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4. Lieberman, J.A., "Comparative effectiveness of antipsychotic drugs: a commentary, " Archives of General Psychiatry October 2006 6; 63: 1069-1072 Rosenheck, R.A., "Outcomes, costs, and policy caution a commentary on the cutlass study, " Archives of General Psychiatry October 2006 6; 63: 1074-1076. Stroup T.S. et al, "Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. American Journal of Psychiatry, April 2006 163 4 ; : 611-622. 7. McEvoy J.P. et al, "Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. American Journal of Psychiatry, April 2006 163 4 ; : 600-610. 8. Davis, J.M., "The choice of drugs for schizophrenia, " New England Journal of Medicine, February 2, 2006 354 5 ; : 518-520. 9. "Drugs for Psychiatric Disorders, " Treatment Guidelines from the Medical Letter June 2006 Vol. 4, No 46. 10. Carpenter, W.T. and Thaker, G.K., "Schizophrenia, " ACP Medicine June 2004 WebMD, Inc.
Atypical antipsychotics includes products containing substances such as amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, remoxipride, risperidone, sertindole, ziprasidone, zotepine. Skills to increase their persuasiveness when recommending referral l develop partnerships within the community to quickly arrange transport, child care, financial, or other support when a severely ill child is identified. l use standard referral notes see page 12 ; l identify those children needing priority care at referral centres, and include a way for feedback to the primary care level health worker l improve radio or telephone communication and visits between primary level health workers and those working at referral centres. Patrick Kachur, Center for Disease Control and Prevention, Mailstop F-22, 4770 Buford Highway, NE Atlanta, Georgia 30341-3724, USA, because zeldox.

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So, from an epistemological point of view, the book is far from purity: the results shown are split between two domains : a first one based on the pharmaceutical language; a second one based on common-sensical language about different mood attitudes.

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All medical procedures have some risk, and this is a fact of life that is often lost in stories about abortion and glipizide. Following the dmi dose in the ziprasidone-treated neuron, way-100, 635 was able to completely reverse the inhibition top ; figure 6 bar graph showing the effect of the 5-ht 1a antagonist way-100, 635 or the ne re-uptake blocker desipramine dmi ; on ziprasidone-, clozapine-, or olanzapine-induced inhibition of serotonin neuronal firing.
Drugs. Furthermore, the effects reversed by the microtubuleThese results are relevant to and grisactin, because fda. News forum wire results 1-9 of 9 in convulsions consumer reports' analysis: drugs for nerve pain, fibromyalgia effective, but not always best wednesday sep 5 med ad news. Formulary update, from page 1 third intramuscular IM ; second generation antipsychotic marketed with a rapid onset of action. Ziprasidobe IM injection, which was listed in the Formulary in January 2003, was the first second generation, rapidly acting injectable antipsychotic. Olanzapine IM injection was added in the Formulary in March 2006. Oral aripiprazole was added in the Formulary in April 2004. The mechanism of action of aripiprazole, as with other drugs having efficacy in schizophrenia, bipolar disorder, and agitation associated with schizophrenia or bipolar disorder, is unknown. However, it has been proposed that the efficacy of aripiprazole is mediated through a combination of partial agonist activity at D2 and 5-HT1A receptors and antagonist activity at 5-HT2A receptors. Actions at receptors other than D2, 5-HT1A, and 5-HT2A may explain some of the other clinical effects of aripiprazole, eg, the orthostatic hypotension observed with aripiprazole may be explained by its antagonist activity at adrenergic alpha1 receptors. Although intramuscular aripiprazole has a labeled indication for the treatment of agitation associated with schizophrenia or bipolar disorder, it is also used off-label to begin or continue oral aripiprazole therapy. Like other first- and second-generation antipsychotics, aripiprazole could be used off-label for the treatment of agitation in dementia, in the intensive care unit setting, and in other medical conditions. Recent warnings regarding increased risk of death in the elderly should prohibit the off-label use of second generation antipsychotics for dementia. This same rationale prohibits use for agitation in the ICU or other patients with severe medical conditions. ICU and severely ill medical patients may have risk factors that would make use in this setting unreasonable at this time. Studies show greater efficacy than placebo for the labeled indication. There are no published studies directly comparing aripiprazole IM with olanzapine or ziprasidone. There are a few studies comparing aripiprazole IM to haloperidol either directly or indirectly ; . Aripiprazole has been shown to have equal efficacy to haloperidol with a different adverse effect profile. Aripiprazole IM is associated with less extrapyramidal symptoms EPS ; compared with haloperidol. It also is associated with less sedation. It is associated with a greater incidence of headache, dizziness, and nausea and vomiting. Aripiprazole IM costs 10 times more than haloperidol IM IV, is simi and griseofulvin.

