Ronald B Schifman

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• Schifman, R. B., & Luevano, D. R. (2019). Value and Use of Urinalysis for Myoglobinuria. Archives of pathology & laboratory medicine, 143(11), 1378-1381.
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  Urine myoglobin testing is primarily indicated for diagnosis and risk assessment of kidney injury in patients with rhabdomyolysis. However, its utility is limited by a lack of rapid and reliable results. Myoglobin reacts positively for blood by urine dipstick, which can serve as an indicator of myoglobinuria.
• Schifman, R. B., & Luevano, D. R. (2018). Aluminum Toxicity: Evaluation of 16-Year Trend Among 14 919 Patients and 45 480 Results. Archives of pathology & laboratory medicine, 142(6), 742-746.
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  - Annual monitoring with serum aluminum measurements is recommended for dialysis patients who are susceptible to toxic accumulation from contaminated dialysis fluid or from ingestion of aluminum-containing medications.
• Schifman, R. B., Perrotta, P. L., Souers, R., & Blond, B. J. (2018). A Q-Probes Study Involving Utilization of Free Prostate-Specific Antigen, Factor V Leiden, and Hepatitis A Serology Tests. Archives of pathology & laboratory medicine.
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  Managing the utilization of laboratory tests is an important quality improvement activity that adds value to health care.
• Schifman, R. B., Talbert, M., & Souers, R. J. (2017). Delta Check Practices and Outcomes: A Q-Probes Study Involving 49 Health Care Facilities and 6541 Delta Check Alerts. Archives of pathology & laboratory medicine, 141(6), 813-823.
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  - Delta checks serve as a patient-based quality control tool to detect testing problems.
• Volmar, K. E., McCall, S. J., Schifman, R. B., Talbert, M. L., Tworek, J. A., Hulkower, K. I., Guidi, A. J., Nakhleh, R. E., Souers, R. J., Bashleben, C. P., & Blond, B. J. (2017). Professional Practice Evaluation for Pathologists: The Development, Life, and Death of the Evalumetrics Program. Archives of pathology & laboratory medicine, 141(4), 551-558.
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  - In 2008, the Joint Commission (JC) implemented a standard mandating formal monitoring of physician professional performance as part of the process of granting and maintaining practice privileges.
• Schifman, R. B., Howanitz, P. J., & Souers, R. J. (2016). Point-of-Care Glucose Critical Values: A Q-Probes Study Involving 50 Health Care Facilities and 2349 Critical Results. Archives of pathology & laboratory medicine, 140(2), 119-24.
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  Accuracy of blood glucose measurements in the critical value range is important for properly treating patients with severe hypoglycemia and hyperglycemia.
• Schifman, R. B., Rivers, S. L., & Delduca, M. (2016). Predonation hematocrit measurement by whole blood electrical conductivity assay. Transfusion, 25(3), 251-3.
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  The whole blood electrical conductivity method for predonation hematocrit determinations was studied. Forty capillary and venous blood samples were tested concurrently with electrical conductivity and centrifugation methods. The electrical conductivity method demonstrated acceptable accuracy but was less precise than the spun microhematocrit technique. Results from capillary samples were uniformly less precise and significantly lower than determinations from venous specimens. This study and previous reports suggest that capillary hematocrit values by any method may not accurately reflect the blood donor's venous hematocrit level. Blood centers should independently validate their anemia screening methods to avoid unnecessary deferrals and protect the anemic donor.
• Meier, F. A., Souers, R. J., Howanitz, P. J., Tworek, J. A., Perrotta, P. L., Nakhleh, R. E., Karcher, D. S., Bashleben, C., Darcy, T. P., Schifman, R. B., & Jones, B. A. (2015). Seven Q-Tracks monitors of laboratory quality drive general performance improvement: experience from the College of American Pathologists Q-Tracks program 1999-2011. Archives of pathology & laboratory medicine, 139(6), 762-75.
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  Many production systems employ standardized statistical monitors that measure defect rates and cycle times, as indices of performance quality. Clinical laboratory testing, a system that produces test results, is amenable to such monitoring.
• Schifman, R. B., Meier, F. A., & Souers, R. J. (2015). Timeliness and accuracy of reporting preliminary blood culture results: a College of American Pathologists Q-probes study of 65 institutions. Archives of pathology & laboratory medicine, 139(5), 621-6.
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  The speed and accuracy of preliminary blood culture reports impacts patient management and outcomes.
• Schifman, R. B., Nguyen, T. T., & Page, S. T. (2014). Reliability of point-of-care capillary blood glucose measurements in the critical value range. Archives of pathology & laboratory medicine, 138(7), 962-6.
