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Biomedical subjects

R Rutledge

Publications and source records attributed to R Rutledge.

At least 19 recordsLinked to original sources
PubMed1992

Multiple resistance to sulfonylureas and imidazolinones conferred by an acetohydroxyacid synthase gene with separate mutations for selective resistance.

The acetohydroxyacid synthase (AHAS) gene from the Arabidopsis thaliana mutant line GH90 carrying the imidazolinone resistance allele imr1 was cloned. Expression of the AHAS gene under the control of the CaMV 35S promoter in transgenic tobacco resulted in selective imidazolinone resistance, confirming that the single base-pair change found near the 3' end of the coding region of this gene is responsible for imidazolinone resistance. A chimeric AHAS gene containing both the imr1 mutation and the csr1 mutation, responsible for selective resistance to sulfonylurea herbicides, was constructed. It conferred on transgenic tobacco plants resistance to both sulfonylurea and imidazolinone herbicides. The data illustrate that a multiple-resistance phenotype can be achieved in an AHAS gene through combinations of separate mutations, each of which individually confers resistance to only one class of herbicides.

Acetolactate Synthase↗
PubMed1992

The relationship between face or skull fractures and cervical spine and spinal cord injuries: a review of 13,834 patients.

A state trauma registry database containing 13,834 patients was evaluated to determine the relationship among 1,062 skull fractures, 1,329 facial fractures, 339 cervical spine injuries, and 299 spinal cord injuries. Categories studied were all trauma patients, motor vehicle crashes, automobile crashes (drivers, passengers, unknown), and belted and unbelted victims. Odds ratios calculated demonstrated that patients with skull and/or facial fractures did not have a higher likelihood of cervical spine or spinal cord injury as has been suggested. The lack of a relationship emphasizes the need for a greater vigilance for cervical spine and spinal cord injury in the group without facial or skull fractures. It appears that the pathological biomechanical forces causing each injury are a reflection of the different multiple forces associated with motor vehicle trauma.

Accidents, Traffic↗
PubMed1992

A population-based, multivariate analysis of the association between 911 access and per-capita county trauma death rates.

STUDY OBJECTIVE: Decreased response times for injury should decrease the morbidity and mortality of trauma. The 911 telephone access is designed to improve the response time for emergencies. The purpose of this study was to analyze the association between county 911 access and per-capita county trauma death rates. METHODS: Data on all trauma deaths from 1986 through 1988 were obtained from the North Carolina Medical Examiner's data base. Counties were divided into those that had 911 access during the entire study period (15), those that never had 911 access (62), and those that installed 911 during 1987 (ten). Counties obtaining 911 access in 1986 or 1988 were excluded (13). RESULTS: The per-capita trauma death rate in counties that had 911 access throughout the study was 4.3 +/- 0.8 versus 5.0 +/- 1.1 per 10,000 population in counties that never had 911 access (P less than .01). Compared with counties with 911 access, counties without 911 were more rural, were less likely to have a trauma center, and were less likely to have advanced life support certification (P less than .03 for all). Controlling for these other factors, multivariate analysis demonstrated that 911 access had no significant independent association with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant change occurred in per-capita county trauma death rates after implementation of 911. CONCLUSION: Although counties with 911 access had lower trauma death rates by t-test, multivariate analysis showed no significant independent association of 911 access with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant changes in trauma death rates occurred after implementation. Although other factors may explain these findings, this study showed no significant independent impact of 911 access on per-capita county trauma death rates.

Emergency Medical Service Communication Systems↗
PubMed1992

Vascular injuries in a rural state: a review of 978 patients from a state trauma registry.

