eastern United States were individually interviewed on their involvement of families in a patient's rehabilitation. The interview data were transcribed, coded, and analyzed for main themes. Family involvement was found to be a significant aspect of a patient's rehabilitation. Factors pertaining to the family, the patient, the healthcare organization and the physical therapist were identified. Factors, such as the family's knowledge, attitudes and skills of the family, their relationship with the patient prior to the injury or disability, the availability and opportunity of family members to be involved, and their physical capabilities, all influenced the degree to which the family participated. Therapists also perceived the cognitive status of the patient as a factor which dictated the proper amount of family participation. The healthcare organization was an important factor which needed to encourage and support the family participation. With decreased lengths of stay there is less time for families to be independent in caring for their loved one. The organization of the department could be instrumental in this by providing multiple formal and informal avenues for family training, such as support groups, home visits, 'open door' policy visiting hours, and scheduling changes. Finally, the physical therapists might have been the single most significant factor in facilitating family involvement. It was important for them to establish open and honest communication and be pro-activists for their patients and their families. The findings were consistent with the existing literature base in relation to the patient and family. Additional findings present physical therapists and healthcare organizations with suggestions for improving family education.

Use of zinc protoporphyrin measured by the Protofluor-Z hematofluorometer in screening children for elevated blood lead levels.

OBJECTIVE: To determine the usefulness of zinc protoporphyrin, as measured by the Helena Protofluor-Z hematofluorometer, for detecting elevated lead levels. DESIGN: Observational, descriptive review of laboratory records from a university toxicology laboratory. SETTING: Inner-city university pediatric clinic and two affiliated community clinics in Chicago, Ill. PATIENTS: Seven hundred seventy-five children younger than 7 years with paired lead-zinc protoporphyrin results. MEASUREMENTS/RESULTS: Fifty-six percent had lead levels of at least 0.48 mumol/L and 8% had lead levels of at least 1.21 mumol/L. The sensitivity, positive predictive value, and negative predictive value of a zinc protoporphyrin level of 70 mumol/mol of hemoglobin for detecting a lead level of 0.48 mumol/L were 42%, 66%, and 50%, respectively, and for a lead level of 1.21 mumol/L were 74%, 18%, and 97%, respectively. Receiver operating characteristic curves demonstrated that for detecting lead levels of 0.48 mumol/L with zinc protoporphyrin, the probability of a true-positive result is close to that of a false-positive one. CONCLUSION: Zinc protoporphyrin is not a reliable screening test for detecting low blood lead levels.

Reliability and validity of the productivity environmental preference survey (PEPS).

This study was conducted to establish the reliability and validity of the Dunn, Dunn, and Price Productivity Environmental Preferences Survey (PEPS) with baccalaureate nursing students and to identify differences between subpopulations (age, class level, sex, type of student (RN versus generic] and students at risk. The findings have implications for nurse educators who choose teaching-learning experiences for a diverse student population.

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.