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  Point-of-care glucose (POCG) testing on capillary blood specimens is central to maintaining glycemic control in patients with diabetes. Although there are known performance issues with POCG methods, especially for maintaining tight glucose control, there is little information about the accuracy of results in the critical ranges that may involve life-threatening conditions.
• Wolk, D. M., Marx, J. L., Dominguez, L., Driscoll, D., & Schifman, R. B. (2009). Comparison of MRSASelect Agar, CHROMagar Methicillin-Resistant Staphylococcus aureus (MRSA) Medium, and Xpert MRSA PCR for detection of MRSA in Nares: diagnostic accuracy for surveillance samples with various bacterial densities. Journal of clinical microbiology, 47(12), 3933-6.
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  Rapid laboratory methods provide optimal support for active surveillance efforts to screen for methicillin-resistant Staphylococcus aureus (MRSA). Most laboratories struggle to determine the optimal use of resources, considering options to balance cost, speed, and diagnostic accuracy. To assess the performance of common methods, the first comparison of MRSASelect agar (MS) and CHROMagar MRSA (CA), with and without broth enrichment followed by a 24-h subculture to MS, was performed. Results were compared to those of the Xpert MRSA assay. For direct culture methods, the agreement between MS and CA was 98.8%. At 18 h, direct MS identified 93% of all positive samples from direct culture and 84% of those identified by the Xpert MRSA. For Trypticase soy broth-enriched MS culture, incubated overnight and then subcultured for an additional 24 h, the agreement with Xpert MRSA was 96%. The agreement between direct MS and Xpert MRSA was 100% when semiquantitative culture revealed a bacterial density of 2+ or greater; however, discrepancies between culture and Xpert MRSA arose for MRSA bacterial densities of 1+ or less, indicating low density as a common cause of false-negative culture results. Since 1+ or less was established as the most common MRSA carrier state, broth enrichment or PCR may be critical for the identification of all MRSA carriers who may be reservoirs for transmission. In this active-surveillance convenience sample, the use of broth enrichment followed by subculture to MS offered a low-cost but sensitive method for MRSA screening, with performance similar to that of Xpert MRSA PCR.
• Zarbo, R. J., Jones, B. A., Friedberg, R. C., Valenstein, P. N., Renner, S. W., Schifman, R. B., Walsh, M. K., & Howanitz, P. J. (2002). Q-tracks: a College of American Pathologists program of continuous laboratory monitoring and longitudinal tracking. Archives of pathology & laboratory medicine, 126(9), 1036-44.
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  Continuous monitoring of key laboratory indicators of quality by hundreds of laboratories in a standardized measurement program affords an opportunity to document the influence of longitudinal tracking on performance improvement by participants focused on that outcome.
• Novis, D. A., Dale, J. C., Schifman, R. B., Ruby, S. G., & Walsh, M. K. (2001). Solitary blood cultures: a College of American Pathologists Q-probes study of 132,778 blood culture sets in 333 small hospitals. Archives of pathology & laboratory medicine, 125(10), 1290-4.
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  To determine the frequency with which solitary blood culture samples were submitted to laboratories serving small hospitals and to ascertain whether certain hospital practices relating to the performance of blood cultures were associated with lower solitary blood culture rates (SBCRs).
• McLaughlin, W. J., Schifman, R. B., Ryan, K. J., Manriquez, G. M., Bhattacharyya, A. K., Dunn, B. E., & Weinstein, R. S. (1998). Telemicrobiology: feasibility study. Telemedicine journal : the official journal of the American Telemedicine Association, 4(1), 11-7.
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  Rural hospitals generally lack staffing with infectious disease specialists or pathologists. Without on-site pathologists, the range of microbiology services offered by clinical laboratories may be limited as well.
• Schifman, R. B. (1998). Phlebotomists at risk. Mayo Clinic proceedings, 73(7), 703-4.
• Schifman, R. B., Strand, C. L., Meier, F. A., & Howanitz, P. J. (1998). Blood culture contamination: a College of American Pathologists Q-Probes study involving 640 institutions and 497134 specimens from adult patients. Archives of pathology & laboratory medicine, 122(3), 216-21.
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  To examine clinical and laboratory practices associated with contamination of blood culture specimens from adults.
• Schifman, R. B., Pindur, A., & Bryan, J. A. (1997). Laboratory practices for reporting bacterial susceptibility tests that affect antibiotic therapy. Archives of pathology & laboratory medicine, 121(11), 1168-70.
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  To evaluate a laboratory-based process for integrating antimicrobial susceptibility, pharmacy, and clinical data with rapid physician notification to improve the care and outcome of patients with bacterial infections.
