Effects of an HIV risk reduction project on sexual risk behavior of low-income STD patients

Primary Sj?gren's syndrome (pSS) is increasingly acknowledged as a disease entity with consistent pathogenesis and clinical presentation. This has encouraged proposals for uniform nomenclature, as well as for classification of disease subsets and clinical disease manifestations. The purpose of this literature survey is to analyse present pathogenetic and clinical data on pSS from the viewpoint of their usability for developing criteria for activity and damage. It appears that the routinely used tests for evaluating clinical disease manifestations in pSS probably measure both activity and damage. Moreover, no immunopathogenic marker has been shown to adequately represent all aspects of disease activity in pSS. The survey demonstrates the need for longitudinal studies in which potential markers of disease activity and damage are validated.     

Physical measurements of the lumbar spine

This article describes measurement of lumbar function. The simplest range of motion devices are compared with the progressive, more complex computerized devices for range and strength testing. The author presents his own opinion as to the place of these devices in both research and clinical practices. The economics of accurate physical testing is compared to the clinical realities of current payment systems.     

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)     

A perspective on clinical evaluation in nursing education

Clinical evaluation in nursing education is an important activity with potentially serious implications for students, teachers, and the recipients of nursing care. The evaluation of student learning in the clinical area has been the focus of much effort and energy as educators struggle with issues arising from the subjective nature of clinical evaluation and the role of clinical instructors as both teachers and evaluators. In this paper, the objectivity-subjectivity debate is reviewed and the limits of evaluation practices based solely in positivism are discussed. The teacher-evaluator and formative-summative distinction is viewed as a false dichotomy which enforces power differentials and impoverishes student learning. A case is built for clinical evaluation as a form of inquiry, the purpose being the discovery and verification of the process and product of the teaching and learning of nursing practice. Fourth generation evaluation is proposed as a basis for evaluation practices that address the unique and context-dependent nature of clinical practice, are capable of producing credible and dependable clinical evaluations, and are supportive of empowering teacher-student relationships.     

Gold Medal Award for life achievement in the application of psychology.

The 2001 Gold Medal Award for Life Achievement in the Application of Psychology was awarded to Joseph D. Matarazzo. He is honored for advancing the applications of psychology as both a science and a profession. His service to students and to patients, as well as his research and scholarly writings in clinical psychology, health psychology, and clinical neuropsychology, have enriched the discipline of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section: Contextualizing significance testing in clinical trials.

The presentation and interpretation of clinical trial data is of crucial importance to psychotherapy research and practice. This introduction briefly describes how this Special Section on significance testing in clinical trials came about, as well as some of the content included in the articles. Between the original theoretical article and the four invited comments, this Special Section provides a concise and accessible overview of current thinking regarding the limitations of clinical trial data, particularly significance testing, as well as improvements and supplements to these analyses that may benefit both psychotherapy research and those who use this information in applied practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Role of clinical trials in memory clinics

The main points of a workshop on the place of clinical trials in the memory clinics in France are reproduced schematically. The efficiency of these centres has been tested at the time of the numerous clinical trials performed in France on Alzheimer's disease. In parallel, several difficulties have been pointed out: inhomogeneity of the technical approaches, official role of psychologists in the hospital teams, integration of clinical research to individual care. A particular effort should be oriented towards specific research on the different types of dementia, on early stages, on information for both media and authorities as well as on specific technical and methodological problems.     

The tie that binds: Affect regulation, attachment, and psychoanalysis.

Psychoanalytic theory has both expanded and altered its constructs in response to clinical work. The attachment system is a construct in need of integration, and it requires its own motivational status in psychoanalytic theory. The author regards affect regulation (mutual and self-regulation) as a key aspect of the attachment system and as an addendum to Bowlby's ideas, one that is consistent with contemporary findings in infant research. A published case and 2 clinical cases are used to demonstrate the usefulness of the concepts of mutual and self-regulation in clinical work. Illustrated as well are the benefits of an integration of affect regulation and traditional motives for optimizing clinical work. The inclusion of these motivational constructs provides for a more comprehensive psychoanalytic theory that offers enriched explanations of complex psychic and behavioral phenomena. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Biology of neurological recovery and functional restoration after spinal cord injury

OBJECTIVE: This article reviews the anatomic and pathophysiological bases for recovery of neurological function after experimental or clinical spinal cord injury (SCI). METHODS: Current knowledge regarding the recovery of neurological function after experimental or clinical SCI was reviewed to determine the biological basis of neurological recovery. RESULTS: There is a great propensity for recovery after clinical or experimental SCI. An examination of the anatomic basis of recovery indicates that there is a potential for both root and cord recovery, with the latter involving recovery of both gray and white matter of the cord. Resolution of acute injury events, such as hemorrhaging, and resolution of secondary pathophysiological processes, such as ischemia and excitotoxicity, can each account for recovery. The third recovery mechanism involves regrowth or regeneration of nervous tissue, resulting from either inherent or induced processes. CONCLUSION: During the Decade of the Brain, there has been a profusion of very promising in vitro and in vivo studies that have shown enhanced neurological recovery after experimental or clinical SCI.     

Blood substitutes: evolution and future applications

The development of oxygen-carrying blood substitutes has progressed significantly in the last decade with phase I and phase II clinical trials of both hemoglobin-based and perfluorocarbon-based oxygen carriers nearing completion. As these products approach clinical use it is important for the laboratory medicine community to be aware of their effects on routine laboratory testing and the settings in which they might be used. Here we review the forces driving the development of oxygen-carrying blood substitutes, the clinical settings in which they might be used, the major categories of oxygen carriers in clinical trials, and the challenges faced by these products as they approach clinical use.     