The demographics, etiology, and outcome of 1148 vascular injuries suffered by 978 patients reported from eight trauma centers in a largely rural state to a trauma registry (NCTR) data base containing 26,617 patients entered over a 39-month time interval were analyzed. Vascular injury patients were more frequently transferred by helicopter (18%), referred from other hospitals (45%), transfused more blood (8 units mean/24 hours), had higher mean ISS values (14 vs. 9), had lower systolic blood pressures on admission (113 vs. 128 mm Hg), had higher emergency department mortality (3.3%), and required immediate surgery more often (79%) when compared with nonvascular injury NCTR patients (p = 0.0001). Vascular injury patients had significantly longer hospital stays (13 vs. 10 days), longer ICU stays (5 vs. 4 days), and greater hospital costs ($22,500 vs. $12,300) while incurring more serious AIS values for the regions of the chest, abdomen, and extremities. One hundred twenty-nine (13.1%) died, 97 after admission compared with a 6.2% mortality for NCTR nonvascular injury victims. Forty-seven percent of vascular injuries were extremity lesions; the amputation rate was 1.3%; and management was most often by simple repair (41.9%) or patching (22.2%). Rural vascular injury patients had a high incidence of blunt trauma (43.4%) and were older (average, 51 years); they were transported by helicopter more often (30.3%) and were frequently referred from another hospital (77.8%); they had longer ICU, ventilator, and hospital stays and greater hospital charges; and they had higher mortality (14.2%) compared with urban vascular trauma victims. The data suggest a need for the trauma care system to focus on earlier recognition, stabilization, and rapid transportation of this most seriously injured group of patients.

Age Factors↗
PubMed1992

Prospective comparison of clinical judgment and APACHE II score in predicting the outcome in critically ill surgical patients.

Prospective identification of patients who will not survive has been proposed as a means of limiting utilization of medical resources including critical care. This study prospectively compared prediction of outcome for surgical ICU patients by clinical assessment and the APACHE II score. Five hundred seventy-eight patients were assessed within 24 hours of admission by the ICU attending physician and predicted to live or die. An APACHE II score was calculated in that same time period. All data were stored in a data base and compared with actual SICU outcome. There were 40 deaths in 578 patients (6.9%). The clinical assessment had an overall accuracy of 95.2% vs. 90.9% for APACHE II. The Pearson correlation coefficients for the two methods of prediction were 0.59 for clinical assessment and 0.44 for APACHE II. Predictive power was not greatly improved by combining both prediction methods. Over 40% of patients predicted to die by both methods actually survived. This study demonstrates that clinical assessment is superior to APACHE II in predicting outcome in this group of surgical patients, although the difference is small. In addition, this study suggests that neither clinical assessment nor the APACHE II score, when obtained within 24 hours of admission, is very reliable at predicting which surgical ICU patients will die.

Adolescent↗
PubMed1992

Multivariate population-based analysis of the association of county trauma centers with per capita county trauma death rates.

UNLABELLED: The purpose of this study was to utilize a large population-based data base to determine the association of trauma centers with per capita county trauma death rates. METHODS: Per capita county trauma death rate, the dependent variable in the model, was obtained from a well-validated state Medical Examiner's data base. Over 200 county demographic, prehospital, and hospital trauma care resource variables were obtained from a variety of sources for multivariate modeling. Bivariate analysis identified candidate variables for multivariate modeling, excluding highly correlated independent variables to avoid problems of collinearity. Multivariate linear regression, logistic regression, and stepwise discriminant analysis were used to determine the relative association of the candidate variables with per capita county trauma death rates. RESULTS: Bivariate analysis identified multiple factors associated with per capita county trauma death rates. These included, among others: county rurality, percentage of unemployment, percentage nonwhite, 911 access, and ALS certified EMS. Per capita trauma death rates were significantly lower in counties with trauma centers compared with counties without trauma centers (4.0 +/- 0.5 and 5.0 +/- 1.1 deaths per 10,000 population, p = 0.0001, respectively). Multivariate analysis demonstrated that the presence of a trauma center in the county and ALS were the best medical system factors predicting decreased per capita county trauma death rates. CONCLUSIONS: This study is unique in utilizing a regional population-based data base of all trauma deaths in a large state to analyze the association of trauma centers and trauma death rates. Multivariate modeling controlling for other county variables demonstrated that the presence of a trauma center and Advanced Life Support training were the best predictors of per capita county trauma death rates. These findings are consistent with the hypothesis that trauma centers decrease trauma death rates.

