Biomedical subjects

C P Collier

Publications and source records attributed to C P Collier.

5 recordsLinked to original sources

PubMed1998

A survey to identify potential outcome indicators for a hospital blood glucose monitoring program.

OBJECTIVE: A survey of operators of a bedside blood glucose monitoring (BGM) program at a tertiary health care institution was performed to identify potential outcome indicators for our quality assurance program. DESIGN AND METHODS: 170 surveys were randomly distributed to each nursing unit. The survey consisted of 20 questions on 4 pages. At the time of the survey, the BGM program consisted of 514 operators and 33 blood glucose meters on 17 inpatient nursing units servicing a total of 445 hospital beds. RESULTS: Seventy-eight percent of surveys were returned. Seventy-one percent of operators used the glucose meter at least once a week, 17% used it less than once a week, and 12% used it less than once a month. When asked how often they thought operators should perform BGM to ensure reliability, 65% stated "at least monthly," 8% said "bimonthly," and 27% said "3 to 4 times a year." In the previous 3 months, 59% of operators recalled "never having to repeat a BGM measurement with the glucose meter." 56% recalled "never having to confirm a BGM result by sending a venous sample to the central laboratory," 38% recalled "sending a venous sample once or twice;" 4% recalled "three or four times;" and 2% recalled "more than four times." Fifty-two percent recalled having to perform a stat analysis "less than once per month," 37% recalled "once or twice per month," and 11% recalled "once or twice per week." CONCLUSIONS: Through this survey we obtained information from our operators about the current functioning of our BGM program. Based on this information, we were able to develop a list of potential outcome indicators that we encourage health care institutions with BGM programs to consider incorporating in their quality assurance (QA) program.

Blood Glucose↗

PubMed1982

Analysis of methotrexate and 7-hydroxymethotrexate by high-performance liquid chromatography and preliminary clinical studies.

The simultaneous analysis of methotrexate (MTX) and its putatively nephrotoxic metabolite, 7-hydroxymethotrexate (7OH-MTX), by high-performance liquid chromatography (HPLC) and ultraviolet spectrophotometric detection is described. Serum extraction employs SEP-PAK C-18 cartridges. Recovery ranges from 78.3 to 84.9% for MTX and 67.6 to 76.1% for 7OH-MTX. Between-day precision studies of serum (controls), containing 2.76 microM MTX and 4.40 microM 7OH-MTX, yielded coefficients of variation of 8.6 and 8.9%, respectively. Reconstitution of the dried residue in 5 mM HCl increases the retention times of 7OH-MTX and MTX, thereby enhancing their separation from extraneous serum peaks. A comparison of MTX levels determined by HPLC and a competitive protein binding assay yielded consistently lower results by HPLC. However, in comparing HPLC to EMIT, two relationships were observed: below 100 microM MTX the methods were in agreement, whereas above 100 microM MTX HPLC again provided lower values. Preliminary pharmacokinetic studies on two patients with osteogenic sarcoma are reported. After receiving 218.2 mg/kg and 148.5 mg/kg MTX in a 6-h infusion, their beta half-lives for MTX were 2.6 and 2.0 h, while their gamma half-lives were 26.2 and 42.9 h, respectively. The 7OH-MTX beta half-lives were 5.8 and 4.0 h, and the gamma half-lives were 10.2 and 15.8 h. Plasma concentration ratios of 7OH-MTX to MTX were 28.5 and 18.1 at 24 h after MTX infusion. 7OH-MTX was detected in the 15-min sample after the beginning of the MTX infusion.

Binding, Competitive↗

PubMedDate not supplied

Cardiac troponin I in patients receiving renal replacement therapy.

Current markers of myocardial injury lack specificity in patients with end-stage renal disease (ESRD). In particular, a false positive creatine kinase-MB (CKMB) elevation occurs in 5-10% of patients with ESRD. The aim of this study was to ascertain the relationship between CKMB and cardiac troponin I (cTnI), a new, highly sensitive and specific marker for myocardial injury, in the authors' dialysis population and compare their specificities. Blood samples were obtained from 112 dialysis patients (35 in peritoneal dialysis; 77 in hemodialysis). Patients were asymptomatic for cardiac ischemia and skeletal muscle injury. Mean +/- SD CKMB mass was 3.16 +/- 2.26 microg/L (range, 0.34-13.62), and cTnI was 0.025 +/- 0.061 ng/ml (range, 0.001-0.496). CKMB and cTnI levels did not correlate (r2 = 0.002; p = 0.61). CKMB mass concentration was significantly higher in men and in diabetics. No patient had a cTnI level greater than 1.5 microg/L, and eight asymptomatic patients had a CKMB mass greater than 6.7 microg/L. These data suggest a specificity of 100% for cTnI vs 94.6% for CKMB at these cutoff values. It is suggested that cTnI replace CKMB as a marker of myocardial injury in patients with ESRD.

Creatine Kinase↗

PubMedDate not supplied

Pemoline pharmacokinetics and long term therapy in children with attention deficit disorder and hyperactivity.

The pharmacokinetic behaviour of pemoline was studied in 28 children, aged 5 to 12 years, diagnosed as having the attention deficit disorder with hyperactivity. The mean elimination half-life of pemoline in these children was approximately 7 hours, which is considerably shorter than the half-life of 11 to 13 hours previously reported in adults. The tendency of the half-life to increase with age may be explained by the statistically significant decrease in total body clearance with age. The increasing half-life of pemoline with age should be considered during long term drug therapy. In this study no tolerance to the beneficial effects of pemoline was observed over 6 months. The apparent therapeutic serum concentration range for these children was attained after doses of 37.5 to 131.25 mg pemoline daily. Since the optimum serum concentration shows wide variation, the dosing regimen must be determined individually. Routine monitoring of the pemoline serum concentrations is not useful because of this apparent variation in optimum serum concentration and because of the linear relationship between dose and concentration.

Aging↗

PubMedDate not supplied

How to develop an effective decentralized laboratory testing program.

In this article, we offer practical guidelines for developing an effective decentralized laboratory testing (DLT) program. Based on more than 10 years of experience with a DLT program for bedside blood glucose monitoring, we have identified eight essential steps in this process, including: developing an effective multidisciplinary DLT committee that oversees the various DLT programs; performing a needs analysis and a cost analysis as part of the application for approval of a program from the DLT committee; instrument selection and method evaluation; and, finally, implementing a DLT program including initiating a quality assurance program. A collaborative effort by everyone from the beginning is an important key to success.

Canada↗