Development and clinical evaluation of a recombinant-antigen-based cytomegalovirus immunoglobulin M automated immunoassay using the Abbott AxSYM analyzer.

A new microparticle enzyme immunoassay (MEIA), the Cytomegalovirus (CMV) Immunoglobulin M (IgM) test, was developed on the Abbott AxSYM analyzer. This test uses recombinant CMV antigens derived from portions of four structural and nonstructural proteins of CMV: pUL32 (pp150), pUL44 (pp52), pUL83 (pp65), and pUL80a (pp38). A total of 1, 608 specimens from random volunteer blood donors (n = 300), pregnant women (n = 1,118), transplant recipients (n = 6), and patients with various clinical conditions and disease states (n = 184) were tested during development and evaluation of this new assay. In a preliminary clinical evaluation we tested specimens collected prospectively from pregnant women (n = 799) and selected CMV IgM-positive archived specimens from pregnant women (n = 39). The results from the new CMV IgM immunoassay were compared to the results of a consensus interpretation of the results obtained with three commercial CMV IgM immunoassays. The results for specimens with discordant results were resolved by a CMV IgM immunoblot assay. The relative sensitivity, specificity, and agreement for the AxSYM CMV IgM assay were 94.29, 96.28, and 96.19%, respectively, and the resolved sensitivity, specificity, and agreement were 95.83, 97.47, and 97.37%, respectively. We also tested serial specimens from women who experienced seroconversion or a recent CMV infection during gestation (n = 17) and potentially cross-reactive specimens negative for CMV IgM antibody by the consensus tests (n = 184). The AxSYM CMV IgM assay was very sensitive for the detection of CMV IgM during primary CMV infection, as shown by the detection of CMV IgM at the same time as or just prior to the detection of CMV IgG. Specimens from individuals with lupus (n = 16) or parvovirus B19 infection (n = 6) or specimens containing hyper IgM (n = 9), hyper IgG (n = 8), or rheumatoid factor (n = 55) did not cross-react with the AxSYM assay. One specimen each from individuals infected with Epstein-Barr virus (n = 26), measles virus (n = 10), herpes simplex virus (n = 12), or varicella-zoster virus (n = 13) infection, one specimen from an influenza vaccinee (n = 14), and one specimen containing antinuclear antibody cross-reacted with the assay. The overall rate of cross-reactivity of the specimens with the assay was 3.3% (6 of 184). The AxSYM CMV IgM assay is a sensitive and specific assay for the detection of CMV-specific IgM.

Realistically meeting the educational needs of hospitalized acute and short-stay patients.

Patient teaching in acute care hospital settings isn't much different from teaching in other settings. The main differences have to do with the amount of time available and the condition of the patients. Using good assessment practices, sticking to "need to know" survival content, simplifying instructions, streamlining programs, providing for practice, providing reference and resource materials, and referring patients for further education are the ingredients that will help get the job done efficiently and effectively.

Staff involvement in patient teaching: making it happen.

Motivating patient care staff to teach is a continuing concern of patient education managers particularly as hospitalized patient acuity levels increase and personnel are busier than over. This article covers strategies to promote staff involvement in patient teaching in four areas: (1) expectations, (2) knowledge base, (3) visibility and recognition, and (4) program planning involvement. Practical suggestions with examples are provided.

An evaluation of the effectiveness of cardiac teaching during hospitalization.

This evaluation demonstrated that inpatient teaching programs can be effective for short-term outcomes. In this evaluation, patients readily learned information that prepared them to deal with postoperative experiences, that is, ambulation, exercise, resumption of sexual activity, and symptoms to report indicating lack of tolerance to such activities. Areas that showed limited knowledge gain were those that required long-term behavioral change, such as stress modification and dietary changes. These findings are particularly relevant when considered in the light of contemporary events in the payment environment. As lengths of stay decrease and acuity levels increase for hospitalized patients, inpatient teaching must be limited to what is possible and reasonable; that is, what is possible for the staff to teach during the short length of stay and what is reasonable for patients to learn given their acuity. This evaluation was conducted for decision-making purposes about a specific cardiac teaching program. Although the evaluation met the purposes of the evaluators, some of the findings suggested possible research hypotheses. A tightly controlled research study should be conducted using the knowledge acquisition test in clinical settings and accounting for such variables as educational level, years of coronary artery disease, severity of illness, and age. Further study could also be undertaken to validate the finding that hospitalized patients learned priority information necessary for adequate functioning immediately after discharge. With regard to patient confidence level and actual behavior change, a study could be conducted to determine if there is a relationship between patients' reported confidence at discharge and their subsequent behavior.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of survey information to develop a hospital-based medication teaching program.

As the volume of prescribed medications and complexity of regimen continue to rise, medication instruction is imperative, particularly for patients with chronic illness who must care for themselves without direct supervision of health care professionals. However, as hospital acuity levels increase and lengths of stay decrease, limited opportunity exists to adequately prepare hospitalized patients who are to be discharged with new prescriptions. Hospital-based medication teaching programs must be designed so that they encourage patient-professional interaction, yet also conserve nursing staff time. In this project, members of a hospital-based, interdisciplinary committee used survey information to develop a basic medication instruction program that emphasized 'need to know' content. The program was designed to involve patients and also to encourage them to seek additional information from other providers. Potential for successful implementation was enhanced by participation of nurse managers who developed the pilot implementation procedure.

Relationship of participation preference and health locus of control in diabetes education.

The relationship between health locus of control type and preference for educational approach was examined in 89 diabetic adults, both hospitalized and ambulatory. In addition, subject personal and demographic variables were examined as they related to health locus of control type and preference for approach. No association was found between hypothesized health locus of control types and preferences for approach. A majority of all health locus of control types (64%) preferred a prescriptive approach. Hospitalized subjects and those who had not attended formal diabetes classes tended to believe that powerful other people had an impact on their health, while subjects who were ambulatory, and those who had previous formal instruction perceived themselves to be more responsible for their health; younger subjects also held high internal beliefs. Participatory approaches were preferred by younger subjects and those who had received formal diabetes instruction. The findings suggested that although educational approaches that maximize participation have been advocated, they did not appear to be the preferred approach. Although participatory approaches might actually be more efficacious in producing behavior change, the finding that people might not prefer them underscores the importance of tailoring educational methodology to individuals; age, place of instruction, and previous diabetes education are factors to be considered in tailoring programs.