Edmunds Reineks | Cleveland State University (original) (raw)

Papers by Edmunds Reineks

Journal of Emergency Nursing, 2021

INTRODUCTION The aim of the study was to identify emergency nurses' knowledge, attitudes, and... more INTRODUCTION The aim of the study was to identify emergency nurses' knowledge, attitudes, and practices related to blood sample hemolysis prevention and explore associations between these factors and demographic characteristics. The current state is unknown. Understanding baseline knowledge, attitudes, and practices addresses a gap in the literature. METHOD An exploratory, descriptive design with cross-sectional survey methodology employing a study-specific instrument was used. RESULTS Request for participation email was sent to a random sample of 5000 Emergency Nurses Association members, and 427 usable surveys were returned (response rate = 8.5%). Mean years in nursing was 13.85 (standard deviation = 10.78), and 226 (52.9%) were certified emergency nurses. Only 85 participants (19.9%) answered all 3 knowledge questions correctly. Answering the 3 knowledge questions correctly was significantly associated with being a certified emergency nurse (χ2 = 7.15, P = .01). Participant responses to attitude items about the sequelae of blood sample hemolysis were skewed toward agreement, and most attitude items were associated with whom participants reported as being primarily responsible for phlebotomy. Emergency nurses remain primarily responsible for phlebotomy as well as addressing hemolyzed samples, but few reported that blood sample hemolysis was addressed at a departmental level. DISCUSSION Findings suggest that emergency nurses lack some knowledge related to blood sample hemolysis prevention best practices. Attitudes toward phlebotomy practices may be 1 reason practice has not changed. Every effort should be made to prevent hemolyzed blood samples to decrease delays and costs in emergency care.

American Journal of Clinical Pathology, 2018

AACE Clinical Case Reports, 2018

Objective: To describe a case of pseudohyponatremia in the setting of hypercholesterolemia. Metho... more Objective: To describe a case of pseudohyponatremia in the setting of hypercholesterolemia. Methods: A 69-year-old man was admitted to the hospital after asymptomatic hyponatremia was detected on follow-up blood work for acute, drug-induced cholestatic hepatitis. Results: Plasma sodium (P Na) was 119 mmol/L and total protein was 4.7 g/dL. Plasma osmolality was 283 mOsm/kg, urine osmolality was 332 mOsm/kg, and random urine sodium was 45 mmol/L. Pseudohyponatremia was suspected and lipid profiling showed triglycerides were 281 mg/dL, cholesterol was 1,340 mg/dL, high-density lipoprotein was 21 mg/dL, and low-density lipoprotein was 1,419 mg/dL. Direct ion-selective electrode (ISE) using a blood gas analyzer revealed a P Na level of 132 mmol/L. P Na concentration can be measured using direct or indirect ISE. With indirect ISE, the sample is diluted before analysis and the P Na is measured with the assumption that plasma is composed of 93% water. When hyperlipidemia is present, the actual plasma water fraction is decreased, and therefore using indirect ISE will result in falsely low P Na levels. Direct ISE analyzes the sample without dilution. Thus, the P Na is measured directly irrespective of plasma water fraction and so is not affected by changes in plasma percentage concentration. Conclusion: Around two thirds of laboratories in the United States use indirect ISE. Awareness of pseudohyponatremia is important to prevent inappropriate management. (AACE Clinical Case Rep. 2019;5:e172-e174) Abbreviations: ISE = ion-selective electrode; P Na = plasma sodium; SIADH = syndrome of inappropriate antidiuretic hormone secretion