• Schifman, R. B., Bachner, P., & Howanitz, P. J. (1996). Blood culture quality improvement: a College of American Pathologists Q-Probes study involving 909 institutions and 289 572 blood culture sets. Archives of pathology & laboratory medicine, 120(11), 999-1002.
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  To evaluate solitary blood culture (SBC) collections as a preanalytic quality indicator of blood culture practice.
• Valenstein, P., & Schifman, R. B. (1996). Duplicate laboratory orders: a College of American Pathologists Q-Probes study of thyrotropin requests in 502 institutions. Archives of pathology & laboratory medicine, 120(10), 917-21.
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  To examine the frequency and cause of duplicate thyrotropin (TSH) testing.
• Zarbo, R. J., Schmidt, W. A., Bachner, P., Howanitz, P. J., Meier, F. A., Schifman, R. B., Boone, D. J., & Herron, R. M. (1996). Indications and immediate patient outcomes of pathology intraoperative consultations. College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group Study. Archives of pathology & laboratory medicine, 120(1), 19-25.
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  To evaluate the reasons (indications) for and immediate intraoperative surgical results (outcomes) associated with pathology intraoperative consultation.
• Boone, D. J., Steindel, S. D., Herron, R., Howanitz, P. J., Bachner, P., Meier, F., Schifman, R. B., & Zarbo, R. B. (1995). Transfusion medicine monitoring practices. A study of the College of American Pathologists/Centers for Disease Control and Prevention Outcomes Working Group. Archives of pathology & laboratory medicine, 119(11), 999-1006.
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  To survey transfusion medicine practices in 1990, to determine the distribution of defects in the transfusion process, to examine the relationship between defects and complications, and to recommend improvements in the transfusion process.
• Schifman, R. B. (1995). Strategies for quality management in clinical microbiology. Clinics in laboratory medicine, 15(2), 437-46.
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  Quality assessment and performance improvement are important management functions that add value to information and services produced by the clinical microbiology laboratory. Analytical quality control procedures are well standardized, and in many cases regulated. Whereas preanalytical and postanalytical factors have considerable impact on quality, performance assessment and improvement in this area have received less consideration. This article describes an approach to quality management of the total testing process in clinical microbiology, including interdisciplinary participation, specimen quality, test use, result use, turnaround time, information quality, user perceptions, and benchmarking.
• Howanitz, P. J., & Schifman, R. B. (1994). Inpatient phlebotomy practices. A College of American Pathologists Q-Probes quality improvement study of 2,351,643 phlebotomy requests. Archives of pathology & laboratory medicine, 118(6), 601-5.
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  We report outcomes of requests for inpatient phlebotomy procedures from 683 institutions participating in the College of American Pathologists Q-Probes programs. Of the 2,351,643 phlebotomy requests analyzed, 93.2% of venipunctures were successful, 1.6% were unsuccessful, 0.4% were partially successful, and 4.9% were not attempted by the assigned phlebotomist. Administrative inefficiencies prevented the assigned phlebotomist from attempting these venipunctures of which the most frequent reasons were patient unavailability (1.4%), patient transferred or discharged (0.9%), followed by the specimen already collected by someone else (0.7%). These results suggest that performance improvement of phlebotomy services, in general, would achieve the greatest gains by focusing attention to specific processes associated with administrative inefficiencies identified, rather than phlebotomists' technical skills.
• Howanitz, P. J., & Schifman, R. B. (1994). Phlebotomists' safety practices. A College of American Pathologists Q-Probes study of 683 institutions. Archives of pathology & laboratory medicine, 118(10), 957-62.
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  We report on phlebotomists' safety practices in 683 institutions participating in the College of American Pathologists Q-Probes program. Participants inspected 38,357 phlebotomy tourniquets and 31,952 blood collection tube holders in use and found 2098 tourniquets and 2966 holders visibly contaminated with blood. In 67.8% of the institutions, at least one tourniquet or collection tube holder was contaminated. Needlestick injuries reported by phlebotomists during 1990 through 1992 were analyzed from approximately 11 million inpatient venipuncture procedures. These injuries ranged between 9.2 and 9.8 needlesticks per 100,000 venipunctures per year. Over 99% of the participants had a policy preventing recapping of needles, 45% discarded tourniquets when contaminated with blood, and 3.3% routinely assigned tourniquets to specific patients. Between 1990 and 1992, increasing frequencies of phlebotomists using gloves, replacing gloves between each inpatient phlebotomy, and handwashing after degloving were found. We cite the lack of compliance of handwashing between glove changes as suggesting need for regulatory rereview.
