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Racial Impact of Crack Sentencing Drug use rates are similar among all racial and ethnic groups. For crack cocaine, two-thirds of users in the U.S. are white or Hispanic. 5 Furthermore, research on drug market patterns demonstrates that drug users generally purchase drugs from sellers of the same racial or ethnic background. 6 Despite these facts, people of color are disproportionately subject to the penalties for both types of cocaine. Indeed, 82.3 percent of crack cocaine defendants in 2005 were African American see Figure 4 ; . 7.
Apokyn, a non-ergoline dopamine agonist for subcutaneous SC ; injection, is indicated for the acute, intermittent treatment of hypomobility or "off" episodes "end-of-dose wearing off" and or unpredictable "on off" episodes ; associated with advanced Parkinson's disease. The agent has been used as an adjunct to other medications. Documents summarizing clinical information on Apokyn and its place in therapy were reviewed. A Committee member explained that Apokyn is unique and a very useful drug. He stated that it has been shown to be beneficial since the 1950s in research studies. He commented that guidelines on appropriate use and treating appropriate candidates who have these off-states would be useful. He added that this drug is not for every kind of off-state problem ; and there can be other less expensive solutions. This Committee member cautioned that this is a very toxic drug; the drug needs to be titrated in a doctor's office, and used in conjunction with the recommended antiemetic. However, because most patients with Parkinson's disease are on dopaminergic drugs chronically, they may not need an antiemetic since they have developed tolerance to the emetogenic effect. This Committee member drew other Committee members' attention to the fact that there are patients who have used apomorphine for erectile dysfunction, and although Apokyn is not that effective for this indication, there is potential for misuse for that purpose. This Committee member noted that even though the chemical structure is so similar to morphine, the issue of opioid cross sensitivity allergic reactions ; has never been addressed and is not addressed in the product information. In summary, he stated that Apokyn is a very useful drug and will be used by patients who are otherwise headed towards surgical treatments for Parkinson's disease and that Apokyn works well in combination with other drugs commonly used for Parkinson's disease. In response to a question about concomitant use in patients on an opioid agonist or antagonist, a Committee member responded that Apokyn has no opioid properties effects ; and that he is not concerned about this issue. In response to an issue raised about safety and physician awareness education ; in regard to concomitant use of an antiemetic, a Committee member stated that supplemental education may be worthwhile, but the instructions in the product labeling are clear that trimethobenzamide should be used concurrently. The Committee members noted that serotonin 5-HT3 ; receptor antagonists were contraindicated with concomitant use with Apokyn due to profound hypotension with loss of consciousness. A Committee member pointed out that also the anti-dopaminergic mechanism of antiemetics, such as that of metoclopramide, can exacerbate the signs symptoms of Parkinson's diseases. He noted that most patients in clinical trials did not need antiemetics after a short time and that as long as a patient is already receiving concomitant dopaminergic therapy, it appears that tolerance may have already developed or will develop quickly to the emetogenic effect. A Committee member noted that trimethobenzamide is an interesting choice because that drug appears on the Beers List of drugs to use with caution in the elderly. Another Committee member stated that trimethobenzamide is labeled as posing a risk for tardive dyskinesia because it is grouped with other.
Tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin-dependent in vitro , a factor of potential importance if the prescription of metoclopramide is contemplated in a patient with previously detected breast cancer.
This paper has been prepared from a continuous review of intensive care and general medical journals supplemented by a computerised bibliographic search of MEDLINE from January 1986 - January 2000 using the following MeSH subject headings: `gastric emptying', `gastroparesis', `enteral nutrition', `metoclopramide', `cisapride' and `erythromycin'. In addition reference lists of selected articles were searched for additional relevant material. Primary research studies were selected for inclusion in this review if they met the following criteria: i ; population: critically ill adult humans, perioperative adult humans, diabetic adult humans with gastroparesis; ii ; content: cause or assessment of gastric emptying, use of prokinetic drugs and reglan.
Altraz arimidex , anastrozole ; used to treat some types of breast cancer that depend on estrogen to grow, and anastrozole can stop tumor growth by blocking estrogen production reglan clopra , maxolon , metoclopramide , octamide ; used to relieve nausea and vomiting; heartburn, stomach pain, and bloating; and a persistent feeling of fullness after meals.
