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PubMed2003

[Historical study of clinical pharmacy education in Japan (part 1). The founding and history of the one-year graduate course of clinical pharmacy practice (yakugaku senkouka) at the Meijo University].

Since there was an increasing demand for highly educated pharmacists with clinical experience, a one-year graduate course in clinical pharmacy practice (Yakugaku Senkouka) was established at Meijo University in 1975. This was aimed to provide pharmacists a training program for clinical skills and hospital settings. The course became a leading school in clinical pharmacy education in Japan. The present study describes what it was like and how it contributed to the development of clinical pharmacy in the country. In this article, the history is divided into five terms ranging from 1975 to 2002. The first term (1975-1979): To introduce the educational system, a system that was modeled on those in USA was introduced. The curriculum of clinical clerkship and the methods for evaluating training process were devised. The second term (1980-1984): Clinical clerkships were systematized and modified to fit to society. A manual textbook for training in clinical pharmacy was edited. The third term (1985-1989): The activities in the course were recognized as a new professional practice of pharmacists in Japan under The New Medical Law and The Law of Healthcare Insurance. The fourth term (1990-1995): Clinical pharmacy became popular nationwide. In Meijo University, a new challenge was made to merge clinical pharmacy skills with scientific backgrounds. The fifth term (1996-2002): To cope with the trends of extending undergraduate pharmacy education to six years, it has been decided that the course will be reorganized into a 2-year master's course in clinical pharmacy and accepted as a graduate course in 2003. The history of the course, a forerunner of clinical pharmacy education in Japan, ended in 2002.

Education, Pharmacy, Graduate↗
PubMed2004

On the threshold of disorder: a study of the impact of the DSM-IV clinical significance criterion on diagnosing depressive and anxiety disorders in clinical practice.

BACKGROUND: Two recent reanalyses of epidemiologic studies found that adding a clinical significance criterion reduced disorder prevalence. Patients presenting for clinical care are usually distressed or impaired by their symptoms; thus, the DSM-IV clinical significance criterion might have little impact on diagnosis in clinical practice. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we examine the impact of the DSM-IV clinical significance criterion on diagnostic frequencies of depressive and anxiety disorders in psychiatric outpatients. METHOD: 1500 psychiatric outpatients were evaluated with the Structured Clinical Interview for DSM-IV. We determined the percentage of patients who met symptom criteria but did not meet the DSM-IV clinical significance criterion for major depressive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), social phobia, specific phobia, panic disorder, and obsessive-compulsive disorder. RESULTS: No patient who met the symptom criteria for current major depressive disorder or PTSD failed to meet the clinical significance criterion. Less than 2% of patients meeting the symptom criteria for current GAD did not meet the clinical significance criterion. There was variability among the remaining anxiety disorders in the percentage of symptomatic patients who met the clinical significance criterion. CONCLUSION: In psychiatric patients, the clinical significance criterion had little impact on diagnosing major depressive disorder, GAD, and PTSD, disorders that are defined, in part, by disruptions of daily regulatory domains such as sleep, appetite, energy, and concentration. In contrast, the clinical significance criterion had a greater impact in determining whether phobic fears, obsessive thoughts, and panic attacks were sufficiently distressing or impairing to qualify for disorder status.

Adult↗
PubMed1998

Assessing clinical competence of medical students in women's health care: use of the objective structured clinical examination.