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Research evaluating the QT interval effect of IM ziprasidone was conducted in which electrocardiographic tracings were obtained at the peak plasma concentrations following administration of ziprasidone 20 mg and 30 mg, four hours apart. The mean QTc increase from baseline for ziprasidone was 4.6 msec following the first IM dose and 12.8 msec following the second injection. None of these subjects had a QTc over 500 msec. Sudden and unexplained deaths have been reported in patients taking the recommended dose of ziprasidone. Therefore, one might elect to initially check baseline electrolytes, especially the serum potassium and magnesium levels because hypokalemia and hypomagnesemia may increase the risk of QT prolongation and cardiac arrhythmias. A calcium assay can.

A--Author: Which author has recommended removing the impairment criterion? B--Author: Journal does not use `gold standard, ' even in quotation marks. C--Author: The sentence here originally `Numerous agents are approved for treating mania, among them a number of atypical antipsychotics, such as olanzapine, risperidone, quetiapine and ziprasidone.` ; seemed to be a repetition of the last sentence of the preceding paragraph, so it was deleted. D--Author: Should `to data` be `to date` or `by data`? E--Author: In ref. 47, please clarify which is the book title and which is the chapter title. F--Author: Please provide page numbers for refs. 57 and 62, if possible. G--Author: Please specify which author is from each department. 1 and gabapentin!


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According to allison et al's meta-analysis study weight gain attributable to ziprasidone therapy is only 44 kg on average and gatifloxacin.

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Pramlintide has been associated with an increased risk of insulin-induced severe hypoglycaemia, particularly in patients with type 1 diabetes within 3 h following a pramlintide injection. Appropriate patient selection, careful patient instruction, and insulin dose adjustments are critical elements for reducing this risk. The initial dose is 60 mg given SQ immediately prior to major meals 250 kcal or containing 30 g of carbohydrate ; . The dose of pre-prandial rapid-acting or short-acting insulin including premixed 70 30 or preparations ; is reduced by 50 per cent and it is recommended that blood glucose be monitored more frequently. If no clinically significant nausea has occurred for 3-7 days, the dose is increased to 120 mg SQ prior to major meals. if the 120 mg dose is not tolerated due to nausea, a reduced dose of 60 mg may be used ; . Once a stable dose of pramlintide has been reached and nausea has subsided, the dose of insulin may be adjusted to optimize glycaemic control. The use of the above pharmacologic agents which augment the effects of gut hormones is clearly associated with improved glucose control and in the case of exenatide, liraglutide and pramlintide with the added benefit of weight loss. However, at the present time, it is unclear as to what extent the various effects of these agents are mediated through central effects on the brain or peripheral effects in the GI system and also whether these beneficial effects are sustained over the long term 29 . It possible that the use of injectable peptides exenatide, liraglutide and pramlintide ; is associated with immunogenicity and the development of neutralizing antibodies that diminish their efficacy over time in some patients. It also remains to be determined whether the use of some of these agents exenatide, liraglutide, and vildagliptin ; will protect b-cells and promote their regeneration as seen in animal studies. On the other hand, recent reports of hyperinsulinaemic hypoglycaemia and nesidioblastosis associated with increased circulating levels of GLP-1 in some patients after gastric bypass surgery highlight the, for example, ziprasidone side effects.

