ED treatment of migraine patients has changed.

STUDY OBJECTIVES: Numerous studies have shown benefits of nonnarcotic treatments for emergency department (ED) migraine patients. Our goal was to determine if ED treatment of migraine patients and the rate of return within 72 h have changed. METHODS: Design: Multi-hospital retrospective cohort. POPULATION: Consecutive ED patients from 1-1-1999 to 9-31-2014. PROTOCOL: For determining treatments, we examined charts at the beginning (1999-2000) and end (2014) of the time period. We combined similar medications into the following groups: parenteral narcotics, oral narcotics, antihistamines and dopamine receptor antagonists prochlorperazine/metoclopramide (DRA). We calculated the percent of migraine patients given each treatment in each time period. We identified those who returned to the same ED within 72 h, and calculated the difference in annual return rates between 1999-2000 and 2014. RESULTS: Of the 2,824,710 total visits, 8046 (0.28%) were for migraine. We reviewed 290 charts (147 in 1999-2000 and 143 in 2014) to determine migraine treatments. The use of IV fluids, DRA, ketorolac and dexamethasone increased from 1999-2000 to 2014, whereas narcotic use and discharge prescriptions for narcotics decreased. Of the 8046 migraine patients, 624 (8%) returned within 72 h. The return rate decreased from 1999-2000 to 2014 from 12% to 4% (difference = 8%, 95% CI 5%-11%). CONCLUSION: For ED migraine patients, the use of IV fluids, DRA, ketorolac and dexamethasone increased whereas the use of narcotics and discharge prescriptions for narcotics decreased. The return rates for migraines decreased. We speculate that the increased use of non-narcotic medications contributed to this decrease.

Delayed emesis: moderately emetogenic chemotherapy.

Data on the incidence and efficacy of antiemetic prophylaxis against delayed emesis induced by moderately emetogenic chemotherapy are scanty. An overview of the literature has been done that showed the efficacy of dexamethasone in two of three randomized trials. Its optimal dose and duration of administration has not been defined. Only one of four randomized studies showed a statistically significant efficacy of 5-HT(3) antagonists. Finally, only weak evidence has been published on the efficacy of dopamine receptor antagonists.

[Subjective aspects of pharmacotherapy in schizophrenia during implementation of chlorpromazine in Poland--a review]. / Subiektywne aspekty farmakoterapii schizofrenii w okresie wprowadzania chlorpromazyny do praktyki psychiatrycznej w Polsce--przeglad pismiennictwa.

Introduction of chlorpromazine was the breakthrough in psychiatric practice. Pharmacotherapy with chlorpromazine started in Polish hospitals in the autumn and winter in 1954 and the first papers covering clinical experiences started to be published in 1955. Some of these papers are very informative about subjective aspects of pharmacotherapy, comparison of older and new method of treatment, changes of psychiatric wards atmosphere. They inform also about some social aspects of introduction of this new drug to the practice. In the example families were involved in gaining the drugs for ill family members and doctors sometimes had to win persons' in charge consent to start treatment. In this papers the hope that patients treated with the new drug are more prone to psychotherapy have been expressed. This kind of hope is now expressed in regard to the second generation of antipsychotics. The paper of a Polish author published 1969 that is the pioneering work in the field of research of subjective aspects of pharmacotherapy is presented. Conclusions and methodology of this study are very similar to the later studies that were published in psychiatric literature at the end of 1970's.