Adult↗
PubMed1992

The association of trauma death and alcohol use in a rural state.

This study documents the strong association of alcohol in trauma-related deaths. In a previous study alcohol was present in 62.8% of homicide victims, 48.6% of unintentional injury fatality victims, 35.3% of persons who committed suicide, and 14.4% of persons who died of natural causes. The present study uses the legal limit of 100 mg/100 mL to include patients as having an alcohol-associated trauma death. In addition the study includes patients who die up to 20 hours after injury. These features of our study result in the lower reported frequency rates. Our study confirms that alcohol is strongly associated with trauma deaths resulting from motor vehicle crashes. It also demonstrates a strong association between alcohol use and victims of all types of trauma mortality; specifically those victims of gunshot wounds, burns, stabbings, and falls all are frequently using alcohol. This information is of importance for those who treat such injured patients, since such tests as neurologic examination frequently will be compromised by the use of alcohol in the victims of major trauma. Perhaps most importantly this information can be of help in designing appropriate strategies in attacking this problem the best possible way--by prevention.

Accidents↗
PubMed1992

The association of advanced life support training and decreased per capita trauma death rates: an analysis of 12,417 trauma deaths.

This study identified a number of significant predictors of per capita county trauma mortality rates: rurality, percentage nonwhite population, percentage unemployment, and Advanced Life Support (ALS) versus Basic Life Support (BLS) status. Of these, ALS versus BLS status is not only the most significant independent predictor, it is the only predictor readily amenable to change. The aspects of ALS clearly associated with decreased trauma death rates should be identified and, if possible, undergo widespread implementation.

Adult↗
PubMed1991

Making the transition from information systems of the 1970s to medical information systems of the 1990s: the role of the physician's workstation.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these systems are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development of a Physician's Workstation which integrates information from multiple existing information systems and discuss how the workstation makes it possible to move from the departmental systems of the present to the computer-based medical record system of the future.

Computer Communication Networks↗
PubMed1991

Acute Physiology and Chronic Health Evaluation (APACHE II) score and outcome in the surgical intensive care unit: an analysis of multiple intervention and outcome variables in 1,238 patients.

OBJECTIVE: To assess the statistical association of the Acute Physiology and Chronic Health Evaluation (APACHE II) score with multiple intervention and outcome variables in surgical ICU patients. DESIGN: Continuous data collection on every patient admitted to the surgical ICU for a 21-month period. MATERIALS AND METHODS: For every admitted patient in the surgical ICU, APACHE II scores were calculated and the relationship between APACHE II score as an independent predictor of outcome was assessed with multiple outcome variables selected for study. The outcome and intervention variables tested included: treatment intervention measures such as days on ventilator; days with an arterial catheter, central venous catheter, triple lumen catheter, pulmonary artery catheter; days receiving total parenteral nutrition; days receiving tube feedings; number of transducers per days in the ICU; number of infusion pumps per ICU days, days in the hospital, number of complete blood counts; number of electrolyte determinations; number of blood gases; number of units of blood transfused; ICU and hospital mortality rates in the presence of complications, including: respiratory distress syndrome, renal failure, congestive heart failure, coma, requirement of cardiopulmonary resuscitation, and others. RESULTS: The APACHE II score was statistically associated with each intervention and outcome variable tested. Unfortunately, the associations, although consistent, were weak with r2 values ranging from .03 to a maximum of .22 for Pearson's correlation coefficients. CONCLUSION: The APACHE II score was statistically associated with all the variables examined in our surgical patients, but its predictive power for the individual surgical patient was limited. These findings suggest that the score may be useful for retrospective analyses of large cohorts of patients but should not be used as a triage tool or as a predictor of outcome for the individual patient. Triage decisions should continue to be based on the best available clinical judgment.

Adult↗
PubMed1991

Comparison of the ability of adult and pediatric trauma scores to predict pediatric outcome following major trauma.