Since there are no laboratory tests for the primary headaches, diagnosis is made by comparing the patient's complaints to established criteria see table 1 and micronase. OAR 436-030-0165 3 ; c ; Testimony: Exhibit #5 The three-day response time for the deselection process is not long enough. A longer period, perhaps ten days, would seem more appropriate. In order to respond, the file must be pulled and reviewed to see what conditions are at issue, and arbiter options must be discussed with the client. In the rare occasion where the parties may want to stipulate on an arbiter, there is insufficient time to contact the opposing counsel and come to an agreement. Response: The medical arbiter deselection process represents a way whereby the parties retain some control over the selection of the arbiter physician. But in implementing this process, a, for example, live longer.
The following researchers participated in data collection: Stefano Biagini, Marco Bianchini, Lorenzo Mellini and Beatrice Berti. We would also like to acknowledge the valuable assistance of the patients and clinical staff of the Bologna Mental Health Community Centre "Borgo Reno and haldol. Family of receptors. Antagonists of GPCRs exhibit diverse patterns of antagonism, which range from the classical surmountable antagonism parallel rightward shift of agonist concentrationresponse curves with no decline of the maximum response ; to insurmountable antagonism partial to complete waning of the response accompanying a seeming rightward shift of the agonist response curve ; . Insurmountable antagonist-occupancy of the receptor generally prolongs the time taken for resensitization to agonist than the surmountable antagonist-occupancy 1 ; . Common mechanisms proposed for insurmountable antagonism involve phenomena attributed to equilibrium between allosteric activity states of receptors that i ; affect the kinetics of drug-receptor interaction; ii ; induce antagonist-dependent receptor conformation that is refractory to agonist binding; and iii ; modulate coupling to unknown molecules that stabilize the antagonist-bound state of the receptor 25 ; . In other instances the insurmountable antagonists forming a covalent bond with the receptor irreversible ; or the insurmountable antagonists dissociating very slowly from the receptor pseudo-irreversible ; have been proposed 2 ; . Even so, the molecular mechanism responsible for distinct efficacy from different types of drug-receptor complexes has remained unclear. Pharmacological behavior of the non-peptide antagonists of the AT 1 receptor provides several.
The first emergency event: On November 8th, 2004 the psychiatrist entered on an initial determination form that the recipient had not been eating or drinking adequately enough to sustain life due to psychosis; emergency medications were subsequently started. Meanwhile, nursing notes from the same timeframe stated the contrary. On the evening of the 5th, the day of admission, ".he ate 100% of snack.", on the 6th, " e breakfast e all supper.", and on the 7th, " e 1 3 lunch e well [at dinner].". The notes include references that the recipient was also spitting out his medications or simply refusing to take them when they were offered during these first days. At 9: 40 a.m. on the 8th, the psychiatrist noted that the recipient displayed profound psychosis with catatonic features. "He has not been eating or taking fluids well creating a danger to self." Progress notes, 11 8 04 ; . When asked about the contradiction in his and the nurses' observations, the psychiatrist explained that the recipient's catatonia did not allow him to swallow and that he would hold food and water in his mouth for extreme periods. While he may have ingested some food, he was certainly at risk for dehydration. He also said that the recipient would not eat or drink at all during another recent hospitalization. "It's not about his weight. The issue is his previous experience and risk for dehydration, electrolyte imbalance and choking because he was so catatonic. I'm not going to allow a patient like him to get back to that place again; it would be cruel and inhumane." According to those interviewed, the nature of the recipient's illness prevented any successful intervention alternatives. It was impossible to talk or reason with him, and non-medical therapies did not work or he refused to participate in them. At one point, they had attempted to spoon-feed him. Emergency administrations of Lorazepam, Ziprassidone or Benztropine were continued uninterrupted through November 27th. Nursing entries reference attempts at pushing fluids and health shakes throughout, and the recipient's calorie intake was being monitored in the meantime. By November 28th, the recipient was taking his medications voluntarily and the emergency orders were stopped. They were restarted on the following day however, when he again refused to take the medications Progress notes and Determination forms, 11 8 04 The psychiatrist repeated to the HRA that without medications, imminent danger still existed. The recipient was at risk for a quick relapse and would likely stop eating and drinking as in the past, and, non-medical interventions remained unsuccessful. Emergency medication orders were discontinued on December 8th after the recipient had been taking his medications by mouth for several days Psychiatry notes, 11 8 04 ; . Progress notes continued to reference times when the recipient would refuse to eat or drink up to December 8th. In addition, redeterminations for the emergency medications were entered in the record every 24 hours, and rights restriction notices were completed along with each medicine administration. But, the record did not include written approval from Singer's Medical Director when emergency administrations and haloperidol. Dr Janis Paterson Co-Director, Pacific Islands Families Study, Research Co-ordinator, Division of Public Health and Psychosocial Studies Pacific children have been shown to have poorer health status than other New Zealand children with hospital rates for respiratory conditions, infectious and parasitic diseases exceeding national rates. The New Zealand immunisation schedule includes DTAP-IPV and Hip-Heb B vaccines for children at sixweeks of age. The aim of the presenation is to describe 1 ; the percetage of children were were immunised, 2 ; the satisfaction with care and treatment provided in this context, and 3 ; the factors associated with the immunisation status of the infant. data were collected as part of the Pacific Islands Familes: First Two Years of LIfe PIF ; Study, a longitudiinal investigation of a cohort of 1398 infants born in South Auckland during 2000 and their mothers and fathers. Six weeks after the birth of the child, Pacific interviewers, fluent in both English and a Pacific language, visted the mothers in their homes and administerd a questionnaire. Findings revealed that there was a low uptake of immunisation with 73.1% of Pacific infants being taken to the relevant health professional for this purpose at six weeks. Socio demographic and maternal factors associated with immunisation will be presented and the cultural implication for health policy and promotion will be discused.
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Data were formed into an 8-item diagnostic heart failure score using logistic regression analysis Table 3 ; , and the score was then externally validated in an independent study cohort from New Zealand.22 As shown in Fig. 2, the score showed a strong linear association with the diagnosis of acute heart failure. As with other diagnostic tests, BNP has the greatest chance to change management when it is measured in patients in whom there is the most diagnostic uncertainty. Based on simple Bayes' Theorem considerations, in patients with pretest probabilities of about 50%, a likelihood ratio for a positive test sensitivity [1 specificity], or the ratio of true positives to false positives ; of about 10 is needed to raise diagnostic certainty after testing to 90% or more see Fig. 3 ; .31 In the meta-analysis of Wang and colleagues, a high clinical index of suspicion for heart failure had a likelihood ratio of about 10, whereas a "positive" BNP had a likelihood ratio of 3 to 4.29 Of note, the likelihood ratio for either a high clinical suspicion or a BNP level of 100 pg mL or greater was 3.1, which was not a significant improvement over BNP alone. In contrast, Wang and colleagues calculated a likelihood ratio for a "negative" BNP [1 sensitivity] specificity, or the ratio of false negatives to true negatives. Ziprasidone Geodon ; is the fifth and newest of the atypical antipsychotics, approved in 2001. It is chemically classified as a benzothiazolylpiperazine. Its pharmacologic activity is comparable to that of quetiapine. It has antagonist activity at several serotonin receptor subtypes, including 5-HT2A 2C, 5-HT1D, and the D2 dopamine receptors. It has agonist activity at the 5-HT1A serotonin receptors. It has also been shown to cause what is considered to be a mild ECG change-- slight prolongation of the QTc interval. It is recommended that ziprasidonw be taken with food to enhance its absorption. However, grapefruit and grapefruit juice have been shown to increase its blood concentration and it is recommended that both be avoided while taking this drug. Zirpasidone is available in oral form as 20-, 40-, 60-, and 80-mg capsules. An intramuscular dosage form for acute agitation is in development. Pregnancy category C. The commonly recommended dosages are given in the table on p. 257. PHARMACOKINETICS Half-Life 7 hr Onset 2-3 days Peak 6-8 hr Duration Unknown and loperamide. Sertindole, ziprasidone and quetiapine none of these drugs is currently available in australia.
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Pda view full version : drugs we're not supposed to touch. Sensory stimulation in genetically susceptible a i a Animals with chronically recurring, nml. spontaneous seizures represent ideal models for human epilepsy; however, the disadvantage of such models for drug evaluation is that in most of the animals the naturally occurring seizures cannot be elicited at will by an investigator, which makes. There are now some multiple choice questions to answer, to see if you have understood the information in this module. Take your time and when you have finished ask your tutor supervisor to check your answers. Multiple Choice Questions Select the One correct answer 1. A prescription to be valid must be signed by: a ; b ; c ; pharmacist A pharmacy technician A doctor A receptionist, because ziprasidone hydrochloride monohydrate.
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Dr. Willmore is Professor of Neurology and Pharmacology and Physiology at Saint Louis University School of Medicine in St. Louis, MO. To whom correspondence should be addressed: L. James Willmore, MD, Saint Louis University School of Medicine, 1402 South Grand Blvd M226 ; , St. Louis, MO 63104; Tel: 314-577-8205; Fax: 314-577-8214; E-mail: willmore slu and glipizide.
Conclusions: During 6 weeks' treatment, ziprasidone and olanzapine demonstrated comparable antipsychotic efficacy. Differences favoring ziprasidone were observed in metabolic parameters. Simpson et al, 2004.

