Arch Intern Med
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We prospectively studied the communication between 27 referring practitioners and their consultants for 464 consecutive patient referrals from a general internal medicine group practice at a university medical center. The rates of referral among practitioners varied from 0 to 28.1 per 100 patients visits. Though referring physicians provided patient background information in 98% of the cases, they made explicit the purpose of the referral in only 76% of the cases. ⋯ In return, consultants communicated their findings to referring practitioners in only 55% of the consultations. Referring physicians who personally contacted consultants or who supplied them with more clinical information were more likely to learn the results of the consultation. While communication between the referring physicians and consultants in this setting is limited, it may be improved if referring physicians supply more clinical information to consultants and contact them directly.
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The neuroleptic malignant syndrome (NMS), clinically manifested by hyperpyrexia, mental status changes, muscular rigidity, and autonomic dysfunction, is an idiosyncratic reaction to major neuroleptic pharmacologic agents. The reported causes of morbidity and mortality include respiratory insufficiency, cardiovascular collapse, arrhythmias, and renal failure. Coagulopathy does not seem to be a prominent component of the syndrome. We observed a case of NMS in which disseminated intravascular coagulation was a prominent feature.
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Comparative Study Clinical Trial Controlled Clinical Trial
A double-blind clinical trial in weight control. Use of fenfluramine and phentermine alone and in combination.
We performed a double-blind, controlled clinical trial comparing phentermine resin (30 mg in the morning), fenfluramine hydrochloride (20 mg three times a day), and a combination of phentermine resin (15 mg in the morning) and fenfluramine hydrochloride (30 mg before the evening meal), and placebo. We combined low doses of the two drugs to maintain efficacy while diminishing adverse effects. Eighty-one people with simple obesity (130% to 180% of ideal body weight) participated. ⋯ Adverse effects were less frequent with the combination regimen than with other active treatments. Thirty-seven participants dropped out of the study, 18 for reasons related to drug treatment. Combining fenfluramine and phentermine capitalized on their pharmacodynamic differences, resulting in equivalent weight loss, fewer adverse effects, and better appetite control.