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Biomedical subjects

L Painter

Publications and source records attributed to L Painter.

10 recordsLinked to original sources
PubMed2000

Synthesis of functionalized chiral carbocyclic cleft molecules complementary to Tröger's base derivatives.

The synthesis of optically pure functionalized cleft molecules derived from dibenzobicyclo[b,f][3.3.1]nona-5a,6a-diene-6,12-dione is reported. These clefts are reminiscent of Tröger's base but contain clefts with different dimensions and additional carbonyl (or alcohol) groups that may be utilized in molecular recognition studies. The 2,8-dimethyl and 2,8-dibromo derivatives were synthesized via an intramolecular Friedel-Crafts acylation and were resolved by chiral HPLC. The 2,8-dinitro derivative was prepared by regiospecific nitration of dibenzobicyclo[b,f][3.3.1]nona-5a, 6a-diene-6,12-dione. The dibromo and dinitro derivatives allow direct access to a range of functionalized molecular clefts. Palladium-catalyzed coupling of the dibromo derivative afforded the disubstituted phenyl, anisole, and acetylene derivatives, while reduction of the dinitro derivative and acetylation provided amino-dione and amide-hydroxyl derivatives. X-ray crystal structures of the dimethyl 12, dibromo 13, di(p-methoxyphenyl) 16, dinitro 18, and dimethyl dinitro 22 derivatives show cleft angles between the planes between the aromatic rings of 84-104 degrees. The synthetic route, structural features, and potential for molecular recognition studies of this class of clefts are compared with those of the more widely studied Tröger's base cleft molecules.

Bridged-Ring Compounds↗
PubMed1998

Reducing the length of stay after kidney transplantation--the intensive outpatient unit.

The need to reduce the costs associated with the initial hospitalization for kidney transplantation has led to the development of outpatient facilities in which patients can be seen on a daily basis. The implementation of a kidney transplant intensive outpatient unit (IOPU) is described. Prior to the opening of the IOPU, the median and mean lengths of stay after kidney transplantation in our program were 14.0 and 18.9 d, respectively. Subsequent to the opening of the IOPU, the median and mean lengths of stay after kidney transplantation have gradually decreased and are currently 5.0 and 7.5 d, respectively. The median inpatient cost of transplantation, excluding organ acquisition charges, has decreased by 54%, from $25516 to $11616. Patient satisfaction has exceeded 80%. The IOPU represents an effective means of reducing the cost associated with transplantation, without sacrificing the quality of care.

Cost Savings↗
PubMed1997

Utility of clinical pathway and prospective case management to achieve cost and hospital stay reduction for aortic aneurysm surgery at a tertiary care hospital.

PURPOSE: We reviewed our experience with a clinical pathway instituted in December 1993 for all nonurgent abdominal aortic aneurysm (AAA) surgery. METHODS: We analyzed a reference group of 49 consecutive pre-pathway AAA patients (group I) and the 44 patients enrolled in the first year of the pathway (group II). On the basis of the interim review of data collected during the first year, pathway modifications were made, and 34 patients enrolled after these modifications (group III) were also analyzed. RESULTS: Comparison of groups I and II showed that institution of the pathway resulted in a marginally significant reduction in mean charges of 14.7% (p = 0.09), and a slight fall in mean length of stay (LOS) (13.8 vs 13.1 days, NS) and mortality rate (4.1% vs 2.3%, NS). For group II, a significant correlate (p < 0.05) of increased charges was fluid overload as diagnosed by chest radiograph. This recognition led to active efforts to reduce perioperative fluid administration. Comparison of groups II and III revealed that the practice modifications led to marked reduction in the incidence of fluid overload (73% vs 24%; p < 0.01), mean charges (30.4% reduction; p < 0.05), mean LOS (13.1 vs 10.2 days; p < 0.05), and median LOS (11 vs 8 days). Multiple regression analysis of all pathway patients showed that preoperative renal insufficiency is a significant predictor of both increased LOS (p < 0.01) and charges (p < 0.01), but that age, sex, and coronary disease were not predictive. Of the postoperative parameters analyzed, important correlates of increased charges were acute renal failure (p < 0.01) and fluid overload (p < 0.01). CONCLUSIONS: Institution of a clinical pathway for AAA repair resulted in significant charge reduction and a slight reduction in stay. Practice modifications based on interim data analysis yielded further significant reductions in charges and LOS, with overall per-patient charge savings (group I vs III) of 40.6% (p < 0.05) and overall LOS reduction of 3.5 days (p < 0.05). The reduction in actual charges was seen despite an overall increase in the hospital rate structure. Comparing groups I, II, and III, we found no indication of increasing mortality rate. Ongoing analysis has identified correlates of increased charges, potentially permitting identification of high-cost subgroups and more focused cost-control efforts. Rather than restricting management, clinical pathways with periodic data analysis may improve quality of care.