J Clin Psychiatry 2003; 64: 451458 Sachs GS, Grossman F, Ghaemi SN, et al. Combination of a mood stabilizer with risperidone or haloperidol for treatment of acute mania: a double-blind, placebo-controlled comparison of efficacy and safety. J Psychiatry 2002; 159: 11461154 Zarate CA Jr, Narendran R, Tohen M, et al. Clinical predictors of acute response with olanzapine in psychotic mood disorders. J Clin Psychiatry 1998; 59: 2428 Tohen M, Goldberg JF, Gonzalez-Pinto Arrillaga AM, et al. A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry 2003; 60: 12181226 Adityanjee, Schulz SC. Clinical use of quetiapine in disease states other than schizophrenia. J Clin Psychiatry 2002; 63 suppl 13 ; : 3238 40. Lewinsohn PM, Klein DN, Seeley JR. Bipolar disorders in a community sample of older adolescents: prevalence, phenomenology, comorbidity, and course. J Acad Child Adolesc Psychiatry 1995; 34: 454463 Faedda GL, Baldessarini RJ, Glovinsky IP, et al. Pediatric bipolar disorder: phenomenology and course of illness. Bipolar Disord 2004; 6: 305313 Geller B, Tillman R, Craney JL, et al. Four-year prospective outcome and natural history of mania in children with a prepubertal and early adolescent bipolar disorder phenotype. Arch Gen Psychiatry 2004; 61: 459467 DelBello M, Grcevich S. Phenomenology and epidemiology of childhood psychiatric disorders that may necessitate treatment with atypical antipsychotics. J Clin Psychiatry 2004; 65 suppl 6 ; : 1219 44. McConville BJ, Sorter MT. Treatment challenges and safety considerations for antipsychotic use in children and adolescents with psychoses. J Clin Psychiatry 2004; 65 suppl 6 ; : 2029 45. Findling RL, McNamara NK. Atypical antipsychotics in the treatment of children and adolescents: clinical applications. J Clin Psychiatry 2004; 65 suppl 6 ; : 3044 46. Barnett MS. Ziprasidnoe monotherapy in pediatric bipolar disorder. J Child Adolesc Psychopharmacol 2004; 14: 471477 McConville M, Carrero L, Sweitzer D, et al. Long-term safety, tolerability, and clinical efficacy of quetiapine in adolescents: an open-label extension trial. J Child Adolesc Psychopharmacol 2003; 13: 7582 Van Gerpen MW, Johnson JE, Winstead DK. Mania in the geriatric patient population: a review of the literature. J Geriatr Psychiatry 1999; 7: 188202 Young RC, Klerman GL. Mania in late life: focus on age at onset. J Psychiatry 1992; 149: 867876 Shulman RW, Singh A, Shulman KI. Treatment of elderly institutionalized bipolar patients with clozapine. Psychopharmacol Bull 1997; 33: 113118 Sajatovic M, Ramirez LF, Vernon L, et al. Outcome of risperidone therapy in elderly patients with chronic psychosis. Int J Psychiatry Med 1996; 26: 309317 Madhusoodanan S, Brenner R, Alcantra A. Clinical experience with quetiapine in elderly patients with psychotic disorders. J Geriatr Psychiatry Neurol 2000; 13: 2832 Loebel A, Siu CO, Romano SJ. Overview of ziprasidone tolerability in patients 55 years of age or older. Presented at the 156th annual meeting of the American Psychiatric Association; May 1722, 2003; San Francisco, Calif 54. Tohen M, Chengappa KNR, Suppes T, et al. Relapse prevention in bipolar I disorder: 18-month comparison of olanzapine plus mood stabiliser v mood stabiliser alone. Br J Psychiatry 2004; 184: 337345 Calabrese JR, MacFadden W, McCoy R, et al. Double-blind, placebocontrolled study of quetiapine in bipolar depression. Presented at the 157th annual meeting of the American Psychiatric Association; May 16, 2004; New York, NY.

