Biomedical subjects
Publications and source records attributed to G E Matthews.
In order for integration between physician practices and hospitals to be successful, each will have to overcome cultural differences that have contributed to a sometimes adversarial relationship. Such differences can be attributed to opposing views related to focus, perspective, working environment, decision making, goals, working style, and management style.
Many physician group practices--particularly practices that have been acquired by hospitals and integrated delivery systems--are experiencing expense increases and productivity decreases. Physician group practices can take steps to reverse these unfavorable trends by carefully reviewing and benchmarking practice costs related to physician compensation plans, support staff salaries and benefits, occupancy costs, clinical supply costs, and malpractice insurance. Group practices also can improve cost management and resource utilization by creating an operating budget based on historical expenditures and anticipated revenues and by comparing it with peer benchmarks.
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In a randomized cross-over study the effect of verapamil on the pharmacokinetics of theophylline was evaluated in eight cigarette smoking male volunteers. Theophylline was administered as an intravenous infusion of aminophylline, 6 mg/kg based on ideal body weight, over 30 minutes in the control phase. In the treatment phase, aminophylline was administered after a four day regimen of oral verapamil 80 mg every 8 hours. Serial blood samples were collected over a 24 hour period following aminophylline administration. Theophylline serum concentrations were determined by a fluorescence polarization immunoassay, the Abbott TDxR. Theophylline clearance decreased by 11.5%, from a mean (+/-SD) of 1.39 +/- 0.38 mL/min/kg in the control phase to 1.23 +/- 0.21 mL/min/kg with the co-administration of verapamil (P = 0.104). Theophylline elimination rate constant decreased by approximately 9.4% from 0.171 +/- 0.032 to 0.155 + 0.023 hr-1 during the treatment phase (P = 0.085). The area under the curve (AUCo alpha) and volume of distribution at steady-state (Vss) for theophylline were also not statistically different between the two study phases. These results are inconsistent with those of other investigators and the relevance of a potential theophylline-verapamil drug interaction remains unclear.
Streptokinase is a thrombolytic agent used most commonly for the dissolution of thrombi obstructing coronary arteries during acute myocardial infarction (MI). Anaphylactic reactions induced by streptokinase occur rarely. We report the case of a patient with acute MI who developed anaphylaxis shortly after the initiation of an intravenous infusion of streptokinase. The patient became profoundly hypotensive and developed an erythematous rash that spread rapidly to cover most of his body. He required mechanical ventilation and the administration of epinephrine for blood pressure support, which succeeded after dopamine and norepinephrine had failed. Streptokinase-induced anaphylaxis is thought to be mediated by immunoglobulin E (IgE), and patients who develop this adverse reaction have been shown to have higher serum concentrations of IgE to streptokinase than those who do not. Epinephrine is the agent of choice for the management of hypotension associated with anaphylaxis. Little evidence exists to support the routine pretreatment of patients who are to receive streptokinase with corticosteroids and/or antihistamines. Streptokinase skin testing may be a useful and accurate means of identifying patients at risk for streptokinase-induced anaphylaxis. Further investigation is required to determine the appropriateness of skin testing in streptokinase therapy.