Annals of Emergency Medicine, 2015

American Journal of Clinical Pathology, 2017

Objectives: Hemolyzed blood samples commonly occur in hospital emergency departments (EDs). Our o... more Objectives: Hemolyzed blood samples commonly occur in hospital emergency departments (EDs). Our objective was to determine whether replacing standard large-volume/ high-vacuum sample tubes with low-volume/low-vacuum tubes would significantly affect ED hemolysis. Methods: This was a prospective intervention of the use of small-volume/vacuum collection tubes. We evaluated all potassium samples in ED patients and associated hemolysis. We used χ 2 tests to compare hemolysis incidence prior to and following utilization of small tubes for chemistry collection. Results: There were 35,481 blood samples collected during the study period. Following implementation of small-volume tubes, overall hemolysis decreased from a baseline of 11.8% to 2.9% (P < .001) with corresponding reductions in hemolysis with comment (8.95% vs 1.99%; P < .001) gross hemolysis (2.84% vs 0.90%; P < .007). Conclusions: This work demonstrates that significant improvements in ED hemolysis can be achieved by utilization of small-volume/vacuum sample collection tubes.

Clinical Biochemistry, 2017

An assessment of blood ammonia concentration is common medical practice in the evaluation of an i... more An assessment of blood ammonia concentration is common medical practice in the evaluation of an individual with an unexplained mental status change or coma. The determination of a blood ammonia level is most commonly done using a glutamate dehydrogenase (GLDH)-based assay, although there are many potential sources of artifact and the literature is inconsistent regarding key preanalytic issues. Using a GLDH-based assay, we first investigated matrix effects using three anticoagulants: heparin, EDTA and oxalate. Heparin-anticoagulated plasma was substantially less precise than EDTA-and oxalateanticoagulated plasma. Oxalate-anticoagulated plasma showed a greater baseline of apparent ammonia than either heparin-or EDTA-derived plasma, presumably due to interferants. We then evaluated the stability of EDTA-anticoagulated plasma for assessment of ammonia when stored at 4°C,-14°C or-70°C. There was a linear increase of ammonia with storage at both 4°C and-14°C. Plasma kept at-70°C for up to three weeks showed no change in measured ammonia relative to the baseline determination. This work clarifies preanalytic conditions for which a precise determination of ammonia can be accomplished using a GLDH-based assay.

Western Journal of Emergency Medicine, 2016

Introduction: Our goal was to determine if the hemolysis among blood samples obtained in an emerg... more Introduction: Our goal was to determine if the hemolysis among blood samples obtained in an emergency department and then sent to the laboratory in a pneumatic tube system was different from those in samples that were hand-carried. Methods: The hemolysis index is measured on all samples submitted for potassium analysis. We queried our hospital laboratory database system (SunQuest ®) for potassium results for specimens obtained between January 2014 and July 2014. From facility maintenance records, we identified periods of system downtime, during which specimens were hand-carried to the laboratory. Results: During the study period, 15,851 blood specimens were transported via our pneumatic tube system and 92 samples were hand delivered. The proportions of hemolyzed specimens in the two groups were not significantly different (13.6% vs. 13.1% [p=0.90]). Results were consistent when the criterion was limited to gross (3.3% vs 3.3% [p=0.99]) or mild (10.3% vs 9.8% [p=0.88]) hemolysis. The hemolysis rate showed minimal variation during the study period (12.6%-14.6%). Conclusion: We found no statistical difference in the percentages of hemolyzed specimens transported by a pneumatic tube system or hand delivered to the laboratory. Certain features of pneumatic tube systems might contribute to hemolysis (e.g., speed, distance, packing material). Since each system is unique in design, we encourage medical facilities to consider whether their method of transport might contribute to hemolysis in samples obtained in the emergency department. [