OBJECTIVE: To assess clinical competency of third-year medical students completing a problem-oriented, primary care emphasis clerkship in obstetrics and gynecology using an objective structured clinical examination, and to determine the feasibility of implementing the objective structured clinical examination in the curriculum. METHODS: Sixteen groups of third-year medical students were evaluated prospectively on their exit performances with a six-station objective structured clinical examination designed to test clinical competency in basic primary care obstetrics-gynecology. Consistency of scores across stations, differences in performance for separate groups, and relationship of objective structured clinical examination scores compared with other indicators of medical proficiency, such as written examinations and faculty evaluations, were assessed. RESULTS: One hundred ninety-eight students were evaluated over 25 months. Test reliability across stations revealed alpha values ranging between .50 and .56. Correlations between performance on the objective structured clinical examination and the written test (r = .10) were low, demonstrating that the objective structured clinical examination clearly tests a separate domain of student capability. Cost of the objective structured clinical examination was $81.66 per student. CONCLUSION: The objective structured clinical examination is a reliable and valid test of the clinical competence of medical students in the primary health care of women. It provides information that is not obtained by more traditional assessment modalities at a reasonable cost.

Clinical Clerkship↗
PubMed2001

Measurement of clinical reflective capacity early in training as a predictor of clinical reasoning performance at the end of residency: an experimental study on the script concordance test.

BACKGROUND: The script concordance (SC) test was conceived to measure knowledge organization, the presence of links between items of knowledge which allow for interpretation of data in clinical decision making situations. Earlier studies have shown that the SC test has good psychometric qualities and overcomes some of the limitations of simulation clinical testing. This study explores the predictive validity of the test. OBJECTIVES: To verify whether scores obtained by students at the end of clerkship predict their clinical reasoning performance at the end of residency. DESIGN: Comparison of scores obtained on a SC test taken at the end of clerkship with those obtained 2 years later at the end of residency on two clinical reasoning assessments of known validity, called the short-answer management problems (SAMPs) and the simulated office orals (SOOs), and an objective structured clinical examination (OSCE) aimed at assessing hands-on skills and clinical reasoning. Data were treated by Pearson correlation analysis. SUBJECTS AND SETTING: A cohort of 24 students from a medical school in Quebec was followed up to the end of their residency in family medicine, completed in several schools across Quebec. RESULTS: The observed Pearson correlation coefficients of the SC test were statistically significant (0.451, P=0.013; 0.447; P=0.015) when compared with the SAMPs and the SOOs, respectively. They were not statistically significant (0.340, P=0.052) when compared with the OSCE. CONCLUSION: The authors assumed that the richness of knowledge organization, as indicated by SC test scores, would predict part of the performance on the measures of clinical reasoning (SAMP and SOO), but would predict less well performance on the OSCE which measures both clinical skills and clinical reasoning. Data found in the study are coherent with this hypothesis. This is evidence in favour of the construct validity of the SC test. It also indicates that, in the context of certification assessment, if a candidate has shown good organization of clinical knowledge at an early point in training, it can be expected that he/she will show good organization at subsequent measurements of this kind of knowledge. This appears to be true even if the later measures bear on a wider clinical domain.

Clinical Clerkship↗
PubMedDate not supplied

An overview of clinical pharmacy and clinical pharmacology.

The relationship between clinical pharmacy and clinical pharmacology can best be assessed by looking at the three major responsibilities of these related professional disciplines--research, education, and patient care. Clinical pharmacologists will continue to dominate clinical research, but clinical pharmacists will continue to expand their contributions in all types of research. Clinical pharmacists are beginning to assume responsibility for providing training in rational therapeutics to medical students and house staff and, because of their greater numbers, probably will ultimately have a greater influence than clinical pharmacologists in this area. Similarly, clinical pharmacists appear to have greater influence on day-to-day patient care than clinical pharmacologists. Successful pursuit of all of these activities by clinical pharmacists assumes a continuing supply of well-trained practitioners. However, many pharmacy schools do not provide adequate classroom and bedside training. This is an unfortunate trend that seems to be accelerating as many schools convert from baccalaureate to doctoral entry degree programs without adequate clinical faculty and teaching hospital facilities.

Certification↗
PubMed1994

Clinical benchmarking improves clinical paths: experience with coronary artery bypass grafting.

