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Tofranil (Imipramine)
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Tofranil

Tofranil, synthetic drug used in the treatment of depression and enuresis (bed-wetting). Introduced into medicine in the late 1950s, Tofranil was the first tricyclic antidepressant, a class named for its three-ring molecular structure.

Other names for this medication:
Alzoset, Antipres, Anxidep, Anxitab, Anxofit, Depik, Depnil, Depsan, Depsol, Depsolam, Depsonil, Diamin, Elidep, Estidep, Finezol, Imidiaz, Imilor, Imipra, Imodep, Impranit, Imprim, Imprin, Karthin, Lastinem, Nimipose, Normadep, Talendep, Toframine, Trydep, Ultradep

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Also known as: Imipramine

Description

Imipramine is used to treat depression. It belongs to a group of medicines known as tricyclic antidepressants (TCA). These medicines are thought to work by increasing the activity of a chemical called serotonin in the brain.

Imipramine tablets are also used to treat enuresis (bedwetting) in children.

This medicine is available only with your doctor's prescription.

Dosage

This section provides information on the proper use of a number of products that contain imipramine. It may not be specific to Tofranil-PM. Please read with care.

Take this medicine only as directed by your doctor to benefit your condition as much as possible. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.

This medicine comes with a Medication Guide. Read and follow these instructions carefully. Ask your doctor if you have any questions.

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules): For depression: Adults—At first, 75 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg per day, unless you are in the hospital. Some hospitalized patients may need higher doses. Teenagers and older adults—At first, 25 to 50 mg per day using the tablets. Your doctor may adjust your dose as needed and switch you to the capsule form. However, the dose is usually not more than 100 mg per day. Children—Use and dose must be determined by your doctor. For oral dosage form (tablets): For depression: Adults—At first, 75 milligrams (mg) per day. Your doctor may adjust your dose as needed. However the dose is usually not more than 200 mg per day. Some hospitalized patients may need higher doses. Teenagers and older adults—30 to 40 mg per day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 100 mg per day. Children—Use and dose must be determined by your doctor. For enuresis (bedwetting): Children 6 years of age and older—At first, 25 milligrams (mg) once a day, taken 1 hour before bedtime. Your doctor may adjust the dose as needed. Children younger than 6 years of age—Use and dose must be determined by your doctor.

Overdose

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of Tofranil can be fatal.

Overdose symptoms may include irregular heartbeats, feeling like you might pass out, seizures, or coma.

Storage

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F) away from moisture and heat. Keep container tightly closed. Throw away any unused medicine after the expiration date. Keep out of the reach of children.

Side effects

The most common side effects associated with Tofranil are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

Do not take Generic Tofranil if you are allergic to Generic Tofranil components. Be very careful with Generic Tofranil if you are pregnant, planning to become pregnant, or are breast-feeding. Do not take Generic Tofranil if you are recovering from a recent heart attack or take MAO inhibitors, such as the antidepressants Nardil and Parnate. Be very careful with Generic Tofranil if you have diabetes, hypoglycemia, a history of mental disorders. Be very careful with Generic Tofranil if you are taking albuterol (Proventil, Ventolin), antidepressants that act on serotonin, including Prozac, Paxil and Zoloft, antipsychotic drugs such as Mellaril and chlorpromazine, barbiturates such as Nembutal and Seconal, blood pressure medications such as Catapres, Carbamazepine (Tegretol), cimetidine (Tagamet), decongestants such as Sudafed, drugs that control spasms, such as Cogentin, Epinephrine (EpiPen), Flecainide (Tambocor), Guanethidine, Methylphenidate (Ritalin), Norepinephrine, other antidepressants such as Elavil and Pamelor, Phenytoin (Dilantin), Propafenone (Rythmol), Quinidine, thyroid medications such as Synthroid, tranquilizers and sleep aids such as Halcion, Xanax, and Valium. Avoid alcohol. Do not participate in any activities that require full alertness if you are unsure about your ability. Try to stay out of the sun as much as possible. It can be dangerous to stop Generic Tofranil taking suddenly.