• Schifman, R. B., & Howanitz, P. J. (1994). Nosocomial infections. A college of American pathologists Q-probes study in 512 North American institutions. Archives of pathology & laboratory medicine, 118(2), 115-9.
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  We report nosocomial infection surveillance methods and hospital infection rates in 512 institutions obtained from a Q-Probes study of the College of American Pathologists, Northfield, Ill. The results showed that nosocomial infection surveillance procedures were well standardized. Use of microbiology reports was the most common case-finding method (97.3%), followed by review of the patient's medical record (86.1%). The median number of full-time equivalents per 100 occupied beds utilized for infection control services was 0.64, and these full-time equivalents spent 40% of their time on surveillance activities. A computer was used in 81% of institutions to assist in conducting surveillance, although this usage was not associated with decreased surveillance time or personnel required. This study provided data on total and site-specific infection rates for a wide range of small to large hospitals. When stratified into subgroups (based on teaching status and hospital size), infections rates in this study were comparable with those of the National Nosocomial Infection Surveillance program, and showed a trend of increasing rates of nosocomial bloodstream and surgical wound infections.
• Schifman, R. B., & Pindur, A. (1993). The effect of skin disinfection materials on reducing blood culture contamination. American journal of clinical pathology, 99(5), 536-8.
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  Contaminated blood cultures may cause results to be misinterpreted, create unnecessary work for the laboratory, and increase costs. Disinfection of the venipuncture site is considered to be necessary for preventing contamination, although there is little information about the effectiveness of using different disinfection materials. The use of 70% isopropyl pads and povidone iodine saturated swabs (conventional method) was compared with the use of a 70% isopropyl/10% acetone scrub and povidone iodine dispenser (PREP method) for skin disinfection. Blood culture "kits" were prepared--bags containing collection tubes, instructions, and either conventional or PREP materials and were distributed randomly. The contents were concealed by a cover to prevent the user from selecting a specific type of decontamination kit. The kits were identified in the laboratory by color-coded labels on the collection tubes. Among 1,546 specimens evaluated, the contamination rate observed with conventional disinfection was significantly higher (4.6%; N = 763) than with PREP materials (2.2%; N = 783, P = 0.011) and was equivalent to the preceding 6-month contamination rate (4.7%). The lower contamination rate may be associated with greater effectiveness of a scrub or isopropyl/acetone solution, or both. Decontamination materials may have a significant impact on reducing blood culture contaminants from skin flora.
• Schifman, R. B., Rivers, S. L., Sampliner, R. E., & Krammes, J. E. (1993). Significance of isolated hepatitis B core antibody in blood donors. Archives of internal medicine, 153(19), 2261-6.
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  About 25% of blood donors who test positive for antibody to hepatitis B core antigen (anti-HBc) have no other positive hepatitis B serologic results. Because of the potential importance and diagnostic uncertainty of this test result, we studied its significance by assessing the serologic response to hepatitis B vaccine in donors with an isolated anti-HBc pattern.
• Verdi, C. J., Ahmann, F. R., Schifman, R. B., Elvick, A. L., Ahmann, M. E., & Marx, P. C. (1993). Comparative evaluation of serum CA 195 and carcinoembryonic antigen in metastatic carcinoma. Cancer, 71(11), 3625-32.
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  Carcinoembryonic antigen (CEA) is a well-described human tumor-associated antigen most useful clinically in colon cancer. However, the clinical usefulness of CEA is limited by the marker's overall poor specificity and low sensitivity in patients with minimal disease. CA 195 is a recently discovered human tumor-associated glycoprotein that can be measured in serum using an immunoradiometric assay. CA 195 is expressed on the membrane of human colon cancer cells and shares an epitope with the Lewis A blood group antigens. The authors initiated a study to compare the clinical utility of serum CA 195 with CEA in patients with advanced cancer. A control population was studied to assess the effects of age, gender, alcohol, and tobacco on the measured levels of serum CA 195.
• Howanitz, P. J., Hoffman, G. G., Schifman, R. B., Zarbo, R. J., Steindel, S. J., & Walker, K. (1992). A nationwide quality assurance program can describe standards for the practice of pathology and laboratory medicine. Quality assurance in health care : the official journal of the International Society for Quality Assurance in Health Care / ISQA, 4(3), 245-56.
