Contribution of clinical pharmacists to patient care

Literature reports of the contributions of clinical pharmacists to patient care are reviewed. The topics covered are: clinical pharmacist functions in the drug use process, specific clinical activities of clinical pharmacists, and specialty areas of clinical pharmacy practice. It is concluded that more research needs to be done on the effectiveness and legal basis of clinical pharmacy services, and that adequate methods of payment for clinical pharmacy services must be developed.     

Work activities of academic clinical psychologists: Do they practice what they teach?

Do PhD-level clinical psychologists who work in academic settings engage in both research and clinical practice, as the Boulder model recommends? Clinical psychology faculty members in 3 types of psychology departments were surveyed regarding their actual and preferred work activities and their attitudes toward clinical practice. Respondents indicated that they spent more than twice as much time in research as in clinical activity, with many (44%) reporting no involvement in clinical practice. Implications of declining practice among clinical faculty include potentially ineffective instruction in clinical course work, less informed clinical research, and the devaluing of clinical practice in traditional academic settings. Recommendations for facilitating practice among clinical faculty who wish to do so are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond clinical trials: Generalizing from research to practice.

Suggests that clinical trials, or evaluations of psychotherapy techniques in clinical settings with patient populations, play a pivotal role in treatment research. Well-controlled psychotherapy trials provide a test of what treatment can do under conditions in which procedures such as therapist training and monitoring and the integrity of treatment are optimal. Methods designed to reduce the hiatus in how treatments are implemented, monitored, and evaluated in clinical research and practice include developing standardized assessment and treatment packages that can be implemented by practitioners, altering the manner in which clinical training is implemented and evaluated, training clinicians in strategies to evaluate their own clinical work, and conducting clinical replication case studies as a way to evaluate treatment applications in clinical practice. These alternatives combine standardization, training, evaluation, and clinical practice to help increase the generality of research findings to clinical work and to help merge research and clinical priorities. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resident and faculty perceptions of effective clinical teaching in family practice

Increasing interest in clinical teaching has led to the realization that the unique subset of skills which characterizes effective clinical teaching needs to be identified. Such identification will lead to development of these skills and improvement in the quality of clinical teaching. Family practice faculty are vitally concerned with improving their clinical teaching skills, since clinical teaching is the core of education in family medicine and since many family physicians who become preceptors have had no formal training as teachers. In this investigation of effective clinical teaching behaviors, faculty and residents generally agree in their perceptions of the helpfulness of 58 clinical teaching behaviors. Neither group felt that emphasis on references and research is as important a factor in effective clinical teaching as are residents' active participation in the learning situation and positive preceptor attitudes toward teaching and residents. It was perceived that the ineffective clinical teacher has a negative attitude toward residents, is inaccessible, and lacks skills in providing feedback, while the effective clinical teacher has skills in two-way communication, creates an educational environment that facilitates learning, and provides constructive feedback to residents.     

Dynamic extension assist splinting of acute central slip lacerations

BACKGROUND: Effective clinical practice guidelines should improve clinical outcomes, and measures of physician use of clinical practice guidelines should correlate with improved outcomes. This study translates a clinical practice guideline on heart failure into review criteria to measure physician performance and the effectiveness of the clinical practice guideline. METHODS: A panel of 11 family physicians and 1 cardiologist systematically reviewed the clinical practice guideline for its clinical importance, educational relevance, and evaluative appropriateness. Then a subset of 4 family physicians rigorously applied each recommendation to established criteria for measurability and developed an evaluation tool useful in medical record review. RESULTS: The heart failure clinical practice guideline was found to be an excellent educational tool. Using it to measure physician performance, however, was limited to diagnostic tests and drug prescribing. Of 45 recommendations, 5 fulfilled criteria for measurability; 1 recommendation had A-level evidence, whereas 2 recommendations had B-level and 2 had C-level evidence. CONCLUSION: This study illustrates the logistic issues and challenges in developing a measure of physician adherence to clinical practice guidelines. Medical record review is inadequate to measure many recommendations. Physicians use of this clinical practice guideline must be evaluated as an intermediate step to measuring the effectiveness of clinical practice guidelines based on patient outcomes.     