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Determinants of operator and patient radiation exposure during cardiac catheterization: Insights from the RadiCure (RADIation reduction during cardiac catheterization using real-timE monitoring) trial. No germ-line mutations were found and the CAG and GGC repeat lengths were similar among MBC cases as among Scandinavian population. Outcomes are similar for the minimally invasive longitudinal and sinus tarsi surgical approaches in the treatment of Sanders type-II and III displaced intra-articular fractures of the calcaneus, with the benefit of a lower complication rate and shorter operative time for the minimally invasive technique. striatum (PFGE types I and II) infection was observed in five cases. Older adults demonstrated decreased sensitivity as well as a more conservative response bias during acquisition.

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Brassinosteroids (BRs) are a group of important phytohormones that play vital roles in plant growth, development and a series of physiological phenomena. For a series of shape-persistent and flexible biradicals with end-to-end distances between 2 and 5 nm, shell factorization and direct conversion of the data are in good agreement with each other and with force-field computations of the end-to-end distances. Attempts to place hapln1a in our previously defined cx43-sema3d pathway suggest that hapln1a functions in a parallel genetic pathway. We also find that condensin-dependent intra-chromosomal gene associations and chromosome territories are co-regulated during the cell cycle. This chapter focuses on these phenomena in ON bipolar cells and the role of metabotropic glutamate receptors in these processes. Relative to prior cross-sectional surveys, epidemiologic profiles for migraine have remained stable in the United States over the last decade. After injection of miR-21 antagonist, the the cardiac atrophy and cardiac fibrosis were conspicuously ameliorated. Both camptothecin-induced cell death and the release of H2O2 were effectively blocked by application of the calcium-channel blocker lanthanum chloride, the caspase-specific inhibitor Z-Asp-CH2-DCB, or the NADPH oxidase inhibitor diphenyl iodonium, indicating that camptothecin exerts its effect on cell death through a calcium- and caspase-dependent stimulation of NADPH oxidase activity.

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Coronary artery calcification (CAC) is a risk factor for adverse outcomes in the general population and in patients with coronary artery disease. Psychological adjustment in the children of mothers with a history of eating disorders. To summarize available information on share risk agreements (RSA) with orphan drugs (OD). After MAPK antisense oligodeoxynucleotide (ASO) was introduced into K562 cell line by liposomal transfection, the effects of ASO on K562 cell were evaluated by cell proliferation, DNA synthesis, MAPK protein content and MAPK activity. Erythrocyte membrane fluidity was measured by fluorescence anisotropy.

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Until the mid-1980s, mainly biologists were conducting peptide research. Some efficient methods to correct confocal images for easy interpretation. General Practitioners (GPs) participated in a national Quality Improvement Collaborative (QIC), focusing on the implementation of a guideline based model for a stepped care approach to depression. Remarks on methods used for the control of the antigenic power of lots of inactivated antipolio-myelitis vaccine. Behavioral responses to repeated cocaine exposure in mice selectively bred for differential sensitivity to pentobarbital. A review of the taxonomy and speciation of the genus Echinococcus Rudolphi 1801. Meta-analysis could not be performed as we included only one study.

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Postchemotherapy-related changes in mediastinal mixed germ cell tumor masquerading as a vascular neoplasm. The cervical length measured by transvaginal ultrasonography is the best one. Seven months after the completion of radiotherapy, pericardial effusion with negative cytology was recognized. This biologically active Ang II 3-8 fragment is referred to as angiotensin IV (Ang IV) and has been reported to participate in memory acquisition and recall as well as in the regulation of blood flow, neurite outgrowth, angiogenesis and kidney function. Based on the differential types in traditional Chinese medicine, 121 asthenozoospermia patients received at our clinic of andrology were divided into groups A (kidney-yin deficiency), B (kidney-yang deficiency) and C (spleen and kidney deficiency), and treated with Yougui Decoction plus Wuziyanzong Pills, Jinkuishenqi Pills plus Wuziyanzong Pills, and Shizi Decoction plus Liujunzi Decoction, respectively, all given once daily for 4 weeks. Because in most patients the risk factors are present lifelong, a healthy dentition and a healthy periodontium are the best way of prevention. The new enzyme is similar to those of mammalian RNA tumor viruses in its molecular size, preference for poly(A).(dT)(12-18) as compared to either poly(dA).(dT)(12-18) or poly(A).poly(dT), and ability to copy poly(C).(dG)(12-18). Evidence that lectin-binding sites are present on the surface of isolated hypothalamic granules containing luteinizing hormone-releasing hormone. However, incomplete embolization due to unembolizable feeders or difficult access into the uterine artery may lead to suboptimal treatment.

