Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC.

OBJECTIVE: Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION: CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS: The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS: CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS: CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.

Teaching family practice residents breast cyst aspiration.

OBJECTIVE: To conduct the first study of teaching family practice residents the technique of breast cyst aspiration (BCA) using the Toronto Breast Cyst Aspiration Model (TBCAM) in a workshop. To determine whether this training increases their likelihood of performing the procedure in the future. To discover how residents evaluate the workshop as a teaching method. DESIGN: Prospective parallel-group trial from August to November 1997. Baseline questionnaires were given to both experimental and control groups in August. The experimental group was given a 1.5-hour workshop and a postworkshop questionnaire. Both groups were then given 3-month follow-up questionnaires. SETTING: Family practice residency program at the University of Toronto. PARTICIPANTS: The experimental group consisted of 15 family practice residents from one university-affiliated hospital site. The control group consisted of 54 family practice residents selected from the remaining sites. MAIN OUTCOME MEASURES: Confidence score, likelihood of performing BCA, and effectiveness of the workshop rated on a Likert scale ranging from 1-low to 5-high; and knowledge of BCA rated from 0 to 7. RESULTS: Three months after the workshop, 62% of study subjects and 31% of controls were above the median confidence score of 3.2 (chi 2 3.4, P > .05); 76% of subjects but only 11% of controls were above the median knowledge score of 4 (chi 2 16.67, P < .001); and 75% of subjects and 34% of controls were above the median likelihood to perform score of 3 (chi 2 5.37, P < .05). Most (95%) workshop effectiveness scores were 4s or 5s. CONCLUSIONS: Workshop training resulted in higher confidence, greater knowledge, and more likelihood of performing BCA. The workshop using the TBCAM was evaluated as a highly effective way to teach BCA.

Lead poisoning of milk--the basic need for the foundation of human civilization.

Three study sites along the roads with different automobile traffic densities were selected and cattle milk samples were collected every month from all the three sites. Lead concentration in samples were determined through atomic absorption spectrometer. Milk collected from area of heavy traffic contained 4.6-7.2 ppm of Pb, which is much higher than its permissible limit (0.3 ppm) according to FDA.

Malignant insulinoma presenting with recurrent episodic loss of consciousness.

A 57 year old male presented with episodic behavioural abnormalities and loss of consciousness for 2 years. His fasting blood glucose was 20 mg/dl and corresponding insulin level 119 uU/ml. His EEG showed intermittent rhythmic delta activity. Abdominal CT scan revealed an enhancing mass in the tail of the pancreas and secondaries in the liver. After distal pancreatectomy, resection of the left lobe of the liver and chemotherapy, the hypoglycaemic spells subsided. Histopathology revealed an islet cell tumour with metastases in the liver. Episodic neurobehavioural dysfunction should alert towards the possibility of hypoglycaemia.

Condylectomies for prolonged bilateral temporomandibular dislocation.

An unusual case of old unreduced bilateral temporomandibular joint (TM joint) dislocation is presented. Extensive reviews of English and Japanese literature described managing such cases by various methods including closed or open joint reduction. However, successful bilateral condylectomies carried out in seven months old dislocation, provided free range of painless movements and good stability. As there is no possibility of redislocation or painful degenerative arthritis following this procedure, it's role in African environment is described.

A study of dental caries in rural and an urban primary school of Zambia.

320 children, 160 from a rural and 160 from an urban primary school were examined for dental caries. The urban children were found to have twice as much caries as their rural counterparts. Their D.M.F./df indices were also much higher. No significant sex difference was noted. The tribal distribution shows that the Tonga are the most susceptible tribe while the Lenje have the least caries. The relationship between caries and brushing habits, as well as consumption of confectionary was established. The commonest teeth affected and their relationship to age was also noted. It was concluded that urbanization has definitely contributed to the higher caries prevalence in the urban school children. Although the situation is not as bad as in the West, if it remains unchecked, 90% of the population may have caries in another 15 years.

Graphical determination of pK values of the active-site groups of enzymes. An analysis of the bell-shaped curves.

Descriptions are given for the graphical determination of molecular pK values from the curves of logV and p(Km/V) against pH. The arguments are based on the model dissociation equilibria LAL in equilibrium (AL + LA) in equilibrium A, where A denotes a molecule having two binding sites for a ligand L.