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Numerous clinical studies have shown that oral and subcutaneous formulations of sumatriptan are significantly superior to nontriptan medications traditionally used for the acute treatment of migraine. A controlled comparator clinical study showed that oral sumatriptan 100 mg was significantly superior to oral ergotamine plus caffeine Cafergot ; . However, comparisons with analgesic combination medications were more equivocal. One study with aspirin plus metoclopramide showed that sumatriptan 100 mg was superior but a second study with aspirin plus metoclopramide and a study with an NSAID rapid-release tolfenamic acid ; showed no significant differences between the treatments. Studies have shown that subcutaneous sumatriptan 6 mg is superior to oral sumatriptan and to subcutaneous and nasal spray DHE. Nasal spray sumatriptan 20 mg was also shown to be significantly more effective than nasal spray DHE. However, sumatriptan suppository was less effective than a suppository formulation of ergotamine see Q 4.xx ; . Sumatriptan has long been the gold standard for acute migraine therapy, as it was the only available triptan for several years. The newer triptans have all conducted comparator studies with sumatriptan and these are discussed below see Q 4.xx, and 4.xx.
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People have always had worms. There is evidence for infection in PreColumbian Incas and Pharaonic officials of the Middle Kingdom. Intestinal nematode infection was historically common in Northern Europe: in Scandinavian Vikings, in Imperial Romans, and in the mediaeval vicars chorale at York Minster. Fifty years ago this year, a classical paper entitled This Wormy World1 showed that intestinal nematode infections were amongst the most common of human infections. Today, these infections still affect more than a quarter of the world's population.2 Their ubiquity has stimulated several major control programmes conducted on a scale only exceeded by global vaccination programmes. The Rockefeller hookworm eradication campaign was started in the southern US at the turn of this century, extended globally in 1913, and finally terminated in the 1950s3. Like many early programmes, it was unable to achieve its stated objective, the eradication of hookworm infection and disease with the tools then available. In more recent times, however, several countries, notably Israel, Japan and South Korea have achieved sustained and successful control of intestinal nematode infections. The Japanese national programme in particular has been remarkably successful: the nation-wide overall prevalence of intestinal nematodes was reduced from 73% in 1949 to 1% in 19904.
1.9.2 Ca2 + release from Stores Calcium mobilization from stores during cellular responses to chemoattractants appears to be an essential mechanism for cellular activation Bolotina, 2004; Oommen et al., 2004 ; . Intracellular Ca2 + in the neutrophils is reportedly stored in specialized storage vesicles known as calciosomes Favre et al., 1996; Corbett and Michalak, 2000; Balsinde and Balboa, 2005 ; . However, since there are two distinct cellular locations of Ca2 + stores in neutrophils, these may have differential involvement in the activation of proinflammatory functions that utilize different molecular biochemical mechanisms of Ca2 + mobilization Pettit and Hallet, 1996; Steel and Anderson, 2002 ; . One site is located peripherally under the plasma membrane and the other probably calciosomes ; is localized in the juxtanuclear space and is mobilized by the chemoatractant, N-formylL-leucyl-L-phenylalanine fMLP ; Pettit and Hallet, 1996 ; . Occupation of neutrophil membrane receptors for the chemotactic tripeptide, fMLP, results in receptor-G-protein coupling with consequent activation of phospholipase C PLC ; and generation of inositol 1, 4, 5 triphosphate IP3 ; by hydrolysis of phosphatidylinositol 4, 5-biphosphate Alonso et al., 1998; Patti and Banting, 2004 ; . Once generated, inositol 1, 4, 5 triphosphate binds to an intracellular IP3 receptor located on the surface of intracellular Ca2 + stores endoplasmic reticulum ; , resulting in a rise in [Ca2 + ]i Machaca and Hartzell, 1999; Linn and Gafka, 2001 ; . The phenomenon of calcium release via the IP3 receptor is commonly termed IP3-induced Ca2 + release IP3ICR ; . These events are extremely rapid, occurring within less than 1 second after the ligand-receptor interaction Arredouani, 2004 ; . In the case of neutrophils the abrupt increase in cytosolic Ca2 + following exposure to fMLP, results exclusively from release of the cation from intracellular stores with little or no contribution at this early stage within the first 30 60 sec. ; from extracellular Ca2 + and results in an increase in the basal [Ca2 + ]i from around 100 nM to 1 Anderson and Goolam Mahomed, 1997; Geiszt et al., 1997 ; . Extracellular Ca2 + influx is delayed, being detectable one minute after addition of fMLP and terminating around 5 minutes. This type of influx is a characteristic of storeoperated Ca2 + influx i.e. primarily involved in refilling of stores like ER, as opposed to contributing to activation of neutrophils ; and is operative in a large variety of nonexcitable cells, including neutrophils. Thus, the empty Ca2 + stores activate store22 and naprelan.
