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At least 19 recordsLinked to original sources
PubMed1992

Metabolism of angiotensin I by different tissues in the intact animal.

To quantify regional conversion of angiotensin (ANG) I to ANG II and its degradation to peptides other than ANG II, monoiodinated 125I-labeled ANG I was given to anesthetized pigs by constant infusion into the left cardiac ventricle. At steady state, blood samples were taken from the aorta and various regional veins. Distribution volume of ANG I appeared to be 24% of body weight. After angiotensin-converting enzyme (ACE) inhibitor treatment, fractional ANG I metabolism (fraction of arterially delivered ANG I that was metabolized during a single passage of blood) was 10% in the lungs (conversion 4%), compared with 56% in the combined systemic vascular beds (conversion 1%). Fractional ANG I metabolism during ACE inhibition was 93% in the kidney; 50-70% in myocardium, skeletal muscle, head, and skin; 21% in the left cardiac cavity; and 14% in the right cardiac cavity. Without ACE inhibition, fractional ANG I metabolism was 29% in the lungs (conversion 25%); 49% in the combined systemic vascular beds (conversion 10%); 38% in the left cardiac cavity (conversion 11%); and 14% in the right cardiac cavity (conversion 0%). It may thus be concluded that 1) extrapulmonary vascular beds make an important contribution to the conversion of circulating ANG I and 2) there is rapid extrapulmonary ANG I degradation that does not depend on ANG I-II conversion.

Angiotensin I↗
PubMed1991

Critical decision making: managing the emergency department in an overcrowded hospital.

Hospital and emergency department overcrowding is a serious and growing problem nationwide. Although EDs are organized around the goals of rapid patient assessment, stabilization, and prompt admission to the hospital, an increasing number are being required to hold admitted floor and critical care patients for extended periods due to lack of vacant inpatient beds. Provision of acceptable patient care under such circumstances requires a fundamental reordering of ED priorities and procedures. Overcrowding is the result of inadequate funding for emergency health care services during a period of increasing demand. The initial focus of management strategies to resolve this problem is the inpatient area and includes evaluation of length of stay, "intent to discharge" policies, flexible bed designations, restriction of in-house transfers, and the use of "over-census beds." If in-hospital management strategies fail, modifications in ED management may include staffing contingency plans, definition of physician responsibility, inpatient charts, revised pharmacy formulary, new floor plans, and modified accounting systems. Successful resolution of hospital and ED overcrowding may be the greatest challenge facing emergency medicine today.

Bed Conversion↗
PubMed1984

The significance of vasopressin as a pressor agent.

The antidiuretic hormone, arginine-vasopressin (AVP), may participate in the regulation of blood pressure (BP) through its vasoconstrictor effects. In anesthetized rats, exogenous AVP induced stronger vasoconstriction in the mesenteric than in the renal vascular bed. Conversely, mesenteric but not renal vascular resistance was reduced by a vascular antagonist of AVP, d(CH2)5 VDAVP, in rats with increased endogenous AVP after anesthesia, dehydration, or injection of glycerol. Another vascular AVP-antagonist, d(CH2)5 Tyr (Me) AVP, induced a transient fall in BP in conscious primates (marmosets) after diuretic-induced volume depletion. In conscious rats with established deoxycorticosterone acetate (DOCA)/salt hypertension, d(CH2)5 Tyr (Me) AVP decreased systolic BP after acute administration. After chronic administration of this antagonist during 6 weeks after the beginning of DOCA/salt treatment, the severity of hypertension was reduced. When another, AVP-antagonist, d(CH2)5-D-Tyr (Et) VAVP, which blocks vascular and renal tubular AVP-receptors, was administered chronically, the development of DOCA/salt hypertension was prevented at the expense of severe and persistent hypernatremia. These results demonstrate that under certain conditions the vascular effects of AVP may contribute to the maintenance of BP, AVP appears to participate in the pathogenesis of DOCA/salt hypertension through both its vasoconstrictor and its antidiuretic effects.

Acute Kidney Injury↗
PubMed1994

Does community care reduce the need for psychiatric beds for schizophrenic patients?

For schizophrenics, the closing down of the old traditional hospital has in many places ended up in a scenario characterized by homelessness, relapse, patients overcrowding acute psychiatric but also somatic hospital wards, increased suicide figures, low living standards--and an increased burden on the family. The beds for schizophrenics have been considerably reduced in many countries. For schizophrenia the critical low number of institution beds--hospital as well as nursing home--seems to be 0.07% of the general population. Schizophrenia in all phases must be treated as the disease it is, not as a social problem.

Adult↗
PubMed1990

America's rural hospitals: a selective review of 1980s research.

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities--including conversion of the facility itself--on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.

Financial Management, Hospital↗
PubMed1992

Small rural hospitals with long-term care: 1983 to 1987.

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long-term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983, 1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long-term care bed supply. Hospitals more likely to have long-term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long-term care. While only 14 percent of the 750 hospitals studied had long-term care, they contributed nearly 30 percent of the total long-term care bed supply in their counties. Population-based need and bed supply measures were not significantly different in counties having a small rural hospital with long-term care. Areas of further analysis of the small rural hospital as a resource for long-term care are suggested. The implications for the health care system of small rural hospitals with long-term care are discussed.