American Journal of Clinical Pathology, 2015

Hemolysis is a common specimen abnormality that can interfere with many laboratory tests and lead... more Hemolysis is a common specimen abnormality that can interfere with many laboratory tests and lead to erroneous results and interpretations and to inappropriate medical decisions. Determination of the hemolysis index (HI), a dimensionless measure, is one method to assess for this interference. Our goals in this study were to: 1) validate our HI measurements as we transition to new core laboratory automated chemistry instruments (previous, Roche Modular [Roche Diagnostics, Indianapolis, IN]; new, Roche Cobas 8000); 2) determine the impact of matrix differences on HI in serum vs plasma and 3) quantify the HI in plasma relative to free hemoglobin concentration, allowing standardization and comparison of HI in common units. Studies were performed to determine the linearity, precision, and comparability of HI on the cobas 8000 system. Matrix differences were assessed by mixing studies. Samples with a range of HI values were also analyzed for free hemoglobin concentration by an external reference laboratory. Performance characteristics of the HI on the cobas 8000 were as follows: %CV = 5% (mean = 19), %CV = 1.1% (mean = 295); linear in plasma for values from 8 to 420; comparison with the Modular P800: R 2 = .99, slope = 1.0. Mixing studies showed recovery between 93%-102%. The plasma hemoglobin concentration shows a consistent, linear relationship with the HI over a range of HI that is typically encountered in our laboratory. This relationship was comparable across the various Roche analyzers, including the cobas 8000, used in our study. The linear fit provides for converting a unitless measure into a standardized quantity; one HI unit corresponds to 1.25 mg/dL. Hemolysis index determinations are comparable in previous and newer generations of Roche chemistry platforms. Our existing interference HI cutoffs can be maintained on the cobas 8000, and can be used for both serum and plasma samples.

Clinical biochemistry, Jan 21, 2016

Symmetric dimethylarginine (SDMA) is a catabolic product of arginine-methylated proteins and is a... more Symmetric dimethylarginine (SDMA) is a catabolic product of arginine-methylated proteins and is an emerging biomarker for kidney function. A limited number of studies in selected populations have shown good correlation between SDMA and a few known markers of glomerular filtration rate (GFR). However, a comprehensive comparison of SDMA with all existing serum endogenous markers in a population with varied kidney function and against measured GFR is lacking. The objective of this study was to compare the correlations of SDMA, creatinine, cystatin C and their eGFR equations against GFR measured by iothalamate clearance in an adult population with varied kidney function. Left-over serum and plasma specimens were collected from 40 adults with normal and reduced kidney function. GFR was measured using a radioactive iothalamate procedure. Creatinine and cystatin C were measured on Roche Cobas 8000. SDMA was measured by a published liquid chromatography-tandem mass spectrometry method. SDMA...

Advanced Techniques in Diagnostic Microbiology, 2012

Journal of separation science, 2014

Vitamins A and E are fat-soluble vitamins that play important roles in several physiological proc... more Vitamins A and E are fat-soluble vitamins that play important roles in several physiological processes. Monitoring their concentrations is needed to detect deficiency and guide therapy. In this study, we developed a high-performance liquid chromatography method to measure the major forms of vitamin A (retinol) and vitamin E (α-tocopherol and γ-tocopherol) in human blood plasma. Vitamins A and E were extracted with hexane and separated on a reversed-phase column using methanol as the mobile phase. Retinol was detected by ultraviolet absorption, whereas tocopherols were detected by fluorescence emission. The chromatographic cycle time was 4.0 min per sample. The analytical measurement range was 0.03-5.14, 0.32-36.02, and 0.10-9.99 mg/L for retinol, α-tocopherol, and γ-tocopherol, respectively. Intr-aassay and total coefficient of variation were <6.0% for all compounds. This method was traceable to standard reference materials offered by the National Institute of Standards and Techn...

The Annals of Thoracic Surgery, 2015

Background. Health care providers are seldom aware of the frequency and volume of phlebotomy for ... more Background. Health care providers are seldom aware of the frequency and volume of phlebotomy for laboratory testing, bloodletting that often leads to hospital-acquired anemia. Our objectives were to examine the frequency of laboratory testing in patients undergoing cardiac surgery, calculate cumulative phlebotomy volume from time of initial surgical consultation to hospital discharge, and propose strategies to reduce phlebotomy volume. Methods. From January 1, 2012 to June 30, 2012, 1,894 patients underwent cardiac surgery at Cleveland Clinic; 1,867 had 1 hospitalization and 27 had 2. Each laboratory test was associated with a test name and blood volume. Phlebotomy volume was estimated separately for the intensive care unit (ICU), hospital floors, and cumulatively. Results. A total of 221,498 laboratory tests were performed, averaging 115 tests per patient. The most frequently performed tests were 88,068 blood gas analyses, 39,535 coagulation tests, 30,421 complete blood counts, and 29,374 metabolic panels. Phlebotomy volume