Direct costs of the treatment itself drugs and related, eg monitoring, treating adverse effects ; . If the treatment extends life, survivors will continue to utilise healthcare resources.
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Mice, ginger significantly impaired cholesterol biosynthesis and lowered serum cholesterol concentrations18. iii. Human data: A single dose 10 grams ; of ginger had no impact on serum lipids in one study22. There are no studies evaluating the effects of long-term ginger supplementation on serum lipids in humans or evaluating potential interactions with lipid lowering medications. 2. Pulmonary: none 3. Renal and electrolyte balance: none 4. Gastrointestinal hepatic: Antinausea antiemetic, carminative and antiulcer a. Antinausea antiemetic i. In vitro data: none ii. Animal data: In mice, ginger's effect in enhancing intestinal motility was similar to metoclopramide's23. In shrews, dogs and rats, ginger extracts effectively reduced chemotherapy-associated vomiting24, 25. Ginger also protected frogs against experimentally induced emesis26. An herbal combination including ginger and ginkgo was as effective as metoclopramide in another animal study of experimentally-induced nausea27. Studies in rats and mice suggest that ginger produces its antiemetic effects by stimulating peripheral anticholinergic and antihistaminic receptors and or by antagonizing 5-hydroxytryptamine serotonin ; receptors in the gut28, 29. iii. Human data: Both during fasting and after a standard test meal, ginger extracts significantly enhanced gastroduodenal motility in 12 normal volunteers30. Several randomized, controlled trials support ginger's use as an antiemetic for nausea secondary to several conditions: morning sickness, chemotherapy-associated nausea, post-operative nausea and motion sickness. In a randomized, double-blind, placebo-controlled cross-over trial of 30 women with hyperemesis gravidarum, ginger 250 mg four times daily ; proved significantly more effective than placebo in preventing and reducing nausea31. Ginger also proved useful in treating chemotherapy-induced nausea in a small pilot study of 11 adult patients; their nausea scores fell from an average of 2 out of.
Have also been reported. Commonly, levels of blood urea nitrogen, creatinine, and uric acid are lower during administration of carbidopa-levodopa preparations than with levodopa. Carbidopa-levodopa preparations, such as SINEMET Carbidopa-Levodopa ; and SINEMET CR, may cause a false-positive reaction for urinary ketone bodies when a test tape is used for determination of ketonuria. This reaction will not be altered by boiling the urine specimen. False-negative tests may result with the use of glucose-oxidase methods of testing for glucosuria. Cases of falsely diagnosed pheochromocytoma in patients on carbidopalevodopa therapy have been reported very rarely. Caution should be exercised when interpreting the plasma and urine levels of catecholamines and their metabolites in patients on levodopa or carbidopa-levodopa therapy. Drug Interactions Caution should be exercised when the following drugs are administered concomitantly with SINEMET CR Carbidopa-Levodopa ; Sustained-Release. Symptomatic postural hypotension has occurred when carbidopa-levodopa preparations were added to the treatment of patients receiving some antihypertensive drugs. Therefore, when therapy with SINEMET CR is started, dosage adjustment of the antihypertensive drug may be required. For patients receiving monoamine oxidase MAO ; inhibitors Type A or B ; , see CONTRAINDICATIONS. Concomitant therapy with selegiline and carbidopalevodopa may be associated with severe orthostatic hypotension not attributable to carbidopa-levodopa alone see CONTRAINDICATIONS ; . There have been rare reports of adverse reactions, including hypertension and dyskinesia, resulting from the concomitant use of tricyclic antidepressants and carbidopa-levodopa preparations. Dopamine D2 receptor antagonists e.g., phenothiazines, butyrophenones, risperidone ; and isoniazid may reduce the therapeutic