Bed Conversion↗
PubMed1986

Idle assets: profits, empty beds make for good bedfellows. Roundtable discussion.

The problem of empty beds does not have to remain a problem. Empty beds can be converted into services or programs that produce revenue for the institution and contribute to the bottom line. In a roundtable discussion sponsored by the Healthcare Financial Management Association and HBO & Company Industry Group, eight individuals met to discuss the problem of empty beds and explore the solutions that are possible. They concluded that hospitals must respond to the marketplace, offer services consumers need, evaluate programs carefully, and pull out when a program no longer is acceptable.

Bed Conversion↗
PubMed1992

[Effects of isosorbide dinitrate and diltiazem used alone or combined on arterial hemodynamic and viscoelastic parameters. Experimental data in the rabbit].

An experimental model of simultaneous recording of aortic pressure and flow and vascular diameter at the entrance to a limited territory of systemic circulation has been developed in the rabbit. A system of data acquisitions and treatment has also been perfected to evaluate the different parietal viscoelastic parameters of arterial flow in capacitance and resistance arteries. This model was used to study the pharmacodynamic effects of two vasodilator drugs, isosorbide dinitrate (ISDN) and diltiazem (DILT), administered alone or in association (ISDN + DILT) by slow intravenous infusion over 30 minutes at dosages chosen to induce comparable hypotension of about 10%. Under these conditions, the effects of ISDN, DILT and ISDN + DILT on resistance parameters were slightly different. The ISDN had no marked effect on mean aortic flow (Qm) apart from a slight decrease after 10 minutes infusion (-10.4 +/- 3.8%, p less than 0.05). On the other hand, DILT alone or in association with IDN was associated with a significant increase in Qm (DILT: +8.5 +/- 0.8%, p less than 0.001; ISDN + DILT: +9.7 +/- 2.1%, p less than 0.01). This explains the absence of a significant effect of ISDN on peripheral resistance (PR) or entrance impedance (Zc) of the vascular bed. Conversely, the effects of DILT and ISDN + DILT on these parameters were very marked (DILT:RP = -17.2 +/- 0.9%, p less than 0.001; Zc = -8.2 +/- 0.5%, p less than 0.001; ISDN + DILT: RP = -16 +/- 1.4%, p less than 0.001; Zc = -8.0 +/- 0.4%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Evaluation of redesignation of acute medical wards to geriatric rehabilitation/assessment.

This paper examines the results of the change of use of 44 out of a complement of 128 general medical beds to geriatric rehabilitation/assessment beds in a general hospital. The method is based on bed utilisation statistics and the results demonstrate that the reduced complement of medical beds functions more efficiently with no reduction in the number of discharges despite a reduction of 34% in available beds.

Acute Disease↗
PubMed1995

Use of general practitioner beds in Leicestershire community hospitals.

BACKGROUND: The shift in care from secondary to primary services is likely to place greater demands on community hospitals. Before changes in the provision of community hospitals can occur, baseline data are needed, outlining their current use. AIM: A study was undertaken to obtain baseline data describing the use of general practitioner beds in Leicestershire community hospitals. METHOD: A three-month prospective, observational study was carried out between February and May 1992 using data from a questionnaire completed by nurses and general practitioners and from patient hospital records. Study patients comprised all patients admitted to general practitioner beds in all eight Leicestershire community hospitals. RESULTS: A 100% questionnaire response rate was obtained giving data on 685 hospital admissions. Around 70% of admissions were of patients aged 75 years and over. Of admissions, 35% were for acute care, 31% for respite care, 22% for rehabilitation, 7% for terminal/palliative care and 5% for other reasons. Fifteen per cent of patients had been transferred from a consultant bed. Of those not transferred, 91% were admitted by their usual general practitioner or practice partner and for 96% of these patients this was the general practitioner's first choice for care. There was significant variation in both the age mix and care category mix of patients between individual hospitals. Medical deterioration in an underlying condition and family pressure on the general practitioner or carers' inability to cope each contributed to around half of all admissions. Of all admissions, 38% lived alone, and 18% of carers were disabled. Incontinence was reported for 35% of patients, and 26% of all patients were of a high nursing dependency. There was low utilization of community services before admission and 33% received none. There was variation between individual hospitals in use of local and district general hospital investigations, specialist referral and types of therapy. Of 685 admissions 11% died during their stay. Of those discharged, 76% went to their own or a relative's home, 10% to a residential or nursing home and 9% were transferred to an acute bed. Nine percent of discharges were postponed and 10% were brought forward. On discharge to non-residential care, 26% of patients received no community services. CONCLUSION: Shifting resources from secondary to primary care is a priority for purchasers. Both the introduction of the National Health Service and community care act 1990, and acute units having increasing incentives for earlier discharge, are likely to place greater demands on community hospital beds. Not all general practitioners have the option of community hospital beds. Before access to general practitioner beds can be broadened, existing beds should be used appropriately and shown to be cost-effective. Purchasers therefore require criteria for the appropriateness of admissions to general practitioner beds, and the results of a general practitioner bed cost-benefit analysis.

Bed Conversion↗