Review: methadone dose reduction is better than alpha2 adrenergic agonists for treatment retention in opioid dependence.
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Exposure and image quality in xeroradiography were studied in a test object and in patient tomographic examinations of the chest. With increased tube voltage and added copper filtration, skin exposure was reduced up to a factor of 10 without loss of image quality.
A region-of-interest (ROI) fluoroscopy device that provides an automatically generated ROI filter with an arbitrary shape, as well as digitally compensated images, was built and evaluated. ROI filters were generated by using a deformable attenuation material. Images were compensated by using a compensation ratio and a running average interpolation method. Image compensation parameters were predicted on the basis of the x-ray tube potential used. The image quality with and without an ROI filter was evaluated. This ROI fluoroscopic technique was shown to substantially reduce patient and operator radiation exposure without degrading image quality within the ROI.
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In 1977 staff members on a 30-bed inpatient ward in a state hospital implemented a program to discontinue the medication of chronic schizophrenic patients who had been hospitalized continuously for five years or more. Six-month follow-up of the 15 patients who met the selection criteria showed that seven were still off medication, and two had improved enough to be discharged. The program was later adopted throughout the hospital; an audit conducted 90 days after its implementation showed that 31 per cent of the patients hospitalized continuously for 90 days or longer were not receiving antipsychotic medication. The authors emphasize the benefits to patients of reducing or discontinuing antipsychotic medication where possible.
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In a general practice survey of the use of Temazepam 'Planpak' ('Planpak'), 31 participating doctors completed questionnaires on 250 patients. Of these, 228 patients had been taking a variety of 8 benzodiazepine hypnotics prior to 'Planpak' therapy while 22 (8.8%) patients received 'Planpak' as a short course, without prior hypnotic therapy. Of the patients being weaned off benzodiazepines with 'Planpak', the majority had been on therapy for longer than 1 year (mean 5.36 +/- 5.58 years, range 0.08 to 22.9 years). Success (68%) or partial success (13%) was achieved in 81% of patients (95% confidence interval 77% to 86%) in terms of total abstinence from or reduced use of hypnotic for at least 1 month after 'Planpak' therapy. Outcome was not related statistically to gender, type, or duration of previous hypnotic therapy. Twenty-six patients received from one to three additional courses of 'Planpak' and 177 (71%) were not taking hypnotics at the time of the survey which represented a mean follow-up of 9.19 +/- 5.36 months (range 1.7 to 36.5 months).
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Studies on a water phantom indicate that the insertion of extra tube filtration combined with the removal of the antiscatter grid can reduce the total energy imparted from paediatric fluoroscopy by a factor of more than four when automatic exposure control is used. The omission of the grid is responsible for up to 40% of the reduction while the addition of 0.7 mm steel filtration is found to account for a further reduction in energy imparted of between 57% and 70%, for depths of water simulating small patients of 6-16 cm thickness. For all contrast paediatric examinations the reduction in image quality was considered to be small and the diagnostic information unimpaired with the filter in place.
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