Psychiatric residency training, managed care, and contemporary clinical practice.

Managed care has transformed the health care environment that residents encounter on completion of their training. Unfortunately, residency education has not kept pace with changes in the field, leaving graduates inadequately prepared. The authors identify necessary changes in the residency training tasks of instilling values, imparting required knowledge, building core skills, selecting appropriate training sites, and offering a diversity of instructors and supervisors. They also discuss the obstacles that have impeded the evolution of academic clinical services and clinical training. They suggest strategies of change that may lead to more relevant educational programs that provide residents with a balanced perspective on the strengths and weaknesses of both traditional and contemporary approaches to delivering care.

The manifestations of schizophrenia in late life: a dearth of data.

Published data about the course of schizophrenia in late life are very limited. Overall, elderly patients with schizophrenia appear to suffer less from active or positive symptoms and more from residual or negative symptoms than they did when they were younger; therefore, older patients usually require a different type of management. There exists strong evidence that deterioration in schizophrenia generally occurs earlier rather than later in the disorder's natural history and is typically not relentlessly progressive. Nonetheless, schizophrenia remains a severe disorder that can be chronic and, in a proportion of patients, unremitting throughout life. Few studies have outlined which factors are associated with a more positive outcome.

Evaluation of the effectiveness of wet ice, dry ice, and cryogenic packs in reducing skin temperature.

The purposes of this study were to evaluate and compare the ability of wet ice (WI), dry ice (DI), and cryogenic packs (CGPs) to reduce and maintain the reduction of skin temperature directly under the cooling agent and to determine whether the cooling effect on skin extended beyond the surface area in contact with the cooling agent. Ten female volunteers participated in the study, and each of the three cold modalities was applied randomly to the skin overlying the right triceps surae muscle. After 15 minutes of cold application, mean skin temperatures recorded under WI, DI, and CGP decreased 12 degrees, 9.9 degrees, and 7.3 degrees C, respectively. The only significant differences in cooling were between WI and DI and between WI and CGP. Fifteen minutes after removal of the cold modalities, no significant differences were found in mean skin temperature between WI, DI, and CGP. The residual mean decrease in skin temperature between the pretreatment rest interval (time 0) and 15 minutes after removal of the cold modality (time 30) was significant for WI only. No cooling was demonstrated 1 cm proximal or distal to any of the cooling agents after 15 minutes of cold application. These findings provide valuable information for the use of cryotherapy in the clinical setting.

Effect of long-term therapy with an oral contraceptive on some aspects of hepatic lipid metabolism in vitro.

PIP: The effect of Enovid (7.5 mg/kg of food) for both short and long periods of therapy in female Blue Spruce Farm rats was studied. Hepatic release of triglyceride and of cholesterol was measured. Tests were made in vitro. Treatment periods were 4 days of 1 year. The short-term treated group ingested 315 mcg/kg body weight of Enovid daily; the long-term treated group ingested 375 mcg/kg of body weight of Enovid daily. These are about 3 times the daily dose for humans. Animal livers were removed and placed in a perfusion apparatus. The perfusion technique is described. The adrenal glands were also removed and the lipid extract, after being similarly treated in the perfusion apparatus, was tested for cholesterol. Body weights of animals were reduced significantly (p less than .05) by both short- and long-term treatment. The amounts of food consumed were reduced only in the short-term tests. In neither group was change in liver weight found. Bile production was reduced 50% in rats treated 4 days but in those treated 1 year with Enovid no effect was noted when compared with controls. However, in both control and test animals, production of bile after 1 year was reduced by 70-75% as compared with younger animals. Perfusion flow rate in rats treated with Enovid for 1 year was significantly faster (p less than .02) than through livers in the control group. Glucose release was reduced by both short- and long-term Enovid therapy. Reduced food intake may have caused this effect in the short-term therapy. In the group treated with Enovid for 1 year, release of cholesterol and triglycerides into the perfusate was reduced 72 and 38%, respectively. This effect was not observed in the 4-day treated animals. Enovid had no effect on the weights of livers or on the concentration of either triglycerides or cholesterol in hepatic tissue after either form of therapy. No elevation of serum triglyceride was found. A 30% decrease in serum cholesterol was found after 4 days of Enovid therapy. However, in those treated 1 year, and in controls, there was a 100% increase over that of younger animals. Enovid had no effect on the weights of adrenal glands. Total sterol content of adrenal glands from animals treated 1 year was decreased significantly (p less than .05) but not in animals treated only 4 days. Results obtained may be attributed to the metabolic effects of the individual components of Enovid. Further experiments are in progress to examine the effects of each component on hepatic triglyceride transport. Each Enovid tablet contained 5 mg norethynodrel and .075 mg of mestranol.^ieng