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Suppressive action of mepacrine, aphacrine, chloroquin, camoquin and proguanil against P. Influence of hypothermia on chlorpromazine-induced changes in brain amine levels. Effect of SP on intracellular free calcium was measured using cell culturing and laser scanning confocal microscopy with fluo-3/AM as a fluorescence probe. Patients were divided in to those who received intravenous fluids above the median volume (3.9 L) and those who received less than the median volume of intra-operative fluid. Thus, alterations of L1 expression may contribute to the profound abnormalities caused by hypothyroidism in the developing brain. Although commercial products that achieve epidermal grafting by suction blistering are presently available, there is still limited knowledge and understanding on the dynamic process of epidermal-dermal separation during suction blistering.

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Thus, a multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. The maxillary frenum is highly associated with a number of syndromes and developmental abnormalities. We propose Fmn2 as a mediator of actin bundle integrity, enabling efficient force transmission to the adhesion sites. The frgB and frgC null mutants, however, formed wild-type fruiting bodies. The isolated species isolated were not influenced by demographic and clinical features. coelicolor (VanRsc) functioned with either sensor kinase partner, while VanR of S. Here, we review the general morphology and molecular composition of tubulobulbar complexes, and also include a description of tubulobulbar complex structure in the human seminiferous epithelium. It is suggested that the immunomodulant activity of ladasten are related to the comitogenic effect and the increase in resistance of the activated T-lymphocytes with respect to non-receptor-induced apoptosis. The development of antibacterial therapy of pulmonary tuberculosis.

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CEA, AFP and CA 19-9 analysis in peritoneal fluid to differentiate causes of ascites formation. Three-dimensional graphene/Pt nanoparticle composites as freestanding anode for enhancing performance of microbial fuel cells. Women who ovulated (high levels of serum progesterone in the luteal phase) had shorter REM latency, more REM sleep, and more positive mood state compared to those who did not ovulate (low luteal progesterone). The system can detect subnanometer displacements and forces below 0.1 pN. However, the risk of HCC, even among patients with cirrhosis, seems to be low--regular HCC surveillance may not be warranted. Eosinophils bound to CS-1 with high avidity, and this binding could be inhibited with neutralizing antibodies to alpha4 integrins expressed by eosinophils or with neutralizing antibodies to CS-1. The blood concentrations of both drugs including their main groups of metabolites were measured simultaneously by LC/electrospray-mass spectrometry. To evaluate the lung function in patients with severe acute respiratory syndrome (SARS) 10 years after recovery and the influencing factors. We conducted the first nonclinic, Internet-based survey of cluster headache to investigate this population with regard to diagnostic problems encountered, effective and ineffective medications, problems obtaining medications through third-party payers, and symptoms as they relate to International Headache Society criteria.

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A majority of specimens exhibited elevated levels of COX-1, not COX-2, mRNA, and protein compared with normal ovarian tissue. Reductions in calorie intake contribute significantly to the positive outcome of bariatric surgeries. Thus, these findings suggest crosstalk between corepressors and coactivators, and indicate fine-tuning of corepressor function by post-translational modification through corepressor acetylation. An examination of perceived stress in family caregivers of older adults with heart failure. Endothelin-1 (ET-1) is thought to play a role in a wide range of pathological conditions. As members of the TGFbeta superfamily have been shown to mediate the effects of Hedgehog in several developmental systems, we proposed a model where TGFbeta acts downstream of Ihh and upstream of PTHrP in a cascade of signals that regulate hypertrophic differentiation in the growth plate. Although phage traits, such as adsorption rate, burst size, and lysis time, varied significantly among these phages, none of the traits correlated significantly with MST.