effects of levodopa. In addition, the beneficial effects of levodopa in Parkinson's disease have been reported to be reversed by phenytoin and papaverine. Patients taking these drugs with SINEMET CR should be carefully observed for loss of therapeutic response. Iron salts may reduce the bioavailability of levodopa and carbidopa. The clinical relevance is unclear. Although metocloparmide may increase the bioavailability of levodopa by increasing gastric emptying, metocl0pramide may also adversely affect disease control by its dopamine receptor antagonistic properties. Carcinogenesis, Mutagenesis, Impairment of Fertility In a two-year bioassay of SINEMET Carbidopa-Levodopa ; , no evidence of carcinogenicity was found in rats receiving doses of approximately two times the maximum daily human dose of carbidopa and four times the maximum daily human dose of levodopa equivalent to 8 SINEMET CR tablets and nimodipine.
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PAIN CONTROL adult & pediatric ; isolated injuries ; OBVIOUS FRACTURES, DISLOCATIONS, BURNS, etc UNIVERSAL PATIENT CARE PROTOCOL & INITIATE BLS PULSE OXIMETER VASCULAR ACCESS MONITOR AS INDICATED SPLINTING PROTOCOL AS INDICATED WOUND MANAGEMENT or BURN PROTOCOL AS INDICATED MORPHINE SULFATE 0.1mg kg adult & pediatric ; Or NUBAIN 0.1 mg kg if allergies to morphine adult only ; METOCLOPRAMIDE HCL 10 mg IV or IM if severe N V pediatric: 2.5 5 mg ; Or Phenergan 12.5 25 mg IV mix in 10 cc saline pediatric: 0.25 mg kg in 10 cc ; MAY CONSIDER IBUPROFEN 400 MG FOR NON-TRAUMA CONTACT MEDICAL CONTROL MORPHINE SULFATE 0.1 mg kg May receive orders Toradol NON-TRAUMA ONLY Paramedic ; Contraindicated for trauma, kidney stones or within 72 hours of a surgical procedure 60 yo: 30 mg IV or 60 IM renal impairment: 15mg IV or 30mg IM * MS allergies recognized by itching, hives, respiratory distress, etc. Respiratory depression and vomiting are not indicators of MS allergy. Allergies to sulfa agents do not contraindicate administration of MS * Do not give Nubain to chronic narcotic abusers * May use Toradol for kidney stones but not within 72 hours of lithotripsy.
BAERs ; , and electromyography of the facial nerve. A standardized isoflurane opioid anesthetic was provided Table 1 ; , representing routine anesthetic management for this procedure in our institution. All patients in the study received both intraoperative standard dose of 8 mg, IV at the time of incision ; and postoperative dexamethasone as requested by the surgeon ; . At the completion of surgery the subject's trachea was extubated if deemed appropriate by the attending anesthesiologist. Patients requiring continued mechanical ventilation for any reason were excluded from further participation to avoid the confounding effects of the endotracheal tube on the gag response and because of the possibility of limited patient communication. At the time of randomization the research pharmacist was provided with the patient's gender and whether a change in eighth cranial nerve function as determined by BAERs at completion of tumor resection ; was detected, as both of these factors appeared to independently alter the incidence of PONV in our preliminary observations. Postoperatively, patients received antiemetic medication on a regularly scheduled basis, either orally disintegrating ondansetron ondansetron ODT 8 mg BID ; or placebo for up to 72 The first dose of ondansetron or placebo was administered between 4 h and 8 h after tracheal extubation. Metocllopramide 10 mg IV prn every 8 h ; was provided as rescue therapy to any patient as needed for PONV events. For each patient, the number of emetic episodes and requirement for rescue antiemetic treatment was determined from nursing notes and medication administration records. Severity of nausea was recorded using a 10-cm visual analog scale VAS ; twice daily during an interview with the patient. "No nausea" was considered a VAS score of 0, whereas the occurrence of any emesis during the preceding 12-h period was considered a VAS score of 10. Patient satisfaction and noroxin.
