This paper evaluates the effectiveness of the Counseling on Access to Lethal Means (CALM) suicide prevention program. CALM trains mental health providers how to counsel suicidal individuals and those who support them on mean restriction during times of crisis. Pre/post/3-month follow-up assessments measured knowledge of lethal means, confidence and comfort in discussing means restriction (self-efficacy), and future intentions to counsel clients on means restriction. Change in the number of clients receiving lethal means counseling was also assessed. All constructs increased significantly at posttest. Confidence and counseling intentions were sustained at follow-up and significantly more clients received means counseling in the 3 months following the CALM training. Knowledge and comfort levels decreased at follow-up but not to pre-training levels. CALM is effective at increasing mental health professionals' comfort, knowledge, and frequency of talking about means restriction with clients. an effective means restriction training program. A template to assess clients for suicidality and lethal means access and booster sessions are recommended to further sustain effects.

Attention deficit hyperactivity disorder (AD/HD), characterized by impulsivity, distractibility, and inattention, has an estimated pediatric population prevalence of 6–8%. Family physicians and pediatricians evaluate and treat the majority of children with this condition. The evidence-based treatment of choice for ADHD, stimulant medication, continues to be a source of public controversy. Surveys suggest that among parents of children with ADHD, there is considerable interest in complementary and alternative medicine (CAM). These therapies include herbal preparations, mineral supplements, sugar restriction, and polyunsaturated fatty acids. Other AD/HD therapies include neuro-feedback, cognitive training, mindfulness meditation, and exposure to “green space.” In order to assist physicians and mental health professionals in responding to patient and parent queries, this paper briefly describes these CAM therapies and current research regarding their effectiveness. While investigations in this area are hampered by research design issues such as sample size and the absence of double-blind placebo-controlled trials, there is some evidence that omega three fatty acids, zinc supplements, and neuro-feedback may have some efficacy.

Previous research has suggested that exposure to outdoor surroundings is associated with improved attention and concentration among children with attention deficit hyperactivity disorder (AD/HD). This effect has been attributed to the impact of exposure to "green space" in restoring fatigued attention. Because of concerns about side effects and misuse of stimulant medication, there has been considerable interest in green space exposure as a possible alternative or complementary therapy for ADHD. In the current study, adults completed a 20-minute walk in three types of outdoor settings: a wooded trail, a residential neighborhood, and a parking lot. Participants completed subtests from the Wechsler Memory Scale assessing attention, concentration, and short-term memory as well as the Profile of Mood States, a self-report measure for assessing current emotional status. Based upon previous green space research, it was anticipated that participants in the wooded trail condition would perform better on the cognitive tasks. However, there was no difference between the three conditions in participants' preand post-walk cognitive functioning. When data from the three groups were pooled, there was a significant benefit associated with the 20-minute walk for short-term memory as well in reducing tension, depression, anger, and fatigue. The results do suggest that relatively brief outdoor physical activity may be a useful complementary intervention for persons with conditions adversely affecting short-term memory.

Patient: Female, 56Final Diagnosis: Fixed-drug eruptionSymptoms: —Medication: MetforminClinical Procedure: Discontinued metforminSpecialty: Family MedicineObjective:Unusual or unexpected effect of treatmentBackground:A fixed-drug eruption (FDE) is a reaction characterized by cutaneous lesions that appear due to exposure to a particular drug. Barbiturates, carbamazepine, sulfamethoxazole, and tetracyclines have all been associated with causation of FDEs. Although these drugs are more commonly associated with FDEs, any introduction of a medication has the potential to result in a FDE. Metformin, a commonly used medication to improve glycemic control, has been reported to cause dermatologic reactions in some case reports, but only a single previously documented case report discusses the potential of metformin-associated FDE.Case Report:We describe a 56-year-old woman who developed a FDE with multiple exposures to metformin. Upon each exposure, small, round, erythematic lesions developed on the palms of the hands and soles of the feet; these lesions resolved each time after discontinuation of metformin. According to the Naranjo scale, there is a definite association between metformin and FDE in this case (score of 8).Conclusions:This report contributes to the limited documented literature on metformin-induced FDE. Clinicians should be made aware of possible FDEs associated with this commonly used medication.

Ziv-aflibercept is a safe and effective option in combination with FOLFIRI for the treatment of mCRC in patients who progress on oxaliplatin-containing therapy. Superiority over other antiangiogenic treatment has not been established.

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