The success of a clinical librarian program in an academic autopsy pathology service

Residents in pathology must acquire a broad base of knowledge in all areas of medicine and the basic medical sciences. We report our experience with the first Clinical Medical Librarian (CL) program used to aid resident training in anatomic pathology. This program was developed by the Lister Hill Library of Health Sciences (LHL) of the University of Alabama at Birmingham (UAB) to test the value of a CL program in filling the clinical needs of medical students and residents by providing key recent references to the wide variety of diseases seen in a busy autopsy service. Use of a CL was accepted completely by both faculty and residents as a method of increasing their efficiency in evaluating the recent literature on diseases seen in the autopsy service. Our use of this program broadened the scope and extent of specific case-oriented medical literature read by both residents and faculty.     

Tubercular mastitis: a pragmatic approach to its management

Six cases of tubercular granulomatous mastitis were studied retrospectively. Three of these six cases posed diagnostic difficulties because of a lack of caseation in granuloma on fine needle aspiration cytology. A pragmatic approach is described here that is based on the correlation of the clinical features with the cytological findings. All six cases improved on therapeutic trial of antitubercular treatment.     

Goal orientations of academic departments: A test of Biglan's model.

Examined variations in the goal orientations of 488 academic departments in 32 public universities by stepwise multiple discriminant analysis procedures. In a nationwide study, department chairmen rated 11 goals on a 5-point scale according to the amount of emphasis placed on each. 3 discriminant functions were statistically significant. The nature of the differentiation provided by these 3 discriminant functions was highly consistent with the 3 dimensions in a model developed by A. Biglan (see record 1974-01819-001). Results suggest that Biglan's clustering of academic areas according to their (a) concern with a single paradigm, (b) concern with application, and (c) concern with life systems has considerable potential for providing a conceptual framework to guide future research investigating academic departments. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adenoacanthoma of the endometrium: a separate entity or a histological curiosity?

In a series of 42 patients with endometrial adenoacanthoma and of 53 with adenocarcinoma, age at the time of diagnosis, age at the onset of the menopause, gravidity, pathological staging, and survival were compared to see if there was any significant difference, apart from morphology, between the two tumours. No significant differences could be established, and it was concluded that adenoacanthoma should be regarded as a histological variant of adenocarcinoma and not as a separate entity.     

A pragmatic approach to early childhood memories: Shifting the focus from truth to clinical utility.

Backlash against repressed trauma memories has led clinicians and theoreticians (e.g., G. K. Ganaway, see PA, Vol 78:24404; and E. F. Loftus, see PA, Vol 80:37888) to redress popular conceptual fallacies regarding the accuracy of early childhood memory. The author reviews pertinent experimental literature to make a cogent case for M. Mayman's (1968) working model of reconstructive memory. The integration of cognitive and psychodynamic theory results in an appreciation for the psychologically revealing quality of early memories. Case illustrations from a young and a middle-aged woman integrate theory with practice, and demonstrate how memory can be construed as a projective test in an initial psychological assessment or analyzed during an ongoing therapy session. Technical recommendations for therapists dealing with patients' memories are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mannosidosis: clinical, morphologic, immunologic, and biochemical studies

