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Biomedical subjects

H R Rubin

Publications and source records attributed to H R Rubin.

53 records · Page 3Linked to original sources
PubMed1990

Are elderly people less responsive to intensive care?

Older patients may be excluded from intensive care units because of the perception that they will benefit less than younger patients. To determine if advanced age is associated with increased mortality independent of severity of illness, we compared older and middle-aged patients admitted to a medical intensive care unit. We reviewed the charts of 130 patients age 75 years or older and 135 patients age 55 to 65 admitted over a 30-month period. We controlled for severity of illness using the Acute Physiology Assessment and Chronic Health Evaluation (APACHE II) system without including points for age (APACHE IIM). The groups were similar with regard to gender, whether or not they had a private attending physician, mean APACHE IIM score, and diagnoses, except that older patients had more chronic obstructive pulmonary disease. Hospital stay was slightly longer in the older group (37 vs. 39 days, rank sum, P less than .02). Hospital mortality was significantly greater in the older group (39% vs. 51%, Chi-square P less than .05) with a crude relative risk of 1.32 (95% confidence interval [CI]: 1.01, 1.73). However, the relation of age group to mortality differed for patients with different diagnoses. When we used logistic regression to adjust for APACHE IIM, whether the patient had a private attending physician, primary admitting diagnosis, or presence of cancer, older patients did not have a significantly greater risk of dying (adjusted relative risk, 1.05; 95% CI: 0.97, 1.12). When pulmonary artery catheterization was added to the model, it independently predicted mortality adjusted relative risk, 1.47; 95% CI: 1.05, 2.06.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1990

Can patients evaluate the quality of hospital care?

We have found that patients have distinct opinions about many components of hospital care, but that little recent work has identified those components important to today's patients in the United States. Investigators have constructed reproducible scales to obtain evaluations. Patient evaluations of the interpersonal features of hospital care are influenced by interventions that physicians or nurses identify as "higher" quality of care. We do not know if patient reports and ratings of specific aspects of care accurately reflect the effects of hospital care on health outcomes--the quality standard that public agencies and payers may consider the most important. However, patient evaluations of nursing care and medical care are independently related to patients' overall satisfaction, overall assessments of quality, and intentions to recommend and return to the same hospital. More studies are needed to clarify whether other components of hospital care also contribute to these ratings and intentions and, if so, how much. Nonresponse bias affects patient surveys, making patient ratings of care in each sample more favorable than the population mean; we do not know how this affects conclusions of surveys that compare hospitals or treatments. Few studies have compared how different methods affect the reproducibility and accuracy of patient reports and ratings. Practical issues may be the most important obstacles for users of patient ratings, particularly regarding whether potential users will be able to interpret results and accept them. Finally, no comprehensive instrument or survey method in the published literature has been tested enough to be recommended as a reproducible, accurate, and interpretable quality measure: a few do, however, appear worthy of further testing.

Consumer Behavior↗
PubMed1983

Suppression of in vitro lymphocyte DNA synthesis by killed Pseudomonas aeruginosa.

Whole antibiotic-killed classic Pseudomonas aeruginosa organisms elicited human lymphocyte [3H]thymidine (TdR) uptake in vitro after 5 days in culture. However, high concentrations of the same preparation did not elicit [3H]TdR incorporation. The investigation of this lymphocyte unresponsiveness revealed that a high dose of P. aeruginosa, when added to lymphocyte cultures together with optimal concentrations of lymphocyte activators (e.g., plant lectins or whole killed Staphylococcus aureus Cowan 1), caused a potent, nonspecifically expressed inhibition of lymphocyte [3H]TdR uptake in response to these mitogens. High doses of P. aeruginosa were not cytotoxic to lymphocytes, and the inhibition caused was reversed when lymphocytes were washed free of bacteria. The inhibition of [3H]TdR uptake by high-dose P. aeruginosa did not require the generation of adherent suppressor cells or prostaglandin-mediated, steroid-sensitive or radiation-sensitive suppressor mechanisms. At optimal lymphocyte stimulatory concentrations of P. aeruginosa, the addition of indomethacin or the depletion of adherent cells caused an increase in lymphocyte [3H]TdR incorporation. This is consistent with an adherent-cell population regulating [3H]TdR uptake in response to P. aeruginosa via a prostaglandin-dependent pathway. This population was not involved in the inhibition of lymphocyte [3H]TdR uptake by high concentrations of P. aeruginosa.

Cell Survival↗
PubMed1981

Tricyclic antidepressant sample stability and the vacutainer effect.

The authors studied the effects of different sample handling techniques on 17 tricyclic plasma samples. They found that the samples were stable at room temperature for up to 3 days when kept in a glass tube sealed with Parafilm, but the samples were not stable when stored in a Vacutainer tube with the stopper in contact with the plasma.

Antidepressive Agents, Tricyclic↗
PubMed1980

Selected hormone levels in victims of the sudden infant death syndrome.

Hormone levels were measured in victims of the sudden infant death syndrome (SIDS) to look for clues to the cause of death. SIDS victims who had petechiae on their intrathoracic organs had higher blood levels of cortisol than victims without such petechiae (25 vs 9 micrograms/100 ml, P less than .005). This raises the possibility that SIDS victims who had petechiae had a longer period of predeath stress than did victims without petechiae since experimental studies have shown that the circulation must continue for a time after stress begins to produce such petechiae. The low normal level of cortisol (9 micrograms/100 ml) in SIDS victims who did not have petechiae raises the possibility that their circulation stopped rather promptly after the final stress began. Hypoxemia may have been the mechanism of death in many of the SIDS victims with petechiae. These victims had 20% more muscle in their pulmonary arteries than did victims without petechiae (P less than .05). This muscle increase is a presumed marker for chronic hypoventilation which leads to hypoxemia.

Apnea↗
PubMedDate not supplied

A convenient thin-layer chromatographic screening method for acetaminophen in serum.

A thin-layer chromatographic screening procedure for acetaminophen in serum was developed that meets the clinical need to identify candidates for antidotal therapy within the critical first 24 hr after ingestion. The key feature of this approach is the use of a detection reagent containing Fe(III) and 2,4,6-tris-(2'-pyridyl)-s-triazine (TPTZ). Acetaminophen on the plate reduces the Fe(III) to Fe(II), which then forms an intensely blue-colored complex with the TPTZ. Concentrations as low as 3 to 4 mg/L can be detected and the procedure is free of interference from 38 other common drugs and metabolites.

Acetaminophen↗