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  An important component of quality assessment is the analysis of peer group comparisons, although little data are available for evaluation. We developed and tested six interinstitutional quality indicators related to Pathology and Laboratory Medicine among 36 institutions. Results showed that the mean frequency of intraoperative frozen section consultations (6.0%), sensitivity of fine needle aspiration cytology diagnosis (87%), nosocomial infections (5.0%) and average cross-match to transfusion ratio (2.1%) was comparable with previous studies, but the range of values was large. The median stat laboratory turnaround time of approximately 1 hr for CSF cell count, glucose, protein and gram smear was considerably longer than expected from previous investigations, and was longer for larger institutions. Analysis of serious laboratory reporting errors showed the lowest number detected by individuals working in transfusion medicine, and highest numbers among hematology workers. We conclude that interinstitutional comparison of data from quality assurance programs can be used to describe performance standards related to the quality and effectiveness of care.
• Schifman, R. B., Strand, C. L., Braun, E., Louis-Charles, A., Spark, R. P., & Fried, M. L. (1991). Solitary blood cultures as a quality assurance indicator. Quality assurance and utilization review : official journal of the American College of Utilization Review Physicians, 6(4), 132-7.
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  For patients with suspected bacteremia, at least two separate blood cultures are recommended to achieve maximum sensitivity and to properly interpret results. Since a single blood collection may signify an improper procedure with serious consequences if the diagnosis of blood stream infection is missed, we investigated this problem with studies at three teaching hospitals (A, B, and C) and by a survey of 38 other hospitals. The incidence of solitary blood cultures ranged from 1 to 99% (median 26%) at the surveyed institutions. Among the cases investigated at hospitals B and C, between 10 and 30% of solitary blood cultures were not clinically indicated, while most of the others were caused by the physician not knowing that one culture was insufficient or by failure to complete the diagnostic plan. Focused concurrent intervention at hospital B was associated with reductions in solitary blood cultures from 40.0 to 24.6% (p = 0.045) and a decline in those not indicated from 38.1 to 12.5% (p = 0.192). Global educational efforts at hospital A were associated with a decrease in solitary blood culture rates from 52 to 37% (p = 0.016). These results show that blood culture practice varies widely among institutions in spite of consensus recommendations for proper specimen collections. We estimate that, nationwide, up to 18,000 etiologic diagnoses of bacteremia are missed annually because of this problem. Monitoring institutional solitary blood cultures is recommended as a test utilization indicator and as the basis for improving blood culture practice.
• Schifman, R. B. (1990). Appropriateness of lab services reviewed. QA review : quality assurance news and views, 2(10), 5, 7.
• Schifman, R. B. (1990). Quality assurance goals in clinical pathology. Archives of pathology & laboratory medicine, 114(11), 1140-4.
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  Certain conditions must be fulfilled to meet quality assurance objectives in clinical pathology. Commitment to goals for improving quality and participation by everyone involved are prerequisites. Quality assurance is driven by information that is used to examine processes so that they can be improved. Inspection alone, however, does not produce quality; quality must be designed into the process to reduce the likelihood of errors and to produce long-lasting improvement. Specifications for meeting quality assurance goals should be determined by the expectations of users of the service. Accomplishments are measured by users' perceptions. Integration of laboratory and clinical information, together with communication links between all components of the health care processes, is critical for success.
• Schifman, R. (1989). Serum prostate specific antigen and prostate pathology in men undergoing simple prostatectomy. American Journal of Clinical Pathology, 92(6), 760-764. doi:http://dx.doi.org/10.1093/ajcp/92.6.760
• THACKER, W. L., BENSON, R. F., SCHIFMAN, R. B., PUGH, E., STEIGERWALT, A. G., MAYBERRY, W. R., BRENNER, D. J., & WILKINSON, H. W. (1989). LEGIONELLA-TUCSONENSIS SP-NOV ISOLATED FROM A RENAL-TRANSPLANT RECIPIENT. JOURNAL OF CLINICAL MICROBIOLOGY, 27(8), 1831-1834.
• BRAWER, M. K., SCHIFMAN, R. B., AHMANN, F. R., AHMANN, M. E., & COULIS, K. M. (1988). THE EFFECT OF DIGITAL RECTAL EXAMINATION ON SERUM LEVELS OF PROSTATIC-SPECIFIC ANTIGEN. ARCHIVES OF PATHOLOGY & LABORATORY MEDICINE, 112(11), 1110-1112.
• PERLMAN, D. M., AMPEL, N. M., SCHIFMAN, R. B., COHN, D. L., PATTON, C. M., AGUIRRE, M. L., WANG, W., & BLASER, M. J. (1988). PERSISTENT CAMPYLOBACTER-JEJUNI INFECTIONS IN PATIENTS INFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS (HIV). ANNALS OF INTERNAL MEDICINE, 108(4), 540-546.