Automated Identification Barcode technology provides a needed mechanism for fail-safe individual identification in the hospital environment. Positive patient identification is essential to safe medical care. Too often clinical practitioners fail to check patient identification prior to drawing blood, giving a medication or rendering treatment. Instead, they rely on their own memory or an appropriate acknowledgment from the patient. In the case of confused, medicated or unreliable patients, this method is fraught with potential problems.
FINDINGS The following conclusions were derived from information published in the Resource Guide: Strategies in suicide prevention programs for adolescents and young adults focus on two general themes. Although the eight strategies for suicide prevention programs for adolescents and young adults differ, they can be classified into two conceptual categories: Strategies to identify and refer suicidal adolescents and young adults for mental health care. This category includes active strategies e.g., general screening programs and targeted screening in the event of a suicide ; and passive strategies e.g., training school and community gatekeepers, providing general education about suicide, and establishing crisis centers and hotlines ; . Some passive strategies are designed to lower barriers to self-referral, and others seek to increase referrals by persons who recognize suicidal tendencies in someone they know. Strategies to address known or suspected risk factors for suicide among adolescents and young adults. These interventions include promoting self-esteem and teaching stress management e.g., general suicide education and peer support programs developing support networks for high-risk adolescents and young adults peer support programs and providing crisis counseling crisis centers, hotlines, and interventions to minimize contagion in the context of suicide clusters ; . Although restricting access to the means of committing suicide may be critically important in reducing risk, none of the programs reviewed placed major emphasis on this strategy.

