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Contemporary medical group practice administrators navigate a complex world of challenges, questions, and ambiguous circumstances. Adverse outcomes and therapeutic misadventures have significant implications within this world. Practice compliance programs must be developed to reduce risk and liability. As with any negative behavior, event or disruptive action, therapeutic misadventure is easily identified; however, determining a strategy to correct physician behavior, attitude, and action is sensitive and difficult, requiring administrative skill, tact, and patience. This article provides corrective action strategies that can be applied to any therapeutic misadventure encountered in a typical medical group practice. Three categories are identified: problematic behavior, problematic practice patterns, and physician impairment. Measures to correct and alter physician behavior and actions are also described.

Using a variety of clinical measures of unilateral neglect 40 right hemisphere lesioned stroke subjects were compared in terms of neuropsychological deficit. The results of the study encourage the view that unilateral neglect is a complex syndrome and subjects who indicate the disorder may vary in systematic dimensions. There are at least two factors contributing to the neglect syndrome--a scanning factor of external stimuli and a disrupted internal representation of space factor. Both the obtained factors were correlated with functional independence at 6 months post-stroke in a further group of 27 right hemisphere lesioned stroke patients. It is probable that most commonly these factors co-exist and form the classical neglect syndrome but theoretically they may occur separately and this leads to implications for management.

Five infants with biopsy proved juvenile xanthogranuloma of the iris were reviewed. Early treatment with subconjunctival injection of steroids and topical steroid drops resulted in regression of the lesion in four patients. One patient, reviewed at the age of 8 months after glaucoma which had developed secondary to the iris xanthogranuloma, had been treated by surgery alone: the visual outcome was very poor.

Mothers of 40 very severely head injured male subjects rated their son's behaviour on the Current Behaviour Scale and their ratings were compared with mothers' ratings of 40 control male subjects. The scale was able to discriminate the two groups, by utilising two factors--loss of emotional control and loss of motivation. The mothers' level of emotional distress was closely related to their reporting of loss of emotional control in their sons, but reporting of loss of motivation, or lowered arousal, was strongly predicted by the functional disability of the son. The utility of refining the measurement of post-trauma behaviour is discussed.

The case is described of a 39-year-old man with previously undiagnosed chronic schizophrenia and with bilateral keratomalacia secondary to his bizarre diet. He presented with a perforation of the right cornea which required an emergency penetrating keratoplasty. The difficulties of clinical management of a patient with an overt psychosis and the use of serum retinol levels to monitor treatment are described. Causes of vitamin A deficiency seen in Great Britain are discussed.

A 49-year-old woman with generalised lichen sclerosus et atrophicus and morphoea developed bilateral Brown's syndrome. Some of the skin lesions were in the vicinity of the trochlea. A characteristic feature of morphoea is subcutaneous fibrosis, so we postulate that the cause of the Brown's syndrome was mechanical tethering of the superior oblique tendon by deep subdermal fibrosis. Histopathological diagnosis was made from biopsies of similar lesions on the patient's face.