BACKGROUND: Clinical paths and clinical benchmarking are consistent with, and readily adaptable to, any health care organization that espouses the principles of continuous quality improvement. CLINICAL PATHWAY: In its initial clinical path project, Borgess Medical Center analyzed and streamlined the processes of caring for a coronary artery bypass graft (CABG) patient. Team discussions were driven by comparative data, specialty guidelines, peer review organization guidelines, patient financial statements, patient records, and the applicable literature. One year after the CABG clinical paths were implemented, average total charges to the patient dropped from $35,700 to $32,700. Average length of stay also dropped, from 11.1 to 9.7 days. The mortality rate held stable at 2.7%. CLINICAL BENCHMARKING: Recognizing the opportunity to further improve its CABG clinical path, Borgess participated in MediQual's CABG benchmarking project. The team followed MediQual's five phases of clinical benchmarking: focus and opportunity assessment, outcome analysis and comparison, clinical process documentation, benchmark process comparison, and action planning, implementation, and monitoring. Using benchmark data provided by MediQual, the CABG benchmark team focused on the high-risk population and identified further opportunities for streamlining the CABG clinical pathway. Several areas for improvement were identified by comparing Borgess's practices to the benchmark hospitals. CONCLUSION: Developing a clinical path before beginning to benchmark "forced" Borgess Medical Center to develop a clear understanding of its own processes. This allowed the benchmark team to easily identify variances between its CABG processes and those of the benchmark hospitals and to select which variations the hospital should adopt.

Clinical Protocols↗
PubMed2002

Clinical trials at AHCs: the perspective of an academic clinical trials office.

Industry-sponsored clinical trials represent a substantial portion of the clinical investigator's portfolio of patient-oriented research. In academia's efforts to reclaim lost ground with respect to the performance of industry-sponsored clinical trials, many academic health centers have established clinical trials offices. An underlying assumption has been that with improved service on the part of universities will come new opportunities for clinical research. The experiences and vantage points of academic research offices have sometimes been ignored and an analysis of what new business might ensue has not been reported. The authors discuss the rationale for creating a centralized clinical trials office and the means of financing such an effort. They then describe the initial experiences (1997-2000) of a central clinical trials office (the Research Services Organization, or RSO) at the University of Minnesota Academic Health Center, analyze the value of such an office to the academic health center, and, based on their experiences with the RSO and elsewhere, consider how industry and academia might further enhance their collaborations. Of 354 clinical research proposals evaluated by the RSO, only 62% were found to be acceptable or highly likely to be acceptable to investigators and the institution. Reasons for not participating in specific clinical trials are discussed. Academic health centers contemplating developing clinical trials offices must be aware of the significant overhead cost associated with evaluating the appropriateness and feasibility of clinical trial proposals that may never be performed. Valuable lessons learned from working with sponsors and from working with investigators are also reviewed.

Academic Medical Centers↗
PubMed1997

Eligibility of Alzheimer's disease clinic patients for clinical trials.

OBJECTIVES: To identify the percentage of patients with Alzheimer's disease (AD) in a general clinic population who would be provisionally eligible for randomized clinical trials and the extent to which these patients represent the overall clinic-based population. BACKGROUND: Many randomized clinical trials have restricted enrollment criteria that may limit generalizability, i.e., AD patients who fulfill selection criteria for phase III clinical trials may not be representative of other AD patients in clinical settings. DESIGN AND SETTING: Patients diagnosed as probable or possible AD from the nine clinical sites of the State of California's Alzheimer's Disease Diagnostic and Treatment Centers (ADDTC) were selected on the basis of their provisionally fulfilling the inclusion and exclusion criteria of two typical AD clinical trials at the time of their first visit (ECG and brain imaging criteria were not available). RESULTS: From a sample of 3470 subjects with possible or probable AD, overall, only 4.4% or 7.9% would have been provisionally eligible for each of two trials. Patients provisionally eligible were younger, relatively underrepresented by women, better educated, wealthier, and more likely to be white than ineligible patients. The major independent demographic predictors for eligibility were (1) income greater than $15,000 per year, (2) male gender, and (3) college education. More than 60% of probable AD patients were excluded because of significant behavioral problems; approximately one-quarter each were excluded because of significant medical or neurological problems. Allowing patients with probable or possible AD to enroll would have resulted in 10.6% being eligible. CONCLUSION: Selection criteria for AD clinical trials result in a demographically and clinically constrained subgroup that is not representative of the overall clinic population.

