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Biomedical subjects

K N Gillespie

Publications and source records attributed to K N Gillespie.

9 recordsLinked to original sources
PubMed1992

Effect of epidermal growth factor in the rat 5/6 renal ablation model.

Acute administration of epidermal growth factor (EGF) has been shown to promote recovery from ischemic and nephrotoxic acute renal failure in vivo. The question of whether chronic subcutaneous administration of EGF (19.1 micrograms/day for 3 or 6 wk) could alter the course of chronic renal failure in rats subjected to 5/6 nephrectomy was studied. By week 6, there was no difference in renal function, as assessed by animal survival, BUN, urea and inulin clearances, proteinuria, renal morphometry, or renal size, between EGF- and vehicle-treated rats. This suggests that chronic renal insufficiency differs from acute tubular injury in its sensitivity to exogenous EGF. Unexpectedly, EGF significantly attenuated the rise in systolic blood pressure that occurred by the fourth week after 5/6 nephrectomy. The antihypertensive effect of EGF was still evident at week 5. Urinary flow rate, free water clearance, and excretion of total solutes, Na+, and K+, however, were not significantly altered by EGF at weeks 2, 4, 5, or 6, suggesting a mechanism other than increased natriuresis or diuresis for this antihypertensive effect.

Acute Kidney Injury↗
PubMed1991

The effects of residency training programs on the financial performance of Veterans Affairs medical centers.

This study examines financial performance and physician productivity in Veterans Affairs teaching hospitals following the elimination of a separate payment for the indirect costs of medical education. Financial performance of teaching hospitals in the VA system was no worse than nonteaching peers even without a teaching subsidy. Residents were found to provide patient care but this contribution to output was offset by indirect teaching costs of resident training. Physicians were less productive in teaching hospitals, possibly reflecting the time spent in training and supervising residents, while nurses were more productive. Finally, as staff size increases, the indirect costs of medical education decrease. Future downsizing of residency programs would financially benefit smaller-staffed VAMCs; larger-staffed facilities would lose.

Costs and Cost Analysis↗
PubMed1990

Evidence for decreased transport of PNMT protein in advanced Alzheimer's disease.

Phenylethanolamine N-methyltransferase (PNMT) is the rate-limiting enzyme in the synthesis of epinephrine and a specific marker for adrenergic neurons. PNMT protein is decreased in axon terminals in brains from patients with Alzheimer's disease due to retrograde degeneration of epinephrine neurons. To determine the subcellular mechanism underlying retrograde degeneration, the distribution of PNMT between axon terminal and cell body was calculated in early and advanced Alzheimer cases compared with age-matched controls. In early Alzheimer's disease there is a decrease in PNMT in axon terminals and in total PNMT in epinephrine cell bodies and terminals compared with control values. There is no difference in the ratio of PNMT in cell body/axon terminal compared with controls. In contrast, in advanced Alzheimer's disease, PNMT activity increases by 124% in epinephrine neuronal cell bodies compared with controls. Immunochemical titration shows that this increased enzyme activity is due to an increase in PNMT protein. The cell body/axon terminal ratio of PNMT is increased 2.5-fold in advanced Alzheimer's disease compared with controls. These findings are consistent with the hypothesis that in early Alzheimer's disease there is a decreased synthesis or increased degradation of PNMT. However, in advanced Alzheimer's disease we propose that the accumulation of this enzyme in the perikarya results from a diminished transport of PNMT to axon terminals. We further postulate that epinephrine, the product of PNMT, and its further metabolites are endogenous neurotoxins. Therefore, the accumulation of PNMT in epinephrine cell bodies may contribute to the degeneration of these neurons in Alzheimer's disease.

Aged↗
PubMed1990

A comparison of in-house and regionalized computerized tomography scanning: clinical impact and cost.

Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were obtained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part of the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that VA hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

Aged↗
PubMed1989

Practice pattern variation between two medical schools.

This study examined physician test-ordering behavior at a large urban Veterans Administration Medical Center staffed by two medical schools. Patients are assigned randomly to the two schools' wards, which operate independently of each other. The medical records of 119 patients, admitted during a 5-month period, were abstracted for data on the process and outcomes of medical care. Only one statistically significant difference in diagnostic testing practices was revealed by the observation that 12% of patients on one service received another abdominal film, while no patients on the other service did. The implications of studies such as this for small-area analysis are discussed. If variation in the utilization of health services is observed in a geographic region, then a study of physician behavior at a single facility may help to identify the reason for the variation.

Diagnosis-Related Groups↗
PubMed1988

Female veterans' use of health care services.

The number of female veterans has more than doubled in the last 15 years, and this growth is expected to continue. This study examines the current utilization of both overall and Veterans Administration (VA) health care services by female veterans. Current utilization is studied as a set of contact decisions: whether or not to utilize any inpatient, VA inpatient, any outpatient, and VA outpatient services. Probit regression is used to estimate these dichotomous choices. Results indicate that health status and some demographic variables are significantly related to the use of all four types of care. In addition, use of other VA benefits, the absence of private insurance coverage, and low income are predictors of use of the VA.

Aged↗
PubMed1988

Older veterans' future use of VA health care services.

This study is a secondary analysis of the Harris Survey of Aging Veterans (SAV) and is designed to identify variables that may be associated with older veterans' future use of the Veterans Administration (VA) health care system. Using regression and discriminant analysis techniques, the study identifies variables that may predispose older veterans to use the VA health care system in the next 10 years. The results indicate that older veterans may elect to use their health care benefits on objective criteria consistent with their health and financial resources, e.g., past use of veterans benefits, expected health status, and private insurance coverage. These variables suggest that the VA's recently enacted means test and the removal of automatic age eligibility will disenfranchise few older veterans.

Aged↗
PubMedDate not supplied

Intraoperative autologous blood salvage with cardiac surgery: an analysis of five years' experience in more than 3,000 patients.

STUDY OBJECTIVE: To analyze intraoperative autologous salvage of shed mediastinal blood and subsequent transfusion in cardiac surgery. DESIGN: Retrospective statistical analysis. SETTING: University hospital. PATIENTS: Three thousand twenty two patients undergoing cardiac surgery from 1984 to 1988. INTERVENTIONS: A review of anesthesia and transfusion records of all patients who underwent intraoperative salvage of shed blood and autologous transfusion using the Sorenson Receptal Auto Transfusion System (ATS) with saline wash prior to reinfusion in cardiac surgery. MEASUREMENTS AND MAIN RESULTS: The salvaged blood volume ranged from 36 to 2,795 ml, with a mean of 321 +/- 222 ml (SD). Eighteen percent of patients did not receive any homologous blood products during their hospitalization. Patients who received only salvaged autologous transfusion were younger, had higher preoperative hemoglobin and hematocrit values, had a larger body surface area, and had shorter surgeries compared with patients who received only homologous blood or both autologous and homologous blood. More blood products were given to patients who received salvaged autologous blood compared with those who did not. Patients who underwent normovolemic hemodilution prior to extracorporeal circulation with subsequent reinfusion received significantly fewer blood products. Ten preoperative and four intraoperative variables significantly influenced the salvaged volume. Previous cardiac surgery was the most significant preoperative variable, and repair of ventricular septal defect produced by myocardial ischemia was the most significant intraoperative variable. CONCLUSION: Considering the average salvaged volume and its current autologous transfusion-related expense, autologous blood salvage is potentially an economic benefit. Perioperative blood conservation requires a considerable commitment from surgeons, anesthesiologists, perfusionists, and intensive care physicians to be effective.

Blood Substitutes↗