The Pediatric Trauma Score (PTS) has been identified as the only accurate and adequate means of predicting outcome in pediatric trauma. In answer to the increasing number of trauma patients arriving at local hospitals, the ability of the adult Trauma Score (TS) to predict pediatric trauma outcome was tested. Of the total 2,604 pediatric trauma cases in the North Carolina State Trauma Registry, 441 had both a PTS and TS available for analysis. The primary measures of outcome were emergency department and hospital dispositions. Logistic regression demonstrated that TS (R2 = 0.50) was a stronger predictor of pediatric outcome and PTS (R2 = 0.35) for emergency department disposition and TS (R2 = 0.63) with PTS (R2 = 0.51) for hospital disposition. The correlation between TS and PTS was high (R = 0.8). Stepwise discriminant analysis demonstrated that TS was the stronger predictor of outcome and the PTS added only 9% (partial R2 = 0.09) more accuracy to TS for emergency department disposition and only 6% (partial R2 = 0.06) for hospital disposition. The results of this research demonstrate that TS is a useful method of predicting outcome in pediatric trauma. The use of both scores for each patient does not increase the predictive value of the scores.

Adolescent↗
PubMed1991

The spectrum of abdominal injuries associated with the use of seat belts.

Several recent reports have described abdominal injuries occurring as a result of seat belt use, raising concerns about seat belts as an agent of injury in motor vehicle crashes. The purpose of this study was to characterize the distribution of abdominal injuries after motor vehicle crashes in belted and unbelted patients admitted to trauma centers. The mortality was higher in unbelted than belted patients (7% vs. 3.2%, respectively, p less than 0.0001). Unbelted patients also had significantly more frequent and more severe head injuries (50.0% vs. 32.9%, respectively, p less than 0.001). The incidence of abdominal injury was equal in both unbelted patients (13.9%), but the spectrum of organs injured was different in the two groups. Gastrointestinal tract injuries (stomach, small bowel, colon and rectum) were significantly more frequent in belted vs. unbelted patients (3.4% vs. 1.8%, respectively, p = 0.001). The frequency of liver and spleen injuries was the same in both groups. This study demonstrates that in patients admitted to trauma centers after motor vehicle crashes, belted and unbelted patients have an equal incidence of abdominal injury, but belted and unbelted patients have a different spectrum of injuries. Hollow viscus injuries are more common in belted crash victims. Seat belt use was associated with significantly fewer head injuries and deaths. Physicians evaluating trauma victims after motor vehicle crashes should be aware of the fact that the types of abdominal injuries may vary substantially depending on seat belt use.

Abdominal Injuries↗
PubMed1991

The Physician's Workstation: an example of end user integration of information systems.

Many hospitals today have implemented widely disparate information systems on mainframe and mini-computer hardware. The advent of network technology in hospitals has made it possible to access information in these systems. Unfortunately, the user interfaces to applications on these system are unique and difficult to learn, which makes them unsuitable for use by clinical services. In this paper we describe the development using rapid prototyping object-oriented programming tools of a Physician's Workstation which integrates information from five different applications running on three separate computer systems.

Computer Communication Networks↗
PubMed1990

Cost-effective use of microcomputers for quality assurance and resource utilization in the surgical intensive care unit.

Need for organ system support, severity of illness, and the risk of life-threatening complications are major factors in determining the need for ICU care and directly affect ICU costs. Using a microcomputer and a relational database program, an ICU database was developed to study ICU utilization. The following information was collected for each ICU patient on admission, then daily, and on ICU discharge: demographic data, procedures, monitors used, laboratory tests, complications, outcome, and Acute Physiology and Chronic Health Evaluation (APACHE II) score as a measure of acuity. In our study, this information was used as a first step in an attempt to define categories of patients who might benefit most from intensive care and those who would not. From September 1, 1987 to March 1, 1989, 1,062 patients were admitted to the surgical ICU (SICU). Otorhinolaryngology (ENT) patients with major head and neck resections, routinely admitted to the SICU, were compared with those from other surgical services. The ENT patients had the lowest mean admission APACHE II (6.8 +/- 0.4 vs. 11.4 +/- 0.3), lowest mean daily APACHE II (7.8 +/- 0.4 vs. 13.2 +/- 0.1), lowest percent of ventilated patients (7.6% vs. 39.4%) and ventilator days (18.9% vs. 64.6%), and had the least monitoring by central venous catheters (20.9% vs. 57.1%) or pulmonary artery catheters (0.9% vs. 29.8%) (p less than .0001 for all of above). They also had the shortest mean ICU stay (1.2 +/- 0.1 vs. 3.3 +/- 0.2 days, p less than .05). The only complication in 105 ENT patients was one uncomplicated myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