Age Factors↗
PubMed2006

Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation.

AIMS: To assess parent satisfaction with a nurse led clinic for children with intractable, functional constipation compared with a paediatric gastroenterology outpatient clinic. METHODS: A validated questionnaire covering six separate domains in 48 statements (provision of information, empathy with the patient, technical quality and competence, attitude towards the patient, access to and continuity with the caregiver, and overall satisfaction) was employed. For all outcomes, the data were analysed on an intention-to-treat basis. RESULTS: 90/107 (84%) questionnaires were returned: 40/51 (78%) from the paediatric gastroenterology clinic and 50/56 (89%) from the nurse led clinic. Results indicated a high "total" satisfaction with the clinical care, but these were statistically significantly higher in the nurse led clinic compared with the paediatric gastroenterology clinic (median score 8.7 and 7.3 respectively, out of a maximum score of 10). This difference was consistent across all domains when the scores from those attending the nurse led clinic were compared with those attending the paediatric gastroenterology clinic (information median score 8.7 v 7.5; empathy 9.0 v 7.3; competence 9.1 v 8.0; attitude 8.7 v 7.3; access 8.2 v 6.7). All comparisons were highly statistically significant. CONCLUSION: These results provide firm evidence that parents of children with intractable constipation are satisfied with the care they receive in both the paediatric and nursing clinic setting. Parent satisfaction, however, was significantly higher in those attending the nurse led clinic. This study adds further support to the development of a nurse led service to manage intractable, functional constipation in children.

Adolescent↗
PubMed1994

Hospital care for adults with cystic fibrosis: an overview and comparison between special cystic fibrosis clinics and general clinics using a patient questionnaire.

BACKGROUND: Provision of medical care for adult patients with cystic fibrosis is an increasing problem as the number of patients surviving into adulthood increases. Recent reports have suggested that care is best provided in specialist centres because of longer survival. Recent changes in the National Health Service funding and delivery of service may adversely affect the provision of such a specialist service. The aim of this study was to assess the current pattern of medical service received by adults with cystic fibrosis and to compare the type of care between special cystic fibrosis and general clinics. METHODS: Confidential postal questionnaires were sent to all 1052 members of the Association of Cystic Fibrosis Adults (ACFA) comprising 59% of the UK population of cystic fibrosis patients over 15 years and 80% over 25 years of age. The response rate was 82%. RESULTS: Two thirds of patients were attending special cystic fibrosis clinics for either adults or adults and children. There were significant differences in the proportion of patients using special cystic fibrosis clinics between regions but not between social class groups. Significant differences between cystic fibrosis and general clinics were noted. Patients attending cystic fibrosis clinics were more likely to have had simple clinical investigations (blood tests, sputum culture, oxygen saturation, chest radiography, weight and lung function measurement) in the previous year. They were also more likely to have received intravenous antibiotics at home, and to have access to paramedical personnel. Patients attending cystic fibrosis clinics were taking higher doses of pancreatic enzyme supplements with respect to quantity and potency of preparation. Such patients also had less severe symptoms irrespective of social class, and were more likely to be satisfied with professional aspects of their care. Regardless of type of clinic, potential deficiencies were identified in overall medical care with omission of clinical investigations in severely affected patients and evidence of undertreated respiratory and digestive symptoms in patients with moderate and severe disease. CONCLUSIONS: This survey provides evidence that adults with cystic fibrosis attending special cystic fibrosis clinics receive more intensive care, have better symptom control, and are more satisfied with the service provided than those attending general clinics.