Aortic Aneurysm, Abdominal↗
PubMed1995

Cortisol secretion and growth in ewe lambs chronically exposed to electric and magnetic fields of a 60-Hertz 500-kilovolt AC transmission line.

A study was conducted to determine whether chronic exposure of ewe lambs to the electric and magnetic fields (EMF) of a high-voltage ac transmission line affected cortisol secretion and growth. Twenty Suffolk ewe lambs were assigned randomly in equal numbers to a control and treatment group. Treatment from 2 to 10 mo of age consisted of continuous exposure within the electrical environment of a 60-Hz, 500-kV transmission line (mean electric field 6 kV/m, mean magnetic field 40 mG). Treated lambs were confined directly beneath the transmission line; control lambs were maintained in a pen of similar construction 229 m from the line where the EMF were at ambient levels (mean electric field < 10 V/m, mean magnetic field < .3 mG). Cortisol was analyzed by RIA in serum of blood samples collected at .5- to 3-h intervals over eight 48-h periods. All ewe lambs were weighed weekly and side-patch wool growth was measured biweekly. Cortisol secretion occurred in a circadian rhythm; daytime serum concentrations were greater (P < .05) than nighttime concentrations for both groups. Concentrations of cortisol did not differ between the control and exposed ewe lambs. Weight gain and wool fiber length and diameter also were not affected by treatment. These data suggest that chronic exposure of developing ewe lambs to 60-Hz environmental EMF does not affect concentrations of cortisol secretion, body weight gain, and wool growth.

Animals↗
PubMed1991

Stressors and rewards of being an AIDS emotional-support volunteer: a scale for use by care-givers for people with AIDS.

This study describes scales which can be used to identify the levels of stress and reward associated with being a AIDS emotional-support volunteer. Four categories of stressors were identified. These were 'emotional overload', 'client problems', 'lack of support' and 'lack of training'. The reward categories were 'personal effectiveness', 'emotional support', 'social support' and 'empathy/self-knowing'. There were low, but positive correlations between these stressor scales and other measures of psychological morbidity, the 28-item General Health Questionnaire (GHQ) and the Maslach Burnout Inventory (MBI). Levels of stress and reward were positively correlated and, taken together, the scales may be of use as a measure of the degree of involvement of volunteers in the AIDS care-giving process. Although these scales were derived from items provided from AIDS emotional-support volunteers many of the items may also be relevant to other health workers providing care for people with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

The Ankali project: a model for the use of volunteers to provide emotional support in terminal illness.

The Ankali project has provided emotional support to about 250 persons with the acquired immunodeficiency syndrome, their partners, family members and friends. Volunteers act as a "supportive friend" and allow subjects the opportunity to express their feelings. The project's model easily could be adapted to meet the needs of persons with other terminal illnesses. One of the most important features of the model is the compulsory support-group structure for volunteers.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Changes in left ventricular ejection fraction after intracoronary thrombolytic therapy. Results of the Registry of the European Society of Cardiology.

Changes of left ventricular ejection fraction (delta EF) determined by monoplane contrast angiography before intracoronary streptokinase infusion and in the chronic stage of infarction before hospital discharge were assessed in 125 patients. Preintervention EF was .49 +/- .136 and chronic EF was .025 +/- .118 higher (p = .02) in the total group. Some subgroups had an improved EF: patients with collaterals (delta EF = .046 +/- .106, p less than .01, n = 42), patients with incomplete obstruction before intervention (delta EF = + .076 +/- .141, p = .03, n = 19) and patients in whom complete obstruction was permanently recanalized (delta EF = .024 +/- .113, p = .04, n = 89). A continuous model relating delta EF to both duration of infarct symptoms before hospital admission and to preintervention EF showed a decline in EF improvement over time in the subgroup that was admitted within less than 6 hours after the onset of chest pain and successfully recanalized (n = 72).

Cardiac Output↗
PubMed1980

Independent regulation of atrial coronary blood flow by atrial contraction rate in conscious dogs.

The effects of separate increases in atrial and ventricular contraction rates on the distribution of coronary flow within the heart were determined in conscious dogs with chronic heart block. Atrial tachycardia increased atrial blood flow and did not change ventricular blood flow. Ventricular tachycardia increased ventricular blood flow but not atrial blood flow. The results are consistent with the concept of local regulation of coronary perfusion by local myocardial energy turnover. The results also call attention to a potential adverse impact of atrial tachyarrhythmia in patients with underlying coronary ischemia.

Animals↗