Risk of discontinuation of atypical antipsychotic agents in the treatment of schizophrenia.

Objectives: To compare discontinuation rates of atypical antipsychotic agents in patients with schizophrenia.

Method: Adult Maryland Medicaid patients with schizophrenia were categorized based on initial atypical antipsychotic drug received: aripiprazole (n=446); olanzapine (n=1705); quetiapine (n=1467); risperidone (n=1580); and ziprasidone (n=700). Discontinuation was measured using refill patterns, allowing 14-day gaps between refill dates.

Effect of initial ziprasidone dose on treatment persistence in schizophrenia.

Objective: To determine the relationship between ziprasidone initial dose and treatment persistence among patients diagnosed with schizophrenia.

Method: Adult Medicaid recipients (N=1096) diagnosed with schizophrenia who had ziprasidone prescription claims between July 1, 2001 and September 30, 2003, were categorized by initial dose: low (20-60 mg per day, n=464), medium (61-119 mg per day, n=320) and high dose (120-160 mg per day, n=312). Treatment persistence up to 365 days was measured using refill patterns, allowing 15-day gaps between expected refill dates.

Approach to ophthalmologic emergencies.

This article presents evaluation and treatment approaches to ophthalmologic conditions that are likely to be encountered in a primary care office. These conditions can be organized by diagnostic category, symptoms, and location of complaint. By using one ora combination of these categories, the practitioner can provide appropriate, timely, and effective ophthalmologic evaluation and treatment.

Prescription noncompliance: contribution to emergency department visits and cost.

We randomly surveyed 100 patients in the acute care section of a large urban university hospital Emergency Department (ED) on 6 days with regard to the existence of and reasons for prescription noncompliance. Noncompliance was considered a major factor contributing to the ED visit if: (1) no medications had been taken for at least 48 h before the ED visit; (2) the medications, when previously taken, had routinely controlled the condition for which the patient was presenting to the ED; and (3) no other significant cause or illness was believed to have precipitated the ED visit. ED, admissions, and yearly medication costs were calculated for all patients.

Cerebral ventricular shunts.

Cerebral ventricular shunts are siphoning devices used to treat hydrocephalus. They are placed within cerebral ventricles and peripheral cavities such as the ventricular atrium or peritoneal cavity. Complications include obstruction of cerebral spinal fluid (malfunction) and infection.

Antiepileptic drug therapy: clinical laboratory significance.

When evaluating a patient who is taking an antiepileptic medication, it is important for the emergency physician to correlate the clinical presentation with the antiepileptic drug level. Therapeutic ranges have been suggested for most antiepileptic medications, but these must be interpreted in light of clinical efficacy and patient tolerance. When considering the efficacy of anti-epileptic medications, it is necessary to consider the patient's unique metabolism, side-effect tolerance, and overall response to therapy.

Acute stroke.

Disruption of cerebral blood flow may influence brain energy metabolism to produce reversible or irreversible neurologic deficits. The emergency physician is in a unique position to provide timely treatment during the first few hours of an acute stroke. He or she must be facile with unique pharmacologic and non-pharmacologic treatment designed for the stroke patient concerning ventilation, blood pressure, and circulation.

Ophthalmologic therapeutics.

For the treatment of ocular disorders, the emergency physician has access to a variety of medications and delivery systems. This article focuses on topically applied ophthalmic medications: ointments and solutions, which are placed in the inferior conjunctival cul-de-sac, and hyperosmotic agents, which are administered parenterally. The indications, contraindications, potential side effects, mechanism of action, and dosage schedules for eight categories of ophthalmic agents are described.

Vascular morphology and permeability in fetal CNS grafts to the renal capsule.

According to conventional neovascularization concepts, due to local tissue factors, a viable graft of central nervous (CNS) tissue should be expected to retain a complete blood-brain barrier (BBB) in its new site. In order to determine if grafted CNS would alter the phenotype of ingrowing peripheral vessels we have used an uncomplicated model. Rat fetal cortex, which already has a BBB to protein, was grafted to the subcapsular space of the host rat kidney.

The cutting-edge microvascular needle. A scanning electron microscopic study.

The authors have compared the vascular endothelial damage caused by blunt-tipped microvascular needles as reported previously with that of sharp cutting-edged needles of comparable size. The same four distinct vascular lesions were found with cutting-edged needles as with the blunt-tipped needles. Even though one experimenter made all of the lesions, and all of the tissue was handled in the same fashion, there was much variation in the extent of the intimal damage.