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Biomedical subjects

K N Gillespie

Publications and source records attributed to K N Gillespie.

23 records · Page 2Linked to original sources
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.

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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↗
PubMedDate not supplied

Anatomy of a meta-analysis: a critical review of "exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance".

BACKGROUND: Accurate diagnosis of coronary heart disease has the potential to contribute substantially to cost-effective delivery of health services. Recent work by Fleischmann et al (JAMA 1998;280:913-20) represents an effort to summarize the accuracy of exercise echocardiography and exercise single photon emission computed tomography (SPECT). METHODS AND RESULTS: A critique of the previous work was constructed, obtaining the 44 articles used. These articles were reviewed and summarized with established techniques for meta-analysis. The studies summarized by Fleischmann et al were found to be significantly heterogeneous (echocardiography and SPECT, both P<.001). In the SPECT cohort, combination of different radioisotopes and reading techniques, and inclusion of reports using experimental techniques, were sources of heterogeneity. In the echocardiography cohort, experimental techniques and an individual series were identified. When the sample was stratified for sources of heterogeneity, it was found that there was no significant difference in diagnostic accuracy between the echocardiography and SPECT techniques used in current clinical practice. Meta-regression with summary receiver operating characteristic curve techniques, after adjustment of the model for multicolinearity and outliers, revealed that there were no significant differences between SPECT as used in current clinical practice and echocardiography. CONCLUSION: The report by Fleischmann et al contains serious flaws that limit its validity and generalizability.

Echocardiography↗
PubMedDate not supplied

A gender-specific hazard-based clinical and noninvasive coronary risk scoring system for patients with suspected coronary artery disease.

OBJECTIVE: An outpatient-based scoring system was developed for at-risk patients with coronary artery disease based on data derived from the clinical history and noninvasive testing results for the prediction of an adverse event, the development of risk subsets, and the evaluation of the appropriateness of utilization patterns in an ambulatory care patient population. METHOD: This was a hospital-based cohort study. From a population of 3,795 consecutively tested patients, 872 with suspected coronary artery disease were enrolled from a midwestern university tertiary medical center from 1988 to 1989. RESULTS: Multivariable Cox modeling was used to develop scoring weights with scores ranging from -1.6 to 8.5 points. Significant multivariable disease predictors of cardiac death or myocardial infarction were use of nitroglycerin or insulin, ST-T wave changes, female gender, left ventricular hypertrophy, and a reversible thallium 201 defect. Receiver operating characteristics curves by use of the hazard score were comparable by gender. A probability threshold of .30 for cardiac death or myocardial infarction yielded a cut point of acceptable sensitivity and specificity for prompting medical management decisions. Below this threshold, the rate of follow-up diagnostic testing was 16.9% for women and 57.8% for men (p=.00001). Above this threshold, the rate of follow-up diagnostic testing was 40.6% for women and 64.3% for men (p= .04). CONCLUSION: Use of cardiac diagnostic services and cardiac event-free survival varies by gender in patients screened by noninvasive testing. For men at low risk of cardiac death or myocardial infarction, a statistically greater use of follow-up diagnostic testing was reported, thus reflecting more aggressive treatment and overuse of services for men as compared with women.

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