The primary metabolic defect in mannosidosis is the deficiency of the acidic alpha-mannosidase A and B activites which results in the lysosomal accumulation of mannose-rich substrates. Out studies demonstrate that the enzymatic diagnosis of suspect homozygotes can be made reliably using plasma, isolated leukocytes, or cultured skin fibroblasts assayed carefully at the appropriate acidic pH. Immunologic studies of a mannosidosis homozygote revealed significant abnormalities of neutrophil function; these included a depressed chemotactic responsiveness and impaired phagocytosis of bacteria. Lymphocyte transformation studies showed a 20% of normal response to purified phytohemagglutinin and a 25% of normal response to concanavalin A. Three major components of alpha-mannosidase activity in normal human liver were resolved by ion exchange chromatography on DEAE-cellulose and electrophoresis on cellulose acetate gels. Electrophoresis of the liver extract from homozygote I with mannosidosis revealed only one band of activity which coelectrophoresed with the alpha-mannosidase C isozyme partially purified from normal liver. However, ion exchange chromatography revealed the presence of residual hepatic acidic activities; the residual A isozyme was eluted in a position corresponding to that of normal alpha-mannosidase A whereas the residual B activity was eluted at a slightly more electronegative position than that of normal B isozyme. The apparent Km values for alpha-mannosidase activity as determined from Linweaver-burk plots were 1.1 mM for normal liver and 0.9 mM for normal leukocytes. In contrast, the residual activity in these sources from homozygote 1 could not be saturated within the solubility range of the substrate; the apparent Km value was estimated at 15.4 mM in liver extracts. Zinc significantly lowered the apparent Km value of the acidic activity in normal liver (from 1.2 to 0.24 mM), whereas this metallic ion had little effect on the values for mannosidosis hepatic activity (from 15.4 to 12.3 mM). Unlike zinc, cobalt had its major effect on the acidic activity in the mannosidosis liver extract, lowering the apparent Km from 15.4 to 3.9 mM, whereas the apparent Km for the normal activity was increased from 1.2 to 1.9 mM. The residual acidic activities were markedly stimulated by zinc in both leukocytes (approximately 300%) and plasma ( approximately 400%) from the homozygotes and to a lesser extent in those sources from normal individuals. In contrast, cobalt enhanced the residual acidic activities in leukocytes (approximately 500%) and plasma (approximately 200%) from the homozygotes while inhibiting these acidic activities (78.9% and 47.7%, respectively) in normal individuals.     

Adjuncts to dopamine replacement: a pragmatic approach to reducing the problem of dyskinesia in Parkinson's disease

Dyskinesias following long-term dopamine replacement therapy are a major limitation of current treatments for Parkinson's disease. Recently, attention has been focused on the concept of using non-dopaminergic adjuncts to currently available therapies in an attempt to reduce the problem of dyskinesia. Thus, an enhanced understanding of the neural mechanisms underlying dyskinetic symptoms has led to the realization that it might be possible to manipulate non-dopaminergic systems and reduce dyskinesia without compromising the anti-parkinsonian efficacy of drugs such as L-dopa. This article discusses how non-dopaminergic manipulations could reverse the abnormalities in basal ganglia circuitry responsible for generating dyskinesia. It is proposed that potential anti-dyskinetic drugs might include glutamate (NMDA) receptor antagonists, opioid receptor antagonists, cannabinoid receptor agonists or antagonists, alpha2 adrenergic receptor antagonists, and 5-HT-enhancing agents.     

Multi-centre clinical respiratory research: a new approach?

BACKGROUND: Recruitment to clinical trials organised by the research committee of the British Thoracic Society (BTS) has declined. We suspected that this was due to increasing workloads for consultant physicians in the National Health Service (NHS). We investigated possible causes in study 1 and a possible solution in study 2. METHODS: Study 1--a questionnaire was sent to BTS members listing possible factors that might deter them from entering patients into trials. These were scored on a 0-5 scale. Study 2--we set up 13 panels of experts to cover all major fields of respiratory medicine. They were asked to design projects that would address the most important research questions that could be answered by multi-centre clinical trials. We sent 11 projects for scoring to consultant members of the BTS who were asked to score them on scientific merit and on their ability to contribute patients to the study. RESULTS: Study 1--of the 59% of consultants who responded, 77% said that competition with increasing demands on their time was the major reason for not participating. Study 2--40% of consultants returned project scores. Three projects were subsequently selected for grant application. CONCLUSIONS: Clinical research in the UK is under threat from increasing workloads on consultants. One solution to this problem is a national approach to commission major projects. The most important clinical research questions might then still be answered in the limited time available to consultants.     