Diagnostic Enzymology, 2014

Therapeutic Drug Monitoring, 2011

Background: Although levetiracetam is recognized for ease of dosing and being well tolerated, the... more Background: Although levetiracetam is recognized for ease of dosing and being well tolerated, therapeutic drug monitoring is potentially useful in certain clinical situations. High-performance liquid chromatography has been commonly used for measuring levetiracetam. Recently, a homogeneous immunoassay for levetiracetam measurement in serum and plasma was introduced by ARK Diagnostics, Inc. The goal of this work was to validate this assay on a random access instrument. Design and Methods: This immunoassay was established on the Siemens ADVIA 1200 automated chemistry analyzer. The intraday precision was assessed by 10 replicates of two levels of quality control materials in a batch, whereas interday precision was estimated by assaying the same materials one set per day for 20 days. Linearity was evaluated by serially diluting the highest calibrator and a high patient specimen run in triplicate, whereas the lower limit of quantification was confirmed by 10 measurements of a low-level specimen diluted from a calibrator and another from a diluted patient specimen. This method was compared with a commercial high-performance liquid chromatography method (Chromsystems) using 63 specimens from patients who were on levetiracetam therapy. Results: The assay cycle was 10 minutes with a theoretical throughput of 800 per hour. The intra-(n = 10) and interday (n = 20) coefficients of variation were 8.1% or less for the two levels tested. The manufacturer-claimed analytical measurable range (2.0-100.0 mg/mL) was confirmed by serial dilution and lower limit of quantification experiments. Among the 63 patient samples studies, four showed levetiracetam levels below 2.0 mg/mL by both methods. Deming regression using the remaining 59 paired patient results by ARK immunoassay and the high-performance liquid chromatography method showed a correlation coefficient of 0.9962, a linear regression slope of 0.98, and an intercept of 0.61 with a mean bias of 0.04%. Conclusion: The ARK immunoassay is suitable for clinical use of monitoring levetiracetam levels in serum/plasma on an automated chemistry analyzer (Siemens ADVIA 1200).

The Journal of Urology, 2008

Journal of Biological Chemistry, 2002

Bcl-2 family members have been shown to be key mediators of apoptosis as either pro-or anti-apopt... more Bcl-2 family members have been shown to be key mediators of apoptosis as either pro-or anti-apoptotic factors. It is thought that both classes of Bcl-2 family members act at the level of the mitochondria to regulate apoptosis, although the founding anti-apoptotic family member, Bcl-2 is localized to the endoplasmic reticulum (ER), mitochondrial, and nuclear membranes. In order to better understand the effect of Bcl-2 localization on its activity, we have utilized a Bcl-2 mutant that localizes only to the ER membrane, designated Bcl-2Cb5. Bcl-2Cb5 was expressed in MDA-MB-468 cells, which protected against apoptosis induced by the kinase inhibitor, staurosporine. Data presented here show that Bcl-2Cb5 inhibits this process by blocking Bax activation and cytochrome c release. Furthermore, we show that Bcl-2Cb5 can inhibit the activation of a constitutively mitochondrial mutant of Bax, indicating that an intermediate between Bcl-2 on the ER and Bax on the mitochondria must exist. We demonstrate that this intermediate is likely a BH3-only subfamily member. Data presented here show that Bcl-2Cb5 can sequester a constitutively active form of Bad (Bad3A) from the mitochondria and prevent it from activating Bax. These data suggest that Bcl-2 indirectly protects mitochondrial membranes from Bax, via BH3-only proteins.