• VANWYCK, D. B., SCHIFMAN, R. B., STIVELMAN, J. C., RUIZ, J., & MARTIN, D. (1988). RAPID SAMPLE PREPARATION FOR DETERMINATION OF IRON IN TISSUE BY CLOSED-VESSEL DIGESTION AND MICROWAVE-ENERGY. CLINICAL CHEMISTRY, 34(6), 1128-1130.
• AHMANN, F. R., & SCHIFMAN, R. B. (1987). PROSPECTIVE COMPARISON BETWEEN SERUM MONOCLONAL PROSTATE SPECIFIC ANTIGEN AND ACID-PHOSPHATASE MEASUREMENTS IN METASTATIC PROSTATIC-CANCER. JOURNAL OF UROLOGY, 137(3), 431-434.
• Ahmann, F. R., Garewal, H. S., Schifman, R., Celniker, A., & Rodney, S. (1987). Intracellular adenosine triphosphate as a measure of human tumor cell viability and drug modulated growth. In vitro cellular & developmental biology : journal of the Tissue Culture Association, 23(7), 474-80.
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  Adenosine triphosphate is the primary energy unit for cells, and levels of this compound offer a potential marker for cell viability and growth. The availability of a bioluminescence assay allows for a rapid, sensitive, and reproducible measurement of ATP. A method is described for the quantification of intracellular ATP levels in human cancer cells. ATP levels were linearly related to the number of viable cells and increased with time in human cancer cell line cultures correlating with growth kinetics. The effect of 5-fluorouracil, doxorubicin, methotrexate, cytosine arabinoside, nitrogen mustard, melphalan, vinblastine, and cisplatin on the growth of human cancer cell lines was studied utilizing ATP levels. ATP levels and colony formation in agar of drug-exposed cells were compared. Overall there was a significant correlation between drug effects on colony formation and ATP levels. The ATP assay is rapid, simple, reproducible, and a relatively inexpensive method of quantifying drug effects on malignant cells. This makes it a potentially useful method for screening new anticancer drugs in human cancer cell lines.
• Draelos, M., Morgan, T., Schifman, R. B., & Sampliner, R. E. (1987). Significance of isolated antibody to hepatitis B core antigen determined by immune response to hepatitis B vaccination. JAMA, 258(9), 1193-5.
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  The immune response to hepatitis B vaccine was studied in 14 individuals with isolated, high-titer antibody to hepatitis B core antigen (anti-HBc) and examined as an indicator of this serologic pattern's significance. Four subjects demonstrated a low-titer antibody to hepatitis B surface antigen (anti-HBs) on repeated testing, and three in this subgroup had anamnestic responses (anti-HBs, 82 to 140 ratio units) after vaccination. Compared with 22 seronegative controls, the remaining ten had significantly higher anti-HBs response rates (78% vs 22%, P = .003) and median anti-HBs titers (4 vs 0 ratio units, P = .008) two weeks after vaccination. One of ten subjects had an anamnestic response, while another exhibited no response. The general pattern of anti-HBs responsiveness observed in those subjects with isolated, high-titer anti-HBc was intermediate between seronegative and anti-HBs-positive groups and may indicate a state of waning immunity after natural infection. Hepatitis B vaccination with follow-up anti-HBs testing should be done for those patients with isolated, high-titer anti-HBc to help exclude chronic infection and boost protective immunity.
• Habib, M. P., Schifman, R. B., Shon, B. Y., Fiastro, J. F., & Campbell, S. C. (1987). Evaluation of whole blood theophylline enzyme immunochromatography assay. Chest, 92(1), 129-31.
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  A new whole blood enzyme immunochromatographic (EIC) theophylline assay was evaluated in 18 low (25 to 37 percent) and 15 high hematocrit (49 to 56 percent) samples. A good correlation was observed between EIC and fluorescence polarization methods for plasma samples (r = 0.95). However, comparison of results between EIC whole blood and plasma values demonstrates a significant proportional bias that is inversely related to the sample's hematocrit. The EIC method for whole blood samples may substantially underestimate theophylline levels in polycythemic patients with theophylline values near or above the toxic range and underestimate levels in those with anemia, if a correction is not made for the sample's hematocrit. A correction formula to approximate plasma theophylline concentrations from whole blood measurements is described.
• SCHIFMAN, R. B., THOMASSON, J. E., & EVERS, J. M. (1987). RED-BLOOD-CELL ZINC PROTOPORPHYRIN TESTING FOR IRON-DEFICIENCY ANEMIA IN PREGNANCY. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, 157(2), 304-307.