Adolescent↗
PubMed1997

Is the quality of diabetes care better in a diabetes clinic or in a general medicine clinic?

OBJECTIVE: To compare the quality of ambulatory diabetes care delivered by physicians in the diabetes clinic versus the general medicine clinic of a university-affiliated Veterans Administration medical center. RESEARCH DESIGN AND METHODS: This is a retrospective study that involved the review of medical records against predetermined process-of-care criteria. A total of 112 patients with diabetes were randomly selected, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were examined: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quality, defined as a blood pressure measurement, a record of type of hypoglycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optometrist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit. RESULTS: The diabetes clinic performed significantly better than the general medicine clinic on the following criteria: a record of a patient's self-monitoring of blood glucose levels; a foot examination; a comprehensive eye examination; a glycated hemoglobin measurement; and a referral for diabetic education. The proportion of patient visits meeting the minimally acceptable levels of quality was better in the diabetes clinic than the general medicine clinic (73 vs. 52%, P = 0.02). CONCLUSIONS: Patients cared for by physicians in the diabetes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attention needs to be paid to ensure that generalists have the knowledge and system resources necessary to deliver an acceptable quality of diabetes care.

Blood Glucose Self-Monitoring↗
PubMed1999

A clinical demonstration model for assessing the effectiveness of therapeutic interventions: an expanded clinical trials methodology.

Both the evaluation of current treatment interventions and the innovation of new ones are vital to maintaining a viable clinical profession. In the field of psychology, however, often there are serious challenges facing these worthy endeavors. This article reviews several problems and limitations with evaluation of innovative psychotherapy treatments in clinical practice and suggests a strategy to overcome these. This approach, which we term the "Systematic Clinical Demonstration Methodology," (SCDM) combines the skills of clinicians with the rigors of clinical trials methods and permits concurrent clinical innovation and scientific evaluation. Here we suggest that the SCDM approach allows innovative practitioners to assist in the development and evaluation of promising clinical interventions by working closely with clinical trials researchers. This allows innovative clinicians to demonstrate new treatment approaches, while clinical researchers evaluate the effectiveness and safety of these interventions using clinical trials methods that incorporate qualitative data. We suggest that this approach can result in the development and evaluation of new treatment innovations more quickly and cost effectively than traditionally has been the case. In addition, some limitations commonly associated with clinical trials, such as not treating patients typically found in clinical practice, failing to treat patients with multiple disorders, or treating patients from different cultural or sociodemographic groups, can be more effectively addressed. Our experiences with using this method to evaluate different psychotherapy treatments for posttraumatic stress disorder are presented as an example of this new approach.

Clinical Competence↗
PubMed2001

Clinical sensitivity: the inseparability of ethical perceptiveness and clinical knowledge.

This article argues that there is an important connection between ethical sensitivity and clinical competency in nursing. This is more than a defense for ethical attitudes and virtues in clinical practice, however. I will show in what way ethical sensitivity is important not only to moral judgment, but to professional clinical knowledge and judgment as well. Drawing on central insights from continental philosophy, Husserl, Heidegger, Levinas and Foucault, as well as classical virtue theory, the article elucidates the inseparability of ethical sensitivity and clinical knowledge in nursing. Ethical sensitivity has bearing upon clinical knowledge and awareness in two important ways. First, what we consider relevant clinical knowledge and therapeutic measures frequently encounter the realities of clinical conditions, realities which embody certain moral qualities and appeal to moral values. In clinical nursing, it is important to understand how this encounter between professional knowledge and moral values informs clinical action, making it morally as well as professionally proper. Second, sensitivity to vulnerability qualifies clinical knowledge in the way that it alerts clinical sensitivity altogether. Perception of morally salient features informs the nurse about significant changes in the patient's pathological condition. The ability to be touched morally by the patient's condition, his or her vulnerability or vitality and positive experience is epistemologically and prognostically significant.

