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Biomedical subjects

D Cottrell

Publications and source records attributed to D Cottrell.

13 recordsLinked to original sources
PubMed1999

Structured teaching methods enhance skill acquisition but not problem-solving abilities: an evaluation of the 'silent run through'.

OBJECTIVES: We aimed to evaluate whether a structured teaching technique (the silent run through) was of benefit in the learning of a skill sequence, and whether it would affect students' ability to improve their problem-solving skills or ability to make judgements. DESIGN: Students from one hospital were taught two different complex skills using a highly structured teaching method involving the breakdown of complex tasks into smaller components and the utilization of an internal, silent 'commentary'. Their subsequent ability to reproduce these skills was compared with a second group of students taught at another hospital. All students were assessed during a common end of attachment Objective Structured Clinical Examination on the two skills, by raters blind to the teaching techniques the students had received. SETTING: School of Medicine, University of Leeds, UK. SUBJECTS: Medical students. RESULTS: Students who received the structured teaching were significantly better at reproducing a complex, sequential clinical skill (examination of a squint). There was no demonstrable improvement in problem-solving skills as assessed on an X-ray interpretation station. Students expressed high levels of satisfaction with learning skills in such a structured way and reported increased confidence in their examination skills. CONCLUSIONS: This study provides some evidence to support the hypothesis that different teaching techniques may be more effective for improving different elements of skills learning. In particular, a highly structured technique involving breaking complex tasks down into smaller components and utilizing an internal 'commentary' may be an effective way of teaching the sequential motor components of complex clinical skills.

Clinical Competence↗
PubMed1999

The natural history of multiple sclerosis: a geographically based study. 7. Progressive-relapsing and relapsing-progressive multiple sclerosis: a re-evaluation.

Classifications of multiple sclerosis subtypes have been largely based on clinical phenomenology. Nevertheless, definitions of relapse, remission and progression have been imprecise. Recently an international consensus group, as part of a reclassification of disease subtypes, recommended dropping the term 'relapsing-progressive' (RP) and retaining the term 'progressive-relapsing' (PR) multiple sclerosis. The term 'RP' multiple sclerosis had been applied when the early course combined both relapses and progression and was believed to identify some patients with a worse than average outcome. The PR group consisted of patients with primary progressive disease who later in their course developed relapses. Since the terminology has been largely arbitrary, we have evaluated the validity of the terms 'RP' and 'PR' multiple sclerosis in the context of long-term outcome within a large population-based cohort of progressive multiple sclerosis patients seen at the London Multiple Sclerosis Clinic (Canada) between 1972 and 1984. Mean follow-up of the