The Effect of Teaching Clinics on Prescribing Practices.

OBJECTIVE: The objective of this study was to investigate the effect of lack of continuity in a teaching clinic and to ascertain the role of supervisory attending in treatment decisions in a teaching psychiatric clinic. METHODS: A retrospective evaluation of paired consecutive visits of patients attending an education clinic was performed. RESULTS: Medication changes occurred in 56.3% of all visit pairs. Visit pairs in which the resident was unchanged had significantly more medication changes than visit pairs in which the attending was unchanged. When the resident stays the same, the number of medication changes is high and does not change significantly even if the attending is the same or different. Similarly, when the resident is different, the number of medication changes is low and does not change significantly if the attending is the same or different. CONCLUSION: Residents, not the attending physicians, are more instrumental in medication changes in patients attending an education clinic.

Hypothesis testing for selective, differential, and conjoined brain activation.

Hypothesis testing in functional neuroimaging studies relies heavily on the computation of categorical contrasts in which brain activation associated with one experimental condition is assessed relative to brain activation associated with a different experimental condition. Often, multiple pair-wise contrasts are computed and reported independently. Here we describe an approach to hypothesis testing that logically combines multiple pair-wise contrasts to distinguish among selective, differential and conjoined brain activation patterns. Using a sample dataset in which participants viewed objects, visual noise patterns or a fixation cross, we demonstrate that selective and differential brain activation patterns are often confounded with current approaches to hypothesis testing but that the logical combination approach can distinguish between these two types of data patterns. Specifically, we show that brain regions that respond selectively to an object recognition task relative to viewing visual noise or a fixation cross (selective activation) are mutually exclusive from brain regions that show a graded response to object viewing, noise viewing and visual fixation (differential activation). We thus show that the logical combination approach sufficiently constrains the results of categorical contrasts to reflect only the data pattern that would be predicted from the cognitive processing account under investigation.