Attitude of Health Personnel↗
PubMed1997

Toward clinically relevant clinical trials.

This article grapples with two closely related tensions threatening the credibility and relevance of clinical trials to clinicians as well as patients and their families: (1) the tension between clinical flexibility and scientific standardization of protocol and (2) the tension between the need to ensure scientific integrity through a standard, pre-specified protocol and the need to increase compliance by involving patients and their families in goal setting and treatment planning. We propose four partial solutions: (1) relaxed exclusion criteria to maximize generalizability, using only those exclusion criteria essential to the treatment; (2) extensive use of clinical algorithms to incorporate clinical flexibility in a standardized way; (3) active involvement of therapists in decision-making, including cross-site clinical decision panels; and (4) active involvement of families through a goal-setting and treatment-planning session as the first step of treatment. Although we focus on clinical trials with children and adolescents, the principles and ideas may also apply to clinical trials with patients of any age. This article summarizes and elaborates on presentations made by three of the authors at workshops on psychiatric clinical trials in children and adolescents at the May 1996 New Clinical Drug Evaluation Unit (NCDEU) meeting. The focus was on enhancing the clinical relevance of clinical trials-making the results useful and credible to practitioners and patients and their families.

Adolescent↗
PubMed1996

What many of us are doing or should be doing in clinical pathology: a list of the activities of the pathologist in the clinical laboratory.

Mr. Paul Mango, Chief Operating Officer of a hospital-based clinical laboratory network in Pittsburgh, recently performed a survey of patients presenting for phlebotomy. The survey included the question, "What does a pathologist do?" The results were that 50% of the patients had no idea what a pathologist did, and 30% of the patients stated that pathologists examined dead bodies. It is not surprising that there is a limited understanding by patients of the activities of pathologists because patients do not usually see pathologists. However, beyond autopsy and surgical pathology, the activities of pathologists are also not well known to nonpathologist physicians and hospital administrators. A poor understanding of activities in clinical pathology have placed these clinical responsibilities of the pathologist under particular scrutiny for cost reduction. The quantitation of output from anatomic pathology, in number of slides reviewed or number of autopsies performed, is objective and easily understood. As noted in the list of clinical pathology activities that follows, the responsibilities within the clinical laboratory are highly diverse and, if the pathologist handles them successfully, highly contributory to patient care. Thus, it is timely that a compilation of activities in clinical pathology be issued for review by the pathologist community. I would hope that this list will serve as a starting point for a universally accepted group of activities that describes clinical pathology today and that it will be useful for pathologists to make their significant contributions in the clinical laboratory apparent to administrators, fellow physicians, and patients. The clinical laboratory responsibilities should also be valuable to directors of residency training programs to focus training in clinical pathology toward the development of currently desirable expertise.

Clinical Laboratory Techniques↗
PubMed1995

Clinical trials in cognitively impaired older adults: home versus clinic assessments.

OBJECTIVE: To compare the reliability of instruments used in clinical trials involving cognitively impaired older adults when the instruments are administered in-home rather than in-clinic and to compare withdrawal rates is these two groups. DESIGN: This study was part of a larger n-of-1 clinical trial to investigate the efficacy and safety of a MAO/A inhibitor (Brofaromine) in patients with Alzheimer's disease. Participants were initially assessed at the clinic (baseline) and then randomly allocated to in-home or in-clinic assessments for the remainder of the trial. The baseline and second assessment (performed before initiation of the treatment) were used for the reliability analysis. Withdrawal rates were examined over the course of the 6-month trial. SETTING: Assessments took place at a geriatric clinic in an urban university teaching hospital and at residences of some of the patients. PARTICIPANTS: Forty-six Alzheimer's disease patients participated in the study, of which, 22 were randomized to in-home assessments and 24 to in-clinic assessments. MEASUREMENTS: Test-retest reliability was measured for all five instruments used in the study and was based on the first two assessments. Sample size requirements, based on within-group variance, were calculated. Withdrawal rates were obtained for the total duration of the trial. RESULTS: Test-retest reliability of the instruments, as determined by intraclass correlations, was good in both groups but favored in-clinic for all but one instrument (range: 0.47-0.90 for in-home vs 0.57-0.92 for in-clinic). Sample size requirements based on reliability assessment data were found to be larger for some instruments when administered in-home. Only four in-home patients withdrew before completion of the study, compared with eight in-clinic patients. CONCLUSION: The results suggest the in-home assessments in cognitively impaired older adults may result in lower withdrawal rates but may necessitate larger sample sizes to offset larger test-retest variability.