• Schifman, R. B., Ahmann, F. R., Elvick, A., Ahmann, M., Coulis, K., & Brawer, M. K. (1987). Analytical and physiological characteristics of prostate-specific antigen and prostatic acid phosphatase in serum compared. Clinical chemistry, 33(11), 2086-8.
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  We did a comparative analysis of the physiological and analytical properties of prostate-specific antigen (PSA), acid phosphatase (ACP; EC 3.1.32) activity, and acid phosphatase antigen (PAP) in serum. The PSA assay is sensitive to 0.2 microgram/L and demonstrates good linearity (y = 1.01x + 0.74). The CV was 3.9% at 40 micrograms/L, 8.0% at 3.1 micrograms/L. PSA and PAP are less stable at 4 degrees C than at -20 degrees C. Serum PAP and ACP concentrations showed large intra-individual fluctuations (average CVs of 22% and 24%, respectively), which were not observed with PSA measurements (average CV 6.2%). We saw significant correlation with the magnitude of physiological change when analytes were compared for serially collected split samples [y(PSA) = 0.14x(PAP) + 0.00, r = 0.767], which indicates that a common factor is influencing this variation. The excellent analytical performance, tissue specificity, and small degree of intra-individual variance are characteristics that favor the measurement of PSA in serum for monitoring patients with prostatic cancer.
• Schifman, R. B., Thomasson, J. E., & Evers, J. M. (1987). Red blood cell zinc protoporphyrin testing for iron-deficiency anemia in pregnancy. American journal of obstetrics and gynecology, 157(2), 304-7.
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  The diagnostic value of ferritin, transferrin saturation, and red blood cell zinc protoporphyrin for detecting iron depletion and predicting third-trimester anemia was studied in 87 women attending a private obstetrics clinic. A decline in ferritin and transferrin saturation and an increase in red blood cell zinc protoporphyrin levels were observed in third-trimester measurements when compared with those of the first trimester. Third-trimester anemia (hemoglobin less than 11.5 gm/dl or 115 gm/L) was detected in 13 (15%) women. Red blood cell zinc protoporphyrin was the only test that consistently demonstrated significantly different mean values between anemic and normal subgroups. The diagnostic sensitivity and predictive value of red blood cell zinc protoporphyrin for evaluating iron depletion and risk of anemia in pregnancy compared favorably to those of ferritin and transferrin saturation measurements. The operational simplicity and low cost of red blood cell zinc protoporphyrin measurements are additional characteristics that favor this procedure for office testing.
• AMPEL, N. M., RYAN, K. J., CARRY, P. J., WIEDEN, M. A., & SCHIFMAN, R. B. (1986). FUNGEMIA DUE TO COCCIDIOIDES-IMMITITIS - AN ANALYSIS OF 16 EPISODES IN 15 PATIENTS AND A REVIEW OF THE LITERATURE. MEDICINE, 65(5), 312-321.
• GAREWAL, H. S., AHMANN, F. R., SCHIFMAN, R. B., & CELNIKER, A. (1986). ATP ASSAY - ABILITY TO DISTINGUISH CYTOSTATIC FROM CYTOCIDAL ANTICANCER DRUG EFFECTS. JOURNAL OF THE NATIONAL CANCER INSTITUTE, 77(5), 1039-1045.
• DUNCAN, B., SCHIFMAN, R. B., CORRIGAN, J. J., & SCHAEFER, C. (1985). IRON AND THE EXCLUSIVELY BREAST-FED INFANT FROM BIRTH TO 6 MONTHS. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 4(3), 421-425.
• SCHIFMAN, R. B., & PALMER, R. A. (1985). SURVEILLANCE OF NOSOCOMIAL INFECTIONS BY COMPUTER-ANALYSIS OF POSITIVE CULTURE RATES. JOURNAL OF CLINICAL MICROBIOLOGY, 21(4), 493-495.
• SCHIFMAN, R. B., WIEDEN, M., BROOKER, J., CHERY, M., DELDUCA, M., NORGARD, K., PALEN, C., REIS, N., SWANSON, J., & WHITE, J. (1984). BACTERIURIA SCREENING BY DIRECT BIOLUMINESCENCE ASSAY OF ATP. JOURNAL OF CLINICAL MICROBIOLOGY, 20(4), 644-648.
• SCHIFMAN, R. B., & RYAN, K. J. (1983). NEISSERIA-LACTAMICA SEPTICEMIA IN AN IMMUNOCOMPROMISED PATIENT. JOURNAL OF CLINICAL MICROBIOLOGY, 17(5), 934-935.
• Schifman, R. B., Garewal, H., & Shillington, D. (1983). Reticulocytopenic, coombs' positive anemia induced by procainamide. American journal of clinical pathology, 80(1), 66-8.