The future of clinical assessment.

In the past 20 yrs, there have been endless arguments over the virtues, limitations, and utility of clinical psychological testing, and alternative perspectives have evolved tied to differing views of personality and clinical intervention. Although investment in the testing role has declined for several reasons, clinical assessment remains an important focus of the clinician's work, and new developments in several areas suggest a revitalization of the field as well as a rapprochement among competing orientations to clinical intervention. The present article reviews emerging trends in the use of projective and objective personality tests, behavioral assessment, clinical interviewing, environmental assessment, and medical uses of psychological assessment. The authors believe that clinical assessment is vital in clinical service, research, and the training of clinical psychologists. (74 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical evaluation--difficulties experienced by sessional clinical teachers of nursing: a qualitative study

Evaluation of nursing students in the clinical field requires the clinical teacher to make judgements regarding student progress in a number of areas. In this study concepts of role theory, oppressed group behaviour and the ethics of caring emerged and were used as conceptual frameworks to interpret the data relating to the evaluation of undergraduate students. The number of experienced faculty available for clinical teaching and evaluation has become inadequate and a large number of casual or sessional clinical teachers are employed to teach students in the clinical field. Despite the well documented problems associated with clinical teaching and the use of inexperienced clinical teachers, sessional clinical teachers are nevertheless expected to evaluate student success in meeting the clinical requirements of the nursing course, often resulting in disparate decisions for students. A phenomenological study was carried out using unstructured interviews and written clinical scenarios, to explore the evaluation process from the perspective of the sessional clinical teachers. Research findings indicate that although the sessional clinical teachers were skilled at identifying student problems, they were reluctant to make difficult evaluation decisions, due to low self-esteem, role conflict and their ethic of caring. It seems that gender socialization, patriarchal dominance and apprenticeship training had effected their confidence in their own decision making. The implications of such findings are of concern for the ongoing credibility and integrity of nursing courses, as clinical teachers have an influence on the nursing profession through the preparation of its practitioners.     

Osteoarthritis and synovitis as major pathoses of the temporomandibular joint: comparison of clinical diagnosis with arthroscopic morphology

PURPOSE: The purposes of this investigation were to determine how common osteoarthritis and synovitis are in patients with severe, recalcitrant temporomandibular joint (TMJ) symptoms using clinical diagnostic criteria as well as arthroscopic examination, and to compare the accuracy of the clinical and arthroscopic diagnoses with respect to specificity and sensitivity. PATIENTS AND METHODS: Clinical and arthroscopic diagnoses were established in 126 joints of 84 patients with severe TMJ symptoms recalcitrant to conservative therapy. All joints were classified as having osteoarthritis (OA) or no osteoarthritis (non-OA) and synovitis (syn) or no synovitis (non-syn) using clinical and arthroscopic criteria. Chi-squared analysis was used to determine whether there was a relationship between the clinical and arthroscopic diagnoses. Preoperative clinical diagnoses were compared with arthroscopic morphologic diagnoses to determine the specificity and sensitivity of the clinical diagnostic criteria for synovitis and osteoarthritis. RESULTS: A preoperative clinical diagnosis of OA was established in 59 of 126 joints (47%) compared with an arthroscopic diagnoses of OA in 82 of 126 joints (65%). Chi-squared analysis showed a significant relationship between the clinical and arthroscopic diagnosis of OA. A clinical diagnosis of OA was associated with a high specificity (.977); however, there were 23 of 82 (.293) false-negative findings and a sensitivity of only .707. A preoperative clinical diagnosis of synovitis was established in 114 of 126 joints (90%), compared with an arthroscopic diagnosis of synovitis in 112 of 126 (89%). Chi-squared analysis did not show a significant relationship between the clinical and arthroscopic diagnosis of synovitis. A clinical diagnosis of synovitis was associated with a high sensitivity (.920); however, there were 11 of 14 false-positive findings (.786) associated with a low specificity (.214). CONCLUSIONS: Although there was high specificity for the clinical diagnosis of OA, the sensitivity was very low. (Comparison of clinical and arthroscopic diagnoses showed that osteoarthritis frequently escapes clinical detection. The clinical diagnosis of synovitis showed that low specificity and symptoms may be caused by other pathoses.     