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LPS elicited degradation of inhibitory protein kappaB (IkappaB)-alpha, but not IkappaB-beta, resulting in activation of nuclear factor (NF)-kappaB in human pulmonary artery endothelial cells. There are some differences in children including the frequency of presenting symptoms, the presence of hypoventilation, and the identification of an associated tumor. The results suggested a new hypothesis of blood circulation in the heart-lung block by demonstrating the lack of necessity for the venovenous anastomosis. Tissue malondialdehyde (MDA), myeloperoxidase (MPO), and nitric oxide (NO) level were increased, whereas superoxide dismutase (SOD) and glutathione peroxidase (GPx) activity was decreased in the EC group. Complete and sequential iron saturation and desaturation of the lactotransferrin.

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In treatment, we have to keep LN metastases, particularly skip LN metastases, in mind, even in cases of small HCC. BioSign PSA was evaluated in terms of its specificity, sensitivity and cost to replace an ELISA (enzyme linked immunosorbent assay) method of PSA detection. In xenopus laevis embryo neuron-muscle co-cultured cells, TCPN.HCl blocked spontaneous miniature endplate currents, and showed preference to blocking the nicotinic receptor ion channels, which had a long open time, and high current amplitude. In case of HCV infection, a careful follow-up of both mother and newborns is required. Importance of serum urea nitrogen, serum creatinine, and their ratio. Using western blot analysis, immunoprecipitation, and immunohistochemistry, we investigated the effect of the mechanical overloading state on RhoA, serum response factor (SRF), and MyoD in the rat plantaris muscle.

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Proceedings of the First International Conference on Recent Advances and Future Directions in Endocrine Therapy for Breast Cancer: summary consensus statement. I had the privilege of traveling and lecturing in Africa, Asia, and Europe. We assessed the potential clinical utility of histomolecular phenotypes defined using a combination of histopathology and protein expression (CDX2 and MUC1) in 208 patients from three independent cohorts who underwent surgical resection for adenocarcinoma of the ampulla of Vater. The discrepancy could not be accounted for by the difference in sensitivity of the two methods. This phenomenologic process identified key dimensions and a preliminary definition of self-advocacy that nurses can recognize and support when patients seek and receive care consistent with their own needs and preferences. Plasmodium DNA, in addition to being used for molecular diagnosis of malaria, find utility in monitoring patient responses to antimalarial drugs, drug resistance studies, genotyping and sequencing purposes. The effect of these mutations on phenotypic stavudine susceptibility is relatively small but apparently large enough to be clinically significant. Patterns of cancer incidence across the world have undergone substantial changes as a result of industrialisation and economic development. Full and Abbreviated Courses of Maintenance Electroconvulsive Therapy. It was shown that valyl-tRNA synthetase regulation is under multivalent control involving both valine and isoleucine.

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This regulatory system can be another standard model for better understanding the regulatory mechanisms of how many mg of zyrtec to give a dog L-rhamnose catabolism in other bacterial species. These cells also anaerobically decomposed alanine to products similar to those from serine and phenylalanine to phenylacetate and formate only in the presence of nitrate. The 3D nanostructure consisted of a gold film containing a NHA with an underlying cavity and a gold nanocone array (NCA) at the bottom of the cavity. Attempts at the interpretation of various failures of the complement fixation test in poliomyelitis by means of the complement fixation inhibition test. The relationship of the plasma concentrations of alpha-MSH with body mass index (BMI), body fat mass (measured by bioelectric impedance), body fat distribution (measured by computed tomography), insulin levels, insulin resistance (assessed by the glucose infusion rate (GIR) during an euglycemic hyperinsulinemic clamp study) and with the serum concentrations of leptin and TNF-alpha were also evaluated. Differential membrane targeting of the SERCA and PMCA calcium pumps: experiments with recombinant chimeras. Parent and Child Independent Report of Emotional Responses to Asthma-Specific Vignettes: The Relationship Between Emotional States, Self-Management Behaviors, and Symptoms. Mitochondria from females exhibit higher antioxidant gene expression and lower oxidative damage than males.