Social psychological research and clinical practice: An academic paradox.

Social psychological research has not had the impact on clinical practice that the nature of its subject matter indicates is appropriate. A major reason for this lack of impact is a paradox inherent in academic life. As they climb the academic ladder, social psychologists, who presumably have chosen their field of study because of an interest in the way in which people live and think, become increasingly remote from and increasingly aloof from the everyday life of normal people. Five aspects of academic training and institutional life that reinforce and maintain this paradox are identified. Two examples of a type of research that can overcome the paradox and increase the impact of social psychology on clinical practice are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insulin-dependent diabetes and psychiatric pathology: general clinical and epidemiologic review

The objective was to determine the diagnostic sensitivity of spinal and femoral dual x-ray absorptiometry (DXA) and to study whether a combination of both sites may enhance discriminatory capability in regard to the presence of vertebral fractures. Spinal and femoral DXA were obtained in 324 postmenopausal women, of whom 90 had at least one vertebral fracture. Age-adjusted logistic regression analyses, ROC analyses, and sensitivity-specificity statistics were used to assess the discriminatory ability of spinal and femoral bone density (BMD) alone and in combination. The age-adjusted odds ratios per standard deviation decrease in BMD (OR) for spinal and femoral measurements were comparable (Ward's triangle: OR = 1.62; femoral neck: OR = 1.51; total hip: OR = 1.47; spine: OR = 1.34). Combining spinal and femoral bone density measurements did not improve diagnostic sensitivity of DXA considerably as compared to using BMD of a single site and adjusting the "fracture threshold." The conclusion drawn is that spinal and femoral BMD measurements using DXA have a comparable diagnostic sensitivity for vertebral fracture discrimination. Different individuals at risk for osteoporosis may be identified using both methods. The clinical usefulness of a combination of two bone density measurements needs further study in a prospective setting.     

A pragmatic framework for smoking cessation: Implications for clinical and public health programs.

Smoking cessation research and programs are shifting toward reaching populations. A framework for intervention for tobacco and other addictive behaviors is presented that can accommodate this emerging paradigm as well as more traditional clinical approaches. Smoking cessation is seen to be determined by 3 sets of factors: (a) motivation, which includes both readiness to try to quit and persistence in the face of withdrawal and stress; (b) addiction level; and (c) environmental supports and barriers. Coping skills that provide ways of dealing with these factors are seen as the essential content of cessation programs. The implications of this framework for assessment and intervention are discussed, with particular attention to the different requirements of clinical (intensive, aimed at self-selected smokers) and population-based (brief, aimed at all smokers in a setting) programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dimensions of outpatient neurotic pathology: Comparison of a clinical versus an empirical assessment.

Assesses a set of 4 clinical clusters, defined by 31 items of the Symptom Distress Checklist (SCL), in terms of their comparability to 4 dimensions isolated in a principal axis factor analysis of the same set of 31 items. The clusters were labeled anxiety, depression, anger-hostility, and obsessive-compulsive-phobic, and were evolved through a clustering procedure involving 20 clinical judges. The factors were determined through a factor analysis of psychiatrists' ratings of 837 anxious neurotic outpatients involved in 3 clinical drug trials. Comparison between the 2 sets of syndromes was effected by casting the clinical clusters in the form of a hypothesis matrix and performing a Procrustes transformation on the original principal components factors. Results of the analysis indicate an extremely high coincidence between the clinical clusters and the transformed factors, implying that the dimensions isolated here possess substantial reliability. This finding, and the high degree of similarity observed between the present dimensions and those identified in previous research, suggest that these factors may represent "core" dimensions of neurotic psychopathology. (35 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovative strategies for promoting clinical scholarship: a holistic approach

The article discusses a holistic approach to clinical scholarship by examining dimensions of scholarship and patterns of knowing. Innovative clinical teaching strategies in relation to these dimensions of scholarship and patterns of knowing are identified. Experiential learning, content mapping, and portable patient problem packs are explored. Knowledge building and creativity in the process of educating students are imperative. Nurse educators are challenged to develop new paradigms for nursing education that create a dynamic learning environment and result in enhanced clinical scholarship.     

