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Biomedical subjects

M Bukowskyj

Publications and source records attributed to M Bukowskyj.

6 recordsLinked to original sources
PubMed1994

Reconciling two solitudes: the example of physicians and managers in Ontario's hospitals.

This paper describes five aspects of the traditional relationship of physicians to hospitals and their administrators which fail to facilitate cost control or quality assurance. Several significant obstacles to changing this relationship are described, including the inertia of tradition, the fallacy of costless care and the chasm between medical and management cultures. It argues that to achieve care which is both cost-efficient and of high quality, physicians and hospital managers must unite to pursue common goals in a well-integrated management structure. Five suggestions for developing an effective new relationship are made, including the adoption of a "social contract" for all hospitals, the integration of physicians into hospital management and quality assurance programs, improved patient-level data collection and obligatory cost-awareness programs for hospital physicians.

Cost Control↗
PubMed1987

The bronchodilator effect of caffeine in adult asthmatics.

UNLABELLED: Caffeine has been reported to result in bronchodilation in asthmatic children. Our study was designed to assess the effect of caffeine on pulmonary function in adults with asthma. We studied 8 patients: 4 men and 4 women with previously documented airway reactivity. A randomized, double-blind cross-over was used. The patients received either placebo or 5 mg/kg of caffeine in solution orally, and FEV1, FVC, FEF25-75, Vmax25 and blood for caffeine concentrations were taken at several time points for as long as 8 h after the drink. RESULTS: there was a significant difference between caffeine and placebo for percent change in FEV1 with peak change at 1.5 h. There was also a significant difference for percent change in FEF25-75 with peak occurring at 4 h. Percent change in Vmax25 was significantly different at 3.0 h only. Peak caffeine concentration of 8.7 +/- 1.7 micrograms/ml occurred at 1 h. The data indicate that caffeine at a dose of 5 mg/kg can produce significant percentage improvement in FEV1, FEF25-75, and Vmax25 in adult asthmatics.

Adult↗
PubMed1984

Theophylline clearance. Lack of effect of influenza vaccination and ascorbic acid.

Warnings have been issued regarding safety in the use of theophylline preparations in patients receiving influenza vaccination. These were prompted by reports that influenza vaccination caused inhibition of metabolism of theophylline and aminopyrine. Previous work has indicated a role for ascorbic acid in mixed function oxidase activity, and ascorbic acid is commonly used by the public. We studied the effect of influenza vaccination and ascorbic acid supplementation on the rate of elimination of theophylline. In 11 patients and 12 normal subjects no significant effects of influenza vaccination or ascorbic acid supplementation on theophylline clearance, serum half-life, or apparent volume of distribution were detected (p greater than 0.3). We conclude that neither influenza vaccination nor ascorbic acid supplementation induce a predictable effect on theophylline disposition.

Adult↗
PubMed1984

Theophylline reassessed.

Advances have recently been made in understanding the pharmacokinetics of theophylline. To correlate the new knowledge of theophylline pharmacokinetics with the drug's current status in therapy, we have critically reviewed the relevant investigations of the last 5 years. We consider data on its presumed mechanisms of action, factors affecting its clearance, its use in pregnancy, treatment of overdoses, and important drug interactions. Theophylline clearance is decreased by concomitant use of erythromycin, cimetidine, high-dose allopurinol, oral contraceptives, and caffeine. Clearance is increased by concomitant use of phenobarbital and phenytoin. Newly discovered actions of theophylline include dose-dependent improvement of diaphragmatic contractility, augmentation of ventilatory response to hypoxia, and sleep disturbances (especially with high-dose treatments). Points clinically relevant to the daily use of theophylline derivatives and the importance of sustained-release preparations are discussed. Theophylline continues to play a major role in therapy for reactive airways disease.

Acidosis↗