Aged↗
PubMed2002

Nursing students' and clinical educators' perceptions of characteristics of effective clinical educators in an Australian university school of nursing.

BACKGROUND: This study is a replication of research undertaken by Mogan and Knox in 1987, which investigated and described characteristics of 'best' and 'worst' clinical educators. They developed and used an instrument known as the Nursing Clinical Teacher Effectiveness Inventory (NCTEI), a 48 item checklist that describes discrete characteristics clustered into five subscales or categories: teaching ability; interpersonal relationships, personality traits, nursing competence and evaluation. The tool has since been used in several countries including Greece, Hong Kong, Israel and North America and is the instrument most frequently used to identify effective clinical teaching characteristics of clinical educators. AIM: The aim of the present study was to administer the NCTEI to undergraduate nursing students and clinical educators in a school of nursing at an Australian university to explore the perceived characteristics of effective clinical educators as rated by students and educators, and the significant differences and commonalities between these perceptions. FINDINGS: Results indicate that the category of Interpersonal Relationships was the most highly valued characteristic rated by both Australian students and clinical educators, and both groups (students and educators) ranked the subset of personality as the lowest amongst five categories. In common with Mogan and Knox, this study found that students who had not been exposed to real clinical situations prior to commencing nursing studies ranked items related to interpersonal relationships more highly than students who had previous nursing experience. Although there were no statistically significant differences in the two groups, students were more concerned with evaluation while clinical educators were more concerned with nursing competence. CONCLUSION: This study is the first research to be reported in Australia, which has simultaneously compared both students' and educators' perceptions and the first to replicate Mogan and Knox's seminal work. Findings point to the need for clinical educators to value interpersonal relationships with students as well as clinical competence.

Adolescent↗
PubMed2000

Screening for HIV infection in genitourinary medicine clinics: a lost opportunity? British Co-operative Clinical Group.

OBJECTIVES: To examine the policy and practice of HIV testing in genitourinary medicine clinics in the United Kingdom. DESIGN: All 176 consultants in charge of genitourinary medicine clinics in the United Kingdom were sent a policy and practice questionnaire. A self selected group of 53 clinics conducted a retrospective case note survey of the first 100 patients seen in each clinic in 1998. SETTING: Genitourinary medicine clinics in the United Kingdom. SUBJECTS: Consultants in charge of, and case notes of patients attending, genitourinary medicine clinics. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Number of patients tested for HIV. RESULTS: Consultants' assessments of their rate of HIV testing often exceeded the actual rates of testing in the clinic as a whole. The majority of patients deemed to be at high risk requested an HIV test. The exception were heterosexuals who had lived in sub-Saharan Africa. Among attenders at high risk of HIV who did not request a test, 57/196 (29%) were not offered one by clinic staff. Two fifths (51/130) of consultants felt the proportion of patients tested in their clinic was too low. The commonest reason given for this was a lack of time, especially that of health advisers. CONCLUSIONS: A substantial minority of people with HIV infection attending genitourinary medicine clinics fail to have their infection diagnosed. Two major reasons were identified. Firstly, a test was not always offered to those at high risk of HIV. Secondly, a lack of resources, mainly staff, which prevents some clinics from increasing their level of testing.

Ambulatory Care↗