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Source: Frequency of hemochromatosis gene HFE ; mutations in Russian healthy women and patients with estrogen-dependent cancers. : ncbi.nlm.nih.gov. Hoshino, 1982 Folia Psychiatrica et Neurologica 36 2 ; : 115-24 36 2 ; : 115Palmer et al., 2006 Health and Place 12: 203-9.

The goal of the supratherapeutic dose is to expose healthy volunteers to the highest plasma levels and systemic exposure of the parent drug and active metabolites that could occur in the patient population, including those associated with maximal inhibition of metabolism of the drug and impairment of liver and kidney functions and target disease-related susceptibility. Obviously, if a maximum tolerated dose of the new agent has not been properly established in Phase I, it may require a separate study to determine whether the ideal supratherapeutic dose is tolerable and safe for the volunteer population enrolled in the TET. Collection of ECGs at multiple timepoints at baseline for each treatment group and again at the same timepoints for each treatment is an important design element of the TET. This technique is the most reliable way to determine if the trial conducted has minimized the large degree of spontaneous QTc variability that can be observed within a single subject. Variability results from many factors, such as diurnal variation, effects of food, and other autonomic influences. Typically, three baseline ECGs are col. Raising Awareness of IBS.275 Marketing medications .275 Learning from a self-help group.277 Surfing the 'Net.280 Infringing on the doctor's turf?.280 Knowing your source .281 Surfing for alternatives .281 Reaping the benefits .282.

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