Evidence-based decision-making: an argumentative approach

A practical theory of argumentation is outlined and applied to a hypothetical clinical scenario to elucidate the use of research evidence in individual treatment decisions. The primary role of research evidence is to establish warrants as opposed to warrant using. Warrants are defined as the rules, principles or interpretive rationales used to justify an inference from observed data to conclusion, or clinical claim. Clarity on the appropriate use of research evidence in clinical decision-making can help resolve current debates over the nature and consequences of evidence-based medicine. The theory of argumentation has potential to inform both the design of decision support tools and to provide criteria for assessing decisional performance.     

Measurement and prediction, clinical and statistical.

Clinical vs. statistical prediction is only ? the problem—and the last ? at that. The prior problem, largely neglected, is clinical vs. mechanical measurement—for data can be collected, as well as combined, in either way. Such neglect promotes an incomplete and mismatched dialogue where "clinical" and "statistical" may have different meanings to different persons. Examining clinical and mechanical methods of both measurement and prediction provides a broadened framework that defines the several possible "clinical" and "statistical" methods, and their combinations. Applying this framework to 45 studies shows an apparent superiority for mechanical modes of both data collection and combination, and also suggests that the clinician is more likely to contribute through observation than integration. Grossly uncontrolled differences, however, in clinical training, Ss, criteria, etc., prevent definitive conclusions. To achieve more adequate comparison requires certain specified methodological improvements. (3 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The emotional impact of MS diagnosis

127 patients were observed: 65 schizophrenic patients and 62 patients with vascular mental disorders. The treatment by hyperbaric oxygenation (HBO) was applied in such patients to overcome resistance to psychopharmacotherapy. A positive clinical effect was marked in 72.5% of cases (in 67.4% of schizophrenic patients and in 77.4% of patients with vascular diseases). The conclusion was made that HBO enabled to shorten the time of hospital treatment as well as to improve both clinical and social prognosis.     

Obituary: David Shakow (1901-1981).

This article describes the career and scientific achievements of David Shakow, PhD. Shakow was a major figure of 20th-century American psychology, one of only two persons honored by the American Psychological Association with two of its most prestigious awards: the Distinguished Scientific Contribution Award and the Distinguished Professional Contribution Award. These two honors embodied the essence of Shakow's career. The award for scientific activity was given for basic contributions that enlarged our understanding of the processes underlying the psychological deficit manifested by schizophrenic patients. These studies spanned half a century, beginning in 1932 and concluding 50 years later, when his final publication on this subject appeared a year after his death. The award for professional achievement recognized his role as the father of contemporary clinical psychology. Shakow, by precept and example, gave meaning to the Boulder model for training clinical psychologists. He provided leadership in espousing the view that the clinical psychologist's role is that of both scientist and practitioner in the mental health field. He deeply respected both activities but gave primacy to the clinical psychologist as research scientist. His credo was one that, on reflection, was as applicable to the practitioner as it was to the researcher. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characterization of six patients who are double heterozygotes for familial hypercholesterolemia and familial defective apo B-100

Familial defective apolipoprotein B-100 (FDB) and familial hypercholesterolemia (FH) are the common causes of monogenic primary hypercholesterolemia. An individual of mixed English and Afrikaner descent with both FDB and the FH Afrikaner-1 low-density lipoprotein receptor mutation was identified in our laboratory. Subsequent analysis of her extended family revealed the presence of heterozygotes for either FH Afrikaner-1, FH Afrikaner-2, or FDB as well as five additional double heterozygotes for FH Afrikaner-1 and FDB and one "complex" heterozygote with all three mutations. The hypercholesterolemic and clinical features of the pure FDB subjects were similar to those of the pure FH heterozygotes. The double heterozygotes with both FH and FDB have lipid levels and clinical features that are intermediate in severity between heterozygous and homozygous FH.     

An overview of clinical policies with implications for clinical practice, medical education, and research

Clinical policies, also known as practice parameters or practice guidelines, are gaining notoriety out of a desire to control escalating medical costs, lessen wide practice variations, and improve quality of care. The clinical policies are supposed to influence medical decision making by summarizing scientific data about a clinical problem in a format that is easily understood by patient and physician alike. Developing an evidence-based policy involves: a clearly defined clinical problem, a comprehensive literature review, a summary table of the data (known as an evidence table), a presentation of this data as outcome possibilities from alternative decisions (in the form of a balance sheet), and creation of clinical recommendations that incorporate both financial costs and patient preferences. Well-developed policies can be used by family physicians as guides in areas of clinical uncertainty and by medical educators as up-to-date literature syntheses for teaching critical appraisal and for outlining approaches to common problems. Explicit policy formulation also highlights the shortcomings of existing literature and can suggest more appropriate future research. The future of the clinical policy movement rests on its ability to reduce costs of care and improve patient outcomes. Explicit clinical policy formulation incurs significant development and implementation costs and the evidence on which many policies are based is lacking. Nevertheless, clinical policies in some form are likely to play an increasing role in medical care.     

Intra-abdominal lymphangioma--clinicopathological profile of a rare lesion

Lymphangioma occurring in an intra-abdominal location is reported to be extremely rare. A series of 5 cases is presented and the differential diagnoses and diagnostic features discussed. None of the cases were diagnosed as lymphangioma clinically. It is suggested that their true incidence may be unknown due to both silent clinical course as well as lack of awareness of clinical and morphological features.