APA internship selection criteria: Relative importance of academic and clinical preparation.

Surveyed American Psychological Association (APA)-approved internships to assess what criteria are important to internship selection committees and to determine how much clinical experience is desired to make an applicant competitive. The survey also assessed the number of courses and amount of hours of supervised experience in both diagnostics and treatment that internships look for in preferred applicants. A brief questionnaire was sent to 120 APA-approved internships, which resulted in a response rate of 75%, or 90 respondents. Results show that internship training centers emphasize clinical training experience and personal qualifications over traditional academic achievements. In addition, internships look for substantially more hours of supervised clinical experience than the amount the minimum APA-accreditation criteria require. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Payday for patients: Federal guidelines or a job-sample approach?

Discusses the practical problems involved with implementation of the 1973 Sounder v. Brennan court ruling that would ensure equitable wage compensation for patient workers and the conflict with US Department of Labor recommended procedures. Techniques are developed that would enable state institutions to determine equitably, reliably, and validly the rates of commensurate pay for patient workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Kidney in Galloway-Mowat syndrome: clinical spectrum with description of pathology

The Galloway-Mowat syndrome, a rare inherited disorder, is characterized by congenital microcephaly with hypotonia and developmental delay, often hiatus hernia, and nephrotic syndrome manifested in infancy or in early childhood. The glomerular lesion has been poorly characterized in the few previous reports of this syndrome. We studied three siblings with microcephaly and nephrotic syndrome occurring during the first two weeks of life. Hematuria, glycosuria and renal failure were also present. Renal biopsy and postmortem specimens of two patients were studied. Glomerular structure was disorganized; capillary lumina were of varying calibers, capillary walls were adherent to one another, and mesangial zones were poorly demarcated. Glomerular basement membrane ultrastructure was markedly altered. The normal trilaminar structure was obscured or replaced by flocculent material; furthermore, 6 to 8 nm fibrils of unknown nature permeated the space between endothelial and epithelial cells. Non-glomerular basement membranes were unaltered in appearance. This syndrome apparently represents, in part, a new disorder of glomerular basement membrane formation and function.     

Reliability of clinical judgments as a function of range of pathology,.

The relationship between the reliability of clinical judgment and the severity of the pathology being judged is investigated using 6 sets of data involving a total of 2055 stimuli and 41 judges. The stimuli were intelligence test items obtained from patients and were judged by experienced clinicians using a 7-point scale to estimate the amount of confusion in thinking exhibited in the response. The hypothesis, that stimuli at the extremes (least and most) of the scale would be judged more reliably than those in the middle, was confirmed in all 6 instances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Home environment, self-concept, and academic achievement: A causal modeling approach.

[Correction Notice: An erratum for this article was reported in Vol 77(3) of Journal of Educational Psychology (see record 2008-10971-001). The caption to Figure 3 on page 1271 is incorrect. "SOSC = social self-concept" should read "NASC = nonacademic self-concept." In addition, on page 1274 in the Results section, the reference to McDonald & Leong (1974) should have been deleted.] Investigated the relation between home environment, self-concept, and academic achievement in 2,297 14–15 yr old Koreans. Data on Ss was collected in 4 different samples to test 4 structural equation models. Group 1 consisted of 537 males, Group 2 consisted of 537 males, Group 3 consisted of 611 females, and Group 4 consisted of 612 females. Results show that over the 4 samples, self-concept was a mediating variable between home environment and academic achievement. Results did not support the commonly held view that home environment exerts direct effects on academic achievement. Social status indicators had indirect effects on self-concept via family psychological characteristics. Academic self-concept affected academic achievement more strongly than did presentation-of-self or social self-concept. (51 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)