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The proper timing of corrective and reconstructive surgical operations for the management of congenital abnormalities in infancy and childhood is exceptionally important. A complement fixation antigen for the serological diagnosis of trachoma. However, Schwann cell dedifferentiation, as demonstrated by extracellular signal-regulated kinase activation and c-Jun induction, and redifferentiation were not significantly affected, and thus the entire repair program progressed normally in atg7 knockout mice. esculenta and Acalypha wilkesiana gave a good volume of secretion while Chromolaena odorata, Elaeis guinensis, Aspilia africana and Citrus sinensis did not favour secretion production. Communication regarding pain control and prognosis were identified as key areas for improvement. Encrusted cystitis is extremely rare in small animals and has previously only been associated with Corynebacterium spp infection of the urinary bladder.

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The activity concentrations in aquatic mosses can be easily measured with good precision even when aqueous concentrations are below the limit of detection. Management of early Fontan failure: a single-institution experience. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. IR introduced on the chorion side of the chorio-amnion did not appear on the amnion side. We describe the 2.8 A resolution crystal structure of this entire extracellular region (sEGFR) in an unactivated state. Under the influence of an ac electric field, electrolytes on planar microelectrodes exhibit fluid flow. To evaluate whether admission day of the week affects the length of stay (LOS) and health care costs for failure to thrive (FTT) admissions. AP-1 activity during the growth, differentiation, and death of O-2A lineage cells. Interferon primes, activates or differentiates various leukocyte populations to promote autoimmunity.

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Evaluation of congenital vascular anomaly needs to take into consideration the combination of other congenital vascular anomalies and their familial occurrence. Deepening anaesthesia with halothane/O2 by mask or adding small dose of relaxant (Succinylcholine) was necessary in 33 patients. Salmon, sole, cod, oysters, clams, and crabs from ocean waters along the coast of Oregon and Washington were examined for the presence of Clostridium botulinum type E. We had the opportunity to assess 3D geometric differences of aneurysms before and after rupture. On the ecology of child health and nutrition in Nigerian villages.

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The framework presented here provides an ideal setting for modeling mutations dispersed through the genome and, in particular, for the analysis of how natural selection operates on different classes of single nucleotide polymorphisms (SNPs). The toxic effects included delayed type leukopenia and thrombocytopenia with nadir of 4 weeks. This repression preferentially inhibited insertion editing compared with deletion editing in vitro. Inhibitors of the Antiapoptotic Myeloid Cell Leukemia-1 (Mcl-1) May Provide Effective Treatment for Cancer. Within these ranges, sleep is perceived as continuous and restorative. Regarding the adhesion receptors involved in TEM, alpha4 (most likely in association with beta1) and alphaLbeta2 were shown to be important in CLL cell TEM in vitro, but only the level of alpha4 expression correlated with the presence of clinical lymphadenopathy. The number of responses judged good to excellent was 182 (85 percent). Protective effect of licoflavone on gastric mucosa in rats with chronic superficial gastritis.

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Group A consisted of those with a past documented history of an episode of acute angle closure (that had resolved after LPI). Whereas many papers focused on the two main phenotypic characteristics (biomass and accumulation), fewer papers studied proteomic and physiological parameters which allow to have a global view of the tolerance of probable willow candidates for phytoremediation purposes. They start to show a significant assembling response from the 8th hour after feeding onwards. The treatment of sacral dermoids by excision and primary wound suture. The fouling hydroid Ectopleura larynx: a lack of effect of next generation antifouling technologies. The possibility has been raised that environmental chemical exposures have played a role in the changes associated with the sex ratio in a number of countries.

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Thin-layer chromatography--progress in methods for the determination of steroids. Data regarding presurgical diagnosis, patient demographics, and incidence of postoperative complications were recorded. To mediate effective loading we used polyarginine (pArg) molecules of various degrees of polymerization, cationic liposomes, or chimeric molecules of transferrin (Tf) and the polycation polyethyleneimine (PEI). Prior research has identified criminal justice referrals or coercion as a predictor of treatment completion among men but questions remain about the same effect in women. For most parents, the decision about the donation seemed to have been a matter of course. Correlation between IVF outcomes and Ureaplasma urealyticum infection in male reproductive tract. Dental procedures in the hospital operating room placement of equipment and the efficient use of dental tetracycline dose uti auxiliaries. The risk of hepatic artery thrombosis after orthotopic liver transplantation is higher in cases of poor hepatic arterial inflow, small or anomalous recipient hepatic arteries, unsafe native hepatic arteries. Schwannoma is a benign neoplasm originating from the neural sheath and occuring most often in the soft tissues of the head and neck.

