PubMed Health⌕ Search

Biomedical subjects

M B Matthews

Publications and source records attributed to M B Matthews.

18 recordsLinked to original sources
PubMed1987

A hospital administrator's guide to successful HMO negotiations.

Many issues must be considered when hospitals negotiate with HMOs. Hospital administrators can improve negotiations with HMOs by understanding the philosophy and terminology of alternative delivery programs, as well as their hospital's own operating requirements.

Health Maintenance Organizations↗
PubMed1985

Subclinical chronic Q fever.

Seven patients are described in whom chronic Q fever was detected by serology (Coxiella burneti phase I antibody titre greater than 1:200) during routine screening at admission for cardiac catheterisation. None had clinical evidence of endocarditis, hepatitis or other foci of infection. Three of the patients were kept under observation without antibiotic treatment for periods of six, 18 and 20 months. In two patients of this group, cardiac tissue was obtained at operation and in one patient seroconversion following guinea-pig inoculation indicated the presence of Coxiella burneti infection. Four patients were given antibiotic treatment when Q fever was confirmed by serology. Courses of antibiotic treatment with a combination of two drugs were maintained for four to six years and in three of these patients phase I antibody titres fell to very low levels with no appearance of overt infection. The fourth patient died after resection of an aortic aneurysm, seven months after starting antibiotic treatment. Cases reported in the literature indicate that while endocarditis is the most common manifestation of chronic Q fever, the infection can persist at other sites. Of the seven cases of subclinical chronic Q fever reported here, the infection was localised in only one. Patients with this subclinical form of infection pose the therapeutic dilemma of whether or not they should receive antibiotic treatment.

Adult↗
PubMed1983

The use of scenario generation for examining future hospital utilization.

The scenario generation method is a straightforward method of isolating and analyzing the effects of several competing trends on future demand for hospital care. Through the use of scenario generation, a hospital has an opportunity to help choose its future, rather than being forced to passively watch health care evolution run its course.

Adolescent↗
PubMed1983

Management of hypertension--a study of hospital outpatient practice.

In this third report on the management of hypertension by general practitioners and hospital physicians we review hospital outpatient practice in a representative sample of 90 new patients and 436 returning patients attending the clinics of three Edinburgh hospitals. Seventyeight per cent of the new patients were seen by a consultant or senior registrar. An unacceptable number of deficiencies was found in clinical assessment and these are discussed. Consultants are shown to be more conservative than junior hospital doctors in their treatment of hypertension.

Adult↗
PubMed1982

Persistence of ductus arteriosus with left to right shunt in the older patient.

Eight hundred and four patients with persistence of the ductus arteriosus were seen in Edinburgh between 1940 and 1979. Thirty-seven of them reached the age of 50 years, and in 32 the shunt was exclusively from left to right. Fifteen of the 32 were subsequently treated surgically. None of the 32 was lost to follow-up. Duration of clinical observation averaged 17 years and extended to over 30 years in eight patients. Their features have been correlated with those from reports of 48 comparable patients in an attempt to clarify the management of the persistent ductus in the older patient. Impairment of left ventricular function is shown as the major risk, even when the ductus is small. Bacterial endarteritis is infrequent. Surgical treatment carries greater risk than in childhood and early adult life but usually reduces heart size and restores exercise tolerance. Left ventricular dysfunction, however, occasionally vitiates the benefits; symptoms are then incompletely relieved and death from heart failure may occur months or years after operation. Experience in older patients thus emphasises the value of elective operation in childhood, however well the child, however trivial the shunt. It is concluded that in older patients, the presence or the development of symptoms or cardiac enlargement are almost always indications for surgical treatment. As age increases, especially by the eighth decade, medical treatment may be preferable. Continued follow-up of symptomless patients without cardiomegaly is important because increase in heart size usually precedes further deterioration which can then be prevented by timely surgical treatment.

Adult↗
PubMed1980

An unusual case of large right atrial myxoma.

A case of right atrial myxoma is described. The patient had vague and variable symptoms and it was not until five years after first presentation that she had developed clinical and electrocardiographic evidence of right atrial hypertrophy, and angiocardiographic evidence of a fist-sized myxoma which was subsequently removed surgically.

Adult↗
PubMed1979

Chronic cryptic Q-fever infection of the heart.

Evidence of chronic Coxiella burneti infection of the heart, a disease previously considered peculiar to patients with valvular heart-disease, was found in a patient during routine serological tests before resection of a ventricular aneurysm and also by isolation of the rickettsia from the resected tissue. The patient had no symptoms or signs of Q-fever endocarditis and none of the laboratory evidence usually associated with it.

Antibodies, Bacterial↗
PubMed1976

Chronic Q fever.

Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, three received medical therapy alone and six required valve replacement as well. Antibiotics have been discontinued in four patients who have had valve surgery and three others. Six patients had received antibiotics for continuous periods varying from 29-62 months. In the period after stopping therapy varying from 15-21 months, no relapse has occured. A seventh patient, who had received antibiotics for four months prior to valve replacement, has survived 43 months after the withdrawal of antibiotics...

Adult↗
PubMed1974

Evolution of an examination: M.R.C.P. (U.K.).

Recent changes in the structure of the examination for M.R.C.P. (U.K.) have prompted a review of these together with a historical outline of the examinations which preceded it at the Royal Colleges of Physicians of Edinburgh, Glasgow, and London.Part I of the examination continues to fulfil its role as a screen and a slight change in the marking system appears to have improved its discriminating powers still further. The major change in part II is the substitution of a more objective written test in place of the essay papers.

Education, Medical, Undergraduate↗
PubMed1970

Evan Jones.

Explore the source record for details and available documents.

Cardiology↗