Evaluation of coronary artery disease in women

Sepsis syndrome and septic shock remain significant causes of morbidity and mortality. To date, clinical trials of novel agents to treat sepsis have failed to demonstrate clinical efficacy despite considerable animal data to suggest a positive therapeutic benefit. This article reviews the recent major clinical trials on sepsis and discusses the hypotheses on which these therapies are based and the critical issues associated with clinical sepsis. Recommendations for future clinical trials on sepsis are made.     

The clinical diagnosis of deep venous thrombosis: integrating incidence, risk factors, and symptoms and signs

Symptoms and clinical signs suggestive of deep venous thrombosis (DVT) are common and have numerous possible causes. Studies have shown that symptoms and clinical signs in themselves are inaccurate for the diagnosis of DVT. However, clinicians have other information at hand, such as data on risk factors for DVT, that may help improve their ability to predict a diagnosis of DVT in the individual patient. Epidemiological data on DVT incidence and risk factors were reviewed, as were published data on the accuracy of clinical diagnosis of DVT, with the use of both symptoms and signs in isolation and symptoms and signs combined with other clinical information in the form of clinical prediction indexes. Symptoms and clinical signs, when combined with other patient information such as the presence or absence of known risk factors for DVT, can improve clinical prediction considerably. Further study is needed to determine whether clinical prediction indexes have a role in improving the diagnostic process in patients with suspected DVT.     

Health care psychology and graduate education.

Contends that health care (HC) psychology should be more strongly emphasized in graduate clinical psychology training programs so that clinical psychologists can better meet demands for services that come from society, the HC field, clinical psychology itself, practicing clinical psychologists, and clinical psychology graduate students. The relationship of clinical psychology to HC psychology and the efficacy of training in HC psychology to meet those sources of demand are described. Various means of implementing graduate programs that stress or include HC psychology are discussed. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stimulation Program Health Research. XI. Evaluation of the section 'Rehabilitation Medicine'

As a part of the SGO Health Research Promotion Programme a research programme on rehabilitation medicine was realized. Aim of the programme was to strengthen clinical research in this field by training clinical researchers and improving clinical research infrastructure. Three clinical specialists have been trained to become senior clinical researchers by a 4-year training programme, concentrated within 2 clusters of a medical faculty, a university hospital and one or more centres for rehabilitation medicine. As a follow-up to the programme a 6-week educational course was developed for intending MDs in rehabilitation medicine and five intending rehabilitation medicine specialists receive a PhD research training during their clinical specialisation.     

Clinical psychology in Poland.

Discusses the history and current practice of clinical psychology in Poland, focusing on recent developmental trends and the educational standards and practices used in the training of Polish clinical psychologists. The preparation of students for the Magister (master's degree) in clinical psychology includes basic courses in psychology, specialization in 1 of 4 clinical areas (adult clinical, child clinical, neuropsychology, or forensic psychology), sensitivity training, and on-site practicum training. Doctoral work includes research and often emphasizes teaching more than in the US. Settings in which clinical psychologists work, programs in which they are involved, and the orientation or style of their work are described. Differences in psychological practices between Eastern and Western countries are examined in the context of sociocultural and political differences. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

TCA-100 tumour chemosensitivity assay: differences in sensitivity between cultured tumour cell lines and clinical studies

The BATLE LE TCA-100 tumour chemosensitivity assay has been used to evaluate chemotherapeutic drug sensitivity of cultured tumour cell lines. Studies were performed using test drug concentrations calibrated to discriminate sensitivity and resistance of clinical specimens. Strong sensitivity which appeared to be inconsistent with clinical experience was detected for some drugs and cell lines. Findings of strong sensitivity were consistent with basic differences between sensitivity testing cultured cell lines and clinical specimens. Results with cell lines frequently may not apply directly to clinical applications. Characterization of differences between cell lines and clinical specimens may assist in application of cell line findings to clinical trials.     