ABGs and arterial lines: the relationship to unnecessarily drawn arterial blood gas samples.

Arterial blood gas measurements (ABGs) are the most common tests ordered in an ICU. ABG utilization in a surgical ICU over a 1-year period (September 1, 1987-October 31, 1988) was evaluated to identify factors that might help reduce overutilization. A total of 842 admissions comprising 2,381 patient days were reviewed. ABGs were the most commonly ordered test (mean of 4.8/patient/day). Patients with arterial lines (A-lines) had more ABGs drawn than those who did not regardless of the value of PaO2 (p less than 0.01), PaCO2 (p less than 0.01 except for PaCO2 greater than 55), APACHE II score (p less than 0.01), use of ventilators (p less than 0.01), pulse oximeters (p less than 0.01), or a combination of the last two (p less than 0.01). Multivariate analysis demonstrated that the presence of an A-line was the most powerful predictor of the number of ABGs drawn per patient (p less than 0.0001) independent of all other measures of the patient's clinical status such as the use of ventilators, oximeters, and values of PaO2, PaCO2, or the APACHE II score. This suggests that ABGs are being drawn unnecessarily simply because of the presence of an A-line. To reduce the number of ABGs drawn, a policy for specific indications for placement of A-lines and ABG analysis should be adopted.

Blood Gas Analysis↗
PubMed1989

Infection of rabbits with human immunodeficiency virus 1. A small animal model for acquired immunodeficiency syndrome.

Injection of rabbits with a human T cell line infected with HIV-1 caused seroconversion within 6 wk, and HIV-1 could be isolated from PBL cultures of infected rabbits. Identity of the isolated virus with HIV-1 was shown by analysis of products amplified by the polymerase chain reaction. HIV-1 infection was seen in rabbits injected with HIV-1-infected cells alone as well as in those that were first infected with HTLV-1 and subsequently with HIV-1. There were no consistent signs of disease in the rabbits infected with HIV-1 alone but HTLV-1/HIV-1-infected rabbits showed signs of illness including diarrhea and weight loss, transient neurologic impairment and, in one animal, a rapidly progressing mammary adenocarcinoma. Examination of organs taken at necropsy from both HIV-1- and HTLV-1/HIV-1-infected animals showed splenic hyperplasia and lymphocyte infiltration of the lungs, as well as moderate damage to liver and kidney in some cases.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Hepatic trauma.

Hepatic trauma is a common form of abdominal injury. Although the majority of hepatic injuries are minor and require little or no treatment, many hepatic injuries are major and lethal if not managed appropriately. Good management of these patients requires a thorough understanding of hepatic anatomy and of the options available for surgical management of hepatic injuries. These options include simple suture, hepatotomy to expose the bleeding vessels and ligation, hepatic artery ligation, packing of hepatic injuries, and, rarely, formal anatomic lobectomy and atriocaval shunting. The trauma surgeon must be familiar with these types of management and be able to apply them in appropriate situations. Nonoperative management is now being reported more commonly and it may be appropriate in a selected group of patients. While the most common cause of death after hepatic injury is from exsanguination occurring early after injury, patients with major hepatic injury remain at risk for a variety of complications after the initial injury. These include hepatic abscess, hemobilia, pseudoaneurysm, and arteriovenous malformations that lead to bleeding. All of these are best treated by CT scan and interventional radiologic techniques. A determined and committed approach to these injured patients can significantly decrease the mortality of these injuries.

Hepatectomy↗