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Patients presenting to general practitioners with unexplained chronic fatigue were recruited to the study. The enhancement of IL-12 at both the mRNA and protein levels was antagonized by naltrexone, indicating that the modulation of this cytokine by morphine is via a classic opioid receptor. When the aversive effects of morphine withdrawal were investigated using the place aversion paradigm, no differences between genotypes were observed. Periodontal infections could also be an interesting target for the application of BALOs as biological Gram-negative bacteria and therefore potentially susceptible to BALOs antimicrobial agents. The SRC represents one example of how early clinical experiences in the cleocin t 1% gel core curriculum might be transformed through the provision of patient care activities of narrow scope. Review of known technologic achievements suggests a possible 6 to 7 reduction factor from present screen-film mammography dose levels without sacrificing image quality. Serum pepsinogen in certain acute surgical diseases of organs of the abdominal cavity.

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cinerea laccases by characterizing laccase genes and evaluating the phenotype of targeted gene replacement mutants. This procedure is supposed to have a triple effect: osseous, muscular and ligamentous. The results of our analysis show that the apolipoprotein E locus has no effect on interindividual variability in systolic blood pressure. Intrathecal administration of morphine, but not small dose, induced spastic paraparesis after a noninjurious interval of aortic occlusion in rats. Nuclear hormone receptors are one of the seven major pharmacological targets into which the Guide is divided, with the others being G protein-coupled receptors, ligand-gated ion channels, ion channels, catalytic receptors, transporters and enzymes. A copper sulfate and hydroxylysine treatment regimen for enhancing collagen cross-linking and biomechanical properties in engineered neocartilage. Major components of honey analysis by near-infrared transflectance spectroscopy. In the present series, the largest tumour was not always representative of overall tumour burden or biological aggression and its potential use to exclude patients from LT is questionable.

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Emerging evidence suggests that transcranial alternating current stimulation (tACS) is an effective, frequency-specific modulator of endogenous brain oscillations, with the potential to alter cognitive performance. Comparative histology of the mouse bladder following initial infection and re-infection with adalat cc cost Escherichia coli. The most likely explanation for these results is diminished fractional turnover of CSF per unit time in patients with CSF volume expansion, regardless of cause. US depicted the different structures of the thoracic EDS with an acceptable precision (confidence interval, 4.6 to 8.7 mm). The model shows that the transport makes a transition from neoclassical to classical values as the collision frequency goes from less than to greater than the axial bounce frequency. Comparative prognostic value of lactate dehydrogenase and neuron-specific enolase in small-cell lung cancer patients treated with platinum-based chemotherapy. Clinical aspects and course of severe poisoning with optalidon special. Suppression of endotoxin-induced renal tumor necrosis factor-alpha and interleukin-6 mRNA by renin-angiotensin system inhibitors. In the latter case, the rate of supply of polymer to the fiber dispersion confined in the reactor was monitored by setting the concentration of the solution being injected at a controlled rate. The aims of this study were to evaluate the effect of IAP on intestinal epithelial cells and macrophages, and on chronic colitis in interleukin-10-deficient (IL-10(-/-)) mice.

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A Study about the Cause and Clinicopathologic Findings of Injection-Induced Dermatitis. The MICdb database has, therefore, been made portable to be administered by a person with the necessary administrative privileges. Studies have demonstrated recently that these neurotrophic factors not only maintain survival of auditory neurons, but that these surviving neurons retain functionality. MLL gene rearrangement in acute myelogenous leukemia after exposure to tegafur/uracil. Medical and economic aspects of the evaluation of permanent disabilities. Thus, other fluctuating elements besides that due to thermal agitation are supposed to cause the dispersion. Egalitarian consultation meetings: an alternative to received wisdom about clinical supervision in tetracycline mg psychiatric nursing practice.

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