The lived experience of clinical educators

This phenomenological study was undertaken to discover the everyday meanings which clinical educators of pre-registration Bachelor of Nursing students attached to their experiences as clinical educators. The researcher employed a qualitative design using audiotaped in-depth interviews with four registered nurses employed as clinical educators in four different schools of nursing in Victoria, Australia. Using hermeneutics, thematic analysis revealed five themes of meaning central to the lived experiences of clinical educators. They are:(a) being human, (b) having standards, (c) developing own teaching style, (d) learn as you go, and (e) not belonging. The first three themes are described in the literature on clinical education, however, the latter two are unique to this research. The results of this study indicate there is need for extensive preparation and on-going support of clinical educators. The researcher, who is respectful of the enormity of the task which educators face in preparing students for practice, speculates whether clinical educators are the vanguards of student learning in the clinical field. It is evident that the participants of this study did not possess many of the role requirements of clinical educators identified in the literature. Further studies are needed which explore the link between student learning and clinical educator support.     

Aging and pharmacology

Research on aging and pharmacology in humans has been termed geriatric clinical pharmacology, which is an established subdiscipline within the broad field of clinical pharmacology. This article reviews information relevant to clinical cancer research and the care of older patients with cancer. Accordingly, the current state of knowledge on drug utilization, pharmacokinetics, pharmacodynamics, adverse drug events, drug interactions, polypharmacy, adherence to treatment, and clinical research considerations are reviewed. Although a review of the literature on aging and cancer chemotherapy is not included in this particular presentation, information is very sparse. Thus, there is significant potential for valuable contributions from clinical research through partnerships between geriatric clinical pharmacologists and medical oncologists.     

The correct formulation of clinical questions for the practice of evidence based medicine

Evidence-based medicine is the conscientious, explicit, and judicious use of the best evidence available to make decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. The good practice of EBM begins with a well formulated clinical question, meaning that it should be clear, directly relevant to the problem at hand and answerable by searching in medical literature. This paper begins by presenting the central tasks of clinical work from which clinical questions arise. The components of well formulated clinical questions are then presented. Finally, some of the steps for the correct formulation of questions are discussed.     

Learned helplessness in the perspective of the depressive disorders: Conceptual and definitional issues.

Examines 3 issues that are important in extending the learned helplessness model to clinical depressive disorders. First, the nature of the heterogeneity of clinical manifestations of depression is examined within several clinical frameworks, and the role that learned helplessness may play in each is discussed. Second, the problems in constructing models for clinical populations are explored through the examination of several parallels between learned helplessness and clinical depression put forth by M. E. Seligman (1975). Third, problems involved in defining and identifying depressed college student Ss in analog research are discussed. Integral to the latter issue is an evaluation of the assumption that depressed college student Ss differ from clinical depressives only quantitatively but not qualitatively. Suggestions are made for research aimed at extending the learned helplessness model to other clinical problem areas. (48 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chiral separations by capillary electrophoresis in process chemistry

BACKGROUND: Conducting research in clinical settings can be problematic for many nurses in practice due to lack of experience and support. METHOD: Research collaboration between clinical nurse specialists and staff nurses in clinical settings can promote development of their research process skills. RESULTS: Strategies identified can be applied by clinical nurse specialists involved in continuing education and staff development in clinical practice through further research development. CONCLUSION: Collaboration among clinical nurse specialists and staff nurses provides a unique and strong link that transcends degrees and roles to make substantial contributions to professional nursing practice.