The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education.

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of "clinical skills," and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.

Advancing psychology as a bio-behavioral science.

Concerns for the integrity of psychology as an independent discipline have caused some psychologists to object to introducing any knowledge from the biological sciences into the training of psychologists. However, calls for the greater incorporation of the behavioral sciences in medical education, increased attention to research on the mechanisms of bio-behavioral interaction, and initiatives in translational medical research and clinical care, have prompted increased interest in interdisciplinary research, health care, and teaching. These changes, in turn, are resulting in a re-conceptualization of the structure of academic medicine with increasing emphasis upon multidisciplinary knowledge and interdisciplinary collaboration, and less emphasis upon disciplinary insularity and competitiveness. If clinical health psychology is to play a role in this evolving concept of academic health care, it must adequately prepare its trainees to function in interdisciplinary academic health care settings. This will require not only expertise in the role of behavioral factors relevant to medical disorders, but also some basic familiarity with the biological processes to which those behavioral factors relate. With the evolution of its fund of knowledge, clinical health psychology has the potential to utilize its science to discover, describe, interpret, teach and clinically apply knowledge of the mechanisms of interaction between biological functions and behavioral, learning, cognitive, socio-cultural and environmental processes. By failing to seize this initiative, clinical health psychology risks becoming irrelevant to the evolving model of medical research, education and health care.

An international perspective on behavioral science education in medical schools.

The behavioral sciences are taught in medical curricula around the world. In the current paper psychologists teaching in medical schools in Australia, Mexico, Saudi Arabia, Thailand, the United Kingdom and the United States share their experience and reflections. Whilst direct comparisons between countries are not made, the themes that are evident within and between accounts are instructive. As behavioral scientists around the globe are struggling to maintain a presence in medical education many of the reasons behind this are shared, regardless of the country. Challenges discussed include those related to the impact of unrealized potential contributions of psychologists as health care professionals, teaching of behavioral sciences by other professions, domination of the biomedical model without a corresponding recognition of psychology as science, and modern medical pedagogies such as problem-based learning, which favor biomedicine. Systemic and political barriers over which we as a discipline may have little control are also highlighted.

Determination of active pharmaceutical ingredients by heteroatom selective detection using inductively coupled plasma mass spectrometry with ultrasonic nebuilization and membrane desolvation sample introduction.

The combination of ultrasonic nebulization with membrane desolvation (USN-MD) is utilized to determine active pharmaceutical ingredients (API) by heteroatom inductively coupled mass spectroscopy (ICP-MS) detection. Ultrasonic nebulization provides efficient sampling while use of the membrane desolvator acts to reduce solvent-based interferences. This approach reduces interferences sufficiently so that a standard argon ICP-quadrupole MS can be utilized. Examined APIs and associated heteroatoms included: phosphomycin (P), amoxicillin (S), chlorpropamide (Cl), and ofloxacin (F). The optimum plasma r.f. powers for P, S, and Cl were in the 1000 to 1200 watts range. The high ionization energy of F required that the plasma be operated at 1500 W. The 16O2+ interference at mass 32 precluded determinations using the sulfur-32. The sulfur-34 (4.2% natural isotopic abundance), however, was relatively free of isobaric interferences. Interferences were relatively small at the mass 35 isotope of Cl, but increased with higher ICP r.f. powers. Overlaps were significant at the masses of monoisotopic species, fluorine-19 and phosphorus-31. Detection limits for P, S, Cl, and F of 2, 3, 90, and 3000 ng/mL, respectively, were generally lower than those produced with other quadrupole systems and comparable to or better than values published utilizing high-resolution instruments.

Effects of liquid chromatography mobile phases and buffer salts on phosphorus inductively coupled plasma atomic emission and mass spectrometries utilizing ultrasonic nebulization and membrane desolvation.

Atomic spectrometry, specifically inductively coupled plasma atomic emission spectrometry (ICP-AES) and mass spectrometry (ICP-MS) show promise for heteroatom-based detection of pharmaceutical compounds. The combination of ultrasonic nebulization (USN) with membrane desolvation (MD) greatly enhances detection limits with these approaches. Because pharmaceutical analyses often incorporate liquid chromatography, the study herein was performed to examine the effects of solvent composition on the analytical behaviors of these approaches. The target analyte was phosphorus, introduced as phosphomycin. AES response was examined at the 253.7 nm atom line and mass 31 ions were monitored for the MS experiments. With pure aqueous solutions, detection limits of 5 ppb (0.5 ng in 0.1 mL injection volumes) were obtained with ICP-MS. The ICP-AES detection limit was 150 ppb. Solvent compositions were varied from 0 to 80% organic (acetonitrile and methanol) with nine buffers at concentrations typically used in liquid chromatography. In general, solvents and buffers had statistically significant, albeit small, effects on ICP-AES sensitivities. A few exceptions occurred in cases where typical liquid chromatography buffer concentrations produced higher mass loadings on the plasma. Indications are that isocratic separations can be reliably performed. Within reasonable accuracy tolerances, it appears that gradient chromatography can be performed without the need for signal response normalization. Organic solvent and buffer effects were more significant with ICP-MS. Sensitivities varied significantly with different buffers and organic solvent content. In these cases, gradient chromatography will require careful analytical calibration as solvent and buffer content is varied. However, for most buffer and solvent combinations, signal and detection limits are only moderately affected. Isocratic separations and detection are feasible.

Relaxation and imagery and cognitive-behavioral training reduce pain during cancer treatment: a controlled clinical trial.

Few controlled clinical trials of psychological interventions for cancer pain relief exist in spite of frequent support for their importance as adjuncts to medical treatment. This study compared oral mucositis pain levels in 4 groups of cancer patients receiving bone marrow transplants (BMT): (1) treatment as usual control, (2) therapist support, (3) relaxation and imagery training, and (4) training in a package of cognitive-behavioral coping skills which included relaxation and imagery. A total of 94 patients completed the study which involved two training sessions prior to treatment and twice a week 'booster' sessions during the first 5 weeks of treatment. Results confirmed our hypothesis that patients who received either relaxation and imagery alone or patients who received the package of cognitive-behavioral coping skills would report less pain than patients in the other 2 groups. The hypothesis that the cognitive-behavioral skills package would have an additive effect beyond relaxation and imagery alone was not confirmed. Average visual analogue scale (VAS) report of pain within the therapist support group was not significantly lower than the control group (P = 0.103) nor significantly higher than the training groups. Patient reports of relative helpfulness of the interventions for managing pain and nausea matched the results of VAS reports. From these results, we conclude that relaxation and imagery training reduces cancer treatment-related pain; adding cognitive-behavioral skills to the relaxation with imagery does not, on average, further improve pain relief.