Journal of the Royal Society of Medicine
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative nausea and vomiting: a comparison of anti-emetic drugs used alone or in combination.
Drugs with anti-emetic properties can exert their actions at more than one receptor site, histamine H1, muscarinic cholinergic or dopaminergic D2 receptors. This study was designed to test the hypothesis that a combination of drugs acting at different receptor sites in lower than standard doses would be at least as effective as a standard therapeutic dose of a single anti-emetic agent. A combination of droperidol, hyoscine and metoclopramide in subtherapeutic doses has been shown to be at least as effective as droperidol (1.25 mg) alone. In both groups there was a low incidence of emetic sequelae in the first 3 hours postoperatively.
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Police crime statistics and crime survey data are known to be poor indicators of levels of violence in society. Longitudinal investigations of assault injury have not been carried out in accident and emergency departments hitherto, but may provide an accurate perspective of trends in violence. The attendance of assault patients at a city centre accident and emergency department was compared with 'wounding against the person' recorded by the police between 1973 and 1990. ⋯ From 1975 to 1990, police statistics showed a 9-fold and accident and emergency data a 6-fold increase. Both data sets showed substantial overall increases in violence after 1987, and a decrease in 1979. Further epidemiological studies of violence are necessary.
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Analysis of National Health Service prescription data for the antidepressants from 1980 to 1989 shows a consistent secular trend towards the increased use of generic names on prescriptions for this group of drugs. This apparently reflects national trends for all drugs, and was similar for most antidepressants. However, generic prescribing had by 1989 increased significantly more rapidly with fluvoxamine, which was introduced in 1987. ⋯ However, the use of the generic name on the prescription has relatively little influence on what is dispensed to the patient. Pharmacists may dispense a brand name when given a generic prescription. Moreover, pressures on doctors to write generic names on prescriptions may have limited relevance for some drugs; generic alternatives were available for only four out of 22 antidepressants.