Fallacies and pitfalls of hospital cost containment.
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Biomedical subjects
Publications and source records attributed to J Webster.
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The forced expiratory volume in one second (FEV1) response to salbutamol administered by pressure-packed aerosol 200 microgram, and intermittent positive pressure ventilation (IPPV), 5 and 10 mg, was determined in 60 patients with chronic bronchitis with airway obstruction. The bronchodilator response to salbutamol by IPPV was greater than by pressure-packed aerosol only in patients with severe airways obstruction and little additional benefit was gained with the 10 mg dose.
Combined treatment with low doses of different drugs is widely used for moderate hypertension. The effects of atenolol and methyldopa at two dose levels and in combination at the lower doses were studied in patients with moderate hypertension on continuous treatment with moderate hypertension on continuous treatment with chlorthalidone. The mean reduction in standing blood pressures obtained with atenolol 150 and 300 mg/day was about 27/17 mm Hg and with methyldopa 750 and 1500 mg/day about 28/14 mm Hg. Combined treatment with atenolol 150 mg/day and methyldopa 750 mg/day for four weeks resulted in a reduction of 38/25 mm Hg. No difference was observed between the two doses of methyldopa. The lower dose of atenolol was better than the lower dose of methyldopa in reducing lying and standing diastolic blood pressures. These findings show that in patients on continuous treatment with chlorthalidone the addition of atenolol alone or methyldopa alone or of atenolol and methyldopa in combination is effective in the treatment of moderate hypertension.
1 The effect of atenolol, a cardioselective beta adrenoceptor antagonist, was studied in a double-blind crossover trial in twenty-one carefully selected hypertensive outpatients. Each patient received atenolol (50 mg/day, 100 mg/day, 200 mg/day) and placebo according to a randomized sequence in a once-daily dose. Wash-out periods on a matching placebo were included between the treatment periods. 2 The effect of lying, standing and post-exercise blood pressure of atenolol 50 mg once-daily was not significantly different from atenolol 100 or 200 mg once-daily. The reduction in lying and standing blood pressure was approximately 23/16 and 22/18 mm Hg from levels at the end of a run-in period on matching placebo of 167/108 and 162/112 mm Hg respectively. 3 The study shows that atenolol is an effective hypotensive agent in a once-daily dose.
A 19-year-old female presented with cardiac tamponade complicated by acute renal failure. Salmonella agona was cultured from pericardial aspirate after repeated pericardiocentesis in several sites. Treatment with ampicillin and intermittent haemodialysis led to complete recovery.
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A new technique is described which utilizes ultrasound to diminish fetal exposure to x ray during intrauterine transfusion. In replacing x ray imagery, ultrasound better localizes the exact position of the intrauterine contents, including the vital fetal intraabdominal structures. Using an A mode needle aspiration transducer, it is possible to guide the tip of the transfusing needle into the center of the fetal intraperitoneal cavity.
Low income diets provide relatively little zinc. This study was designed to evaluate the zinc nutritional states of 74 low income preschool children enrolled in the Denver Head Start Program. Zinc is necessary for normal growth, hence children were selected on the bases of low height percentiles. The mean (+/- SE) hair zinc concentration was 87.0 +/- 5.9 mug/g, and the mean plasma zinc concentration was 74.5 +/- 1.5 mug/100 ml. These levels were both lower (P is less than 0.005) than those of middle income children of similar age. Sixty-eight percent of the study group had a hair zinc concentration less than 70 mug/g and/or a plasma zinc concentration less than 68 mug/100 ml. These results indicate that inadequate zinc nutrition may be common among preschool children with low growth percentiles from low income families.
In order to investigate the mode of action of the electrical discharges from a surgical electronic lithoclast in shattering bladder stones high speed pressure-time recordings were made. The results indicated effects similar to those following an underwater detonation of high explosive. Subsequent high speed photographic analysis confirmed this. Calculations based on the results suggested that the shock waves and pressure pulses generated were of a potentially hazardous magnitude and that gas-containing bowel close to the bladder might be at particular risk as well as solid tissue as the bladder wall. Photographic data also suggested that danger might be incurred by the use of similar devices in a small enclosed space such as the ureter or renal pelvis.
Adverse reactions may occur as a predictable or unpredictable drug-induced illness can be reduced if the awareness of the prescribing doctor of clinically relevant drug and patient factors, which affect the response to the drug, can be increased. However, unexpected and unpredictable adverse reactions, sometimes reported as a single case in an anecdotal case report, are more difficult to evaluate and explain. Beta-blocking agents such as propranolol, oxprenolol and practolol have been asssociated with numerous adverse reactions. The influence of drug factors, such as range of action, absorption, metabolism, excretion, interactions, and patient factors such as disease states, idiosyncrasy, and personality are discussed.
The effect of atenolol, a new beta-1-adrenergic receptor blocking agent, was studied in a double-blind cross-over trial in 24 carefully selected hypertensive outpatients. After a four-week run-in period on matching placebo each patient received atenolol 200 mg/day, atenolol 400 mg/day, a combination of atenolol 200/mg day with bendrofluazide 5 mg/day, and bendrofluazide 5 mg/day alone, according to a random sequence. Atenolol at either dose produced a significantly greater reduction in all blood pressure levels except standing systolic pressure than bendrofluazide alone. There was no statistically significant difference between the effects of the two atenolol doses on either blood pressure or pulse rate. The addition of bendrofluazide to atenolol resulted in a further significant lowering of the blood pressure. A significant effect of thiazide on weight was noted. The study shows that atenolol, a cardioselective beta-blocker of similar potency to propranolol in animals but without membrane-stabilizing or partial agonist acitivity, is an effective and well-tolerated hypotensive agent.