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  A case of Coombs' positive anemia in a man who had procainamide-induced lupus erythematosus syndrome is reported. The patient had a hemoglobin of 4.3 gm/dl and reticulocytopenia (3.1% corrected). Serum lactate dehydrogenase and haptoglobin levels were normal, and total bilirubin was only slightly elevated. Two other reported cases of procainamide-induced hemolytic anemia have demonstrated similar findings. Apparently, procainamide occasionally may induce a reversible, reticulocytopenic, Coombs' positive anemia that is not associated with laboratory evidence of acute hemolysis.
• SCHIFMAN, R. B., RIVERS, S. L., FINLEY, P. R., & THIES, C. (1982). RBC ZINC PROTOPORPHYRIN TO SCREEN BLOOD-DONORS FOR IRON-DEFICIENCY ANEMIA. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 248(16), 2012-2015.
• Schifman, R. B., & Ryan, K. J. (1982). Rapid automated identification of gram-negative bacilli from blood cultures with the AutoMicrobic system. Journal of clinical microbiology, 15(2), 260-4.
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  Automated identification of gram-negative bacilli directly from blood culture bottles by using the AutoMicrobic System (AMS) was evaluated with a modified procedure for the AMS Enterobacteriaceae-plus nonfermenter identification card. A total of 150 strains were tested (44 clinical and 106 seeded) and compared with a conventional identification procedure. These strains included 107 Enterobacteriaceae and 43 oxidase-positive or glucose-nonfermenting, or both, organisms. AMS identifications on one of these strains were not interpretable owing to equal probability AMS identification values. Of the remaining 149 strains, 138 (92.6%) were correctly identified within 8 to 13 h of the first reading. Of 69 identifications analyzed after 6 h of incubation, 91% were correct. This procedure was found to be rapid, convenient, and nonlabor intensive and is recommended for presumptive identification of gram-negative bacilli in blood cultures.
• SCHIFMAN, R. B., & FINLEY, P. R. (1981). MEASUREMENT OF NEAR-NORMAL CONCENTRATIONS OF ERYTHROCYTE PROTOPORPHYRIN WITH THE HEMATOFLUOROMETER - INFLUENCE OF PLASMA ON FRONT-SURFACE ILLUMINATION ASSAY. CLINICAL CHEMISTRY, 27(1), 153-156.
• Schifman, R. B., Brumbaugh, P. F., Grover, D., Finley, P. R., & Harrow, E. J. (1981). A cellulose acetate electrophoretic procedure evaluated for quantitation of high-density lipoprotein cholesterol. Clinical chemistry, 27(1), 175-8.
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  We evaluated the performance of a commercially available cellulose acetate electrophoretic method for quantitating high-density lipoprotein cholesterol (I) in serum by comparing it to a method involving precipitation with dextran sulfate-500/Mg2+. In both methods, enzymic reagents are used for cholesterol measurement. For electrophoretic measurement of I the mean intramembrane CV ws 4.1% (at 220 to 360 mg/L) and the intermembrane CV ranged from 12.2 to 21.0% (at 220 to 880 mg/L). Interassay precision was significantly better for the precipitation method (CV = 3.9% at 390 mg/L). The electrophoretic procedure demonstrated significant measurement bias, both at high and low I concentrations. However, low-density lipoprotein cholesterol, measured electrophoretically correlated well with its calculated concentrations obtained by the precipitation method. Measurement of I by this electrophoretic procedure did not achieve the accuracy and reproducibility that have been demonstrated for precipitation methods and that are necessary for reliable clinical interpretation of results for I.
• Finley, P. R., Schifman, R. B., Williams, R. J., & Lichti, D. A. (1978). Cholesterol in high-density lipoprotein: use of Mg2+/dextran sulfate in its enzymic measurement. Clinical chemistry, 24(6), 931-3.
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  We describe a method for measuring high-density lipoprotein cholesterol. MgCl2 and dextran sulfate are used to precipitate all low-density and very-low-density lipoproteins. The supernate contains only high-density lipoproteins, the cholesterol concentration of which is estimated by an enzymic method, with a discrete analyzer (Abbott Bichromatic Analyzer). Concentration and instrument response are linearly related to 50 mg/liter. The precision of the method is excellent in the range of clinical interest (100 to 1000 mg of cholesterol per liter). The precision and efficiency of the precipitation are shown at various concentrations of high-density lipoprotein cholesterol. The method was compared to that of two laboratories in the Cooperative Lipoprotein Phenotyping Study group by testing a number of split samples, and agreement was good.