Dhe plus me6oclopramide achieved greater reductions in pain scale scores than meperidine plus hydroxyzine p 1.
Introduction Xenotransplantation of pig organs into humans is a possible solution to the shortage of donor organs for transplantation 1, 2 ; , but hyperacute rejection HAR ; is a major obstacle to its success. In pig-to-primate species combinations, HAR is initiated by the binding of naturally occurring antibodies against the carbohydrate Gal1, 3Gal Gal ; epitope on vascular endothelium of the xenografts 35 ; . Although a variety of strategies to prevent anti-Galmediated rejection have been proposed 611 ; , none has proved entirely successful. Although HAR is avoided with these approaches, acute vascular rejection or delayed xenograft rejection DXR ; , which appears to be mediated in part by anti-Gal antibodies and may be complement independent, inevitably occurs 1214 ; . Thus, it is likely that complete, or almost complete, elimination of Gal epitopes from the xenografts, or specific suppression of anti-Gal production, will be required to prevent anti-Galmediated rejection of porcine xenografts in humans 12, 13, 15 ; . Induction of B-cell tolerance to specific xenoantigens would permanently avoid the problem of antibody-mediated rejecThe Journal of Clinical Investigation | and norfloxacin.
Approximately 40% of patients with seizure disorders achieve adequate control on monodrug therapy.
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References 1. Morrison I. "The Future of Physicians' Time, " Ann Intern Med, 2000; 132: 80-84. Morrison I. "Health Care in the New Millennium, " Jossey-Bass Publishers, San Francisco, 2000. 3. Gertis M, Edgman-Levitan S, Daley J, Delbanco T eds. "Through the Patient's Eyes, " Jossey-Bass, 1993. Bibliography Alvord LA. "The Scalpel and the Silver Bear: the First Navajo Woman Surgeon Combines Western Medicine and Traditional Healing, " Bantam, 1999. Dossey L. "Whatever Happened to Healers?" Alternative Therapies 1995; 5: 6-13. Kenagy J, Berwick D. "Service Quality in Health Care, " JAMA 1999; 281: 661-665. Sobel D, "Rethinking Medicine: Improving Health Outcomes With Cost-effective Psychosocial Interventions, " Psychosom Med, 1995; 57: 234-244 and nateglinide and metoclopramide, because side effects of metoclopramide.
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Have found intravenous dihydroergotamine to be effective in reducing both pain and emergency room use, three clinical trials failed to find any effect of oral ergotamines on migraine pain Kumar and Cooney, 1995 ; . Metoclopramidee and chlorpromazine also have clinical trial and viramune.
| Metoclopramide urinary retentionThe MI Principles do not allow consent to treatment or to the waiver of any of an individual's rights by members of his or her family. A "personal representative" for a person who lacks capacity for a certain decision may only be appointed after a hearing by an "independent and impartial tribunal, " at which a patient has a right to counsel.xxxii The Inspector General of Psychopaths reported that no procedure currently exists for obtaining the informed consent of patients or family members to psychotropic medication or ECT. He said that he is planning to institute a new procedure for establishing the informed consent of family members to ECT. In the future, the Inspector says that he will institute a similar form for consent to psychotropic medication. The Inspector mentioned no intention to introduce procedures to obtain patients' informed consent to treatment. Current practice regarding family consent appears to be varied. Some family members in Uruguay report that they are occasionally asked to provide consent to ECT on behalf of their relatives. Two of nine families MDRI interviewed said that public psychiatric institutions asked for authorization to administer ECT, while other relatives reported that they were never asked. Similarly, the majority of families reported that they were never informed about the side effects of ECT. A number of family members explained that private psychiatric institutions regularly ask for permission to perform ECT because the family must agree to pay for the treatment. In one case, members of a family reported objecting strenuously when a psychiatrist ordered a series of eight administrations of ECT for their son. ECT was administered on one occasion despite their objections, but the series was discontinued. d. Reproductive rights parental rights.
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In patients receiving metoclopramide than those receiving ondansetron irrespective of low high dose cisplatin regimen. The difference was statistically significant P 0.05 ; only in low dose cisplatin groups. The dropouts and withdrawals were also significantly P 0.001 ; higher in the high dose cisplatin groups irrespective of whether ondansetron or metoclopramide was used as an antiemetic. There was no significant difference in the patient profiles of different groups Table II ; . Vomiting : The mean latency to first emetic episode varied from 1.9 to 5.0 h. The number of emetic episodes were more in patients given metoclopramide in comparison to those receiving ondansetron irrespective of dose of cisplatin P 0.05 ; . Dexamethasone significantly potentiated the antiemetic effect of metoclopramide but the potentiation was not significant in case of ondansetron. The effectiveness of ondansetron was not different against the two regimens of cisplatin whereas metoclopramide was significantly less effective against high dose cisplatin. The combination of metoclopramide and dexamethasone matched the antiemetic efficacy of ondansetron monotherapy Table III.
| The following coding system is used to indicate the nature of the supporting evidence in the references: [A] Randomized clinical trial. A study of an intervention in which subjects are prospectively followed over time; there are treatment and control groups; subjects are randomly assigned to the two groups; both the subjects and the investigators are blind to the assignments. [B] Clinical trial. A prospective study in which an intervention is made and the results of that intervention are tracked longitudinally; study does not meet standards for a randomized clinical trial. [C] Cohort or longitudinal study. A study in which subjects are prospectively followed over time without any specific intervention. [D] Case-control study. A study in which a group of patients and a group of control subjects are identified in the present and information about them is pursued retrospectively or backward in time. [E] Review with secondary data analysis. A structured analytic review of existing data, e.g., a meta-analysis or a decision analysis. [F] Review. A qualitative review and discussion of previously published literature without a quantitative synthesis of the data. [G] Other. Textbooks, expert opinion, case reports, and other reports not included above. 1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, Text Revision DSM-IV-TR ; . Washington, DC, APA, 2000 [G] 2. Jobson KO, Potter WZ: International Psychopharmacology Algorithm Project report. Psychopharmacol Bull 1995; 31: 457507 [F] 3. American Psychiatric Association: Practice Guideline for Psychiatric Evaluation of Adults. J Psychiatry 1995; 152 Nov suppl ; [G] 4. Kernberg OF, Selzer M, Koenigsberg H, Carr A, Appelbaum A: Psychodynamic Psychotherapy of Borderline Patients. New York, Basic Books, 1989 [G] 5. Linehan MM, Heard HL, Armstrong HE: Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry 1993; 50: 971974; correction, 1994; 51: 422 [A] 6. Kjelsberg E, Eikeseth PH, Dahl AA: Suicide in borderline patients--predictive factors. Acta Psychiatr Scand 1991; 84: 283287 [D] 7. Sederer LI, Ellison J, Keyes C: Guidelines for prescribing psychiatrists in consultative, collaborative, and supervisory relationships. Psychiatr Serv 1998; 49: 11971202 [F] 8. Linehan MM, Armstrong HE, Suarez A, Allmon D, Heard HL: Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Arch Gen Psychiatry 1991; 48: 10601064 [A] 9. Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. J Psychiatry 1999; 156: 15631569 [A] 10. Bateman A, Fonagy P: Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18-month follow-up. J Psychiatry 2001; 158: 3642 [A] 11. Gabbard GO, Horwitz L, Allen JG, Frieswyk S, Newsom G, Colson DB, Coyne L: Transference interpretation in the psychotherapy of borderline patients: a high-risk, highgain phenomenon. Harv Rev Psychiatry 1994; 2: 5969 [B] 12. Gunderson JG: Borderline Personality Disorder: A Clinical Guide. Washington, DC, American Psychiatric Press, 2001 [G] Treatment of Patients With Borderline Personality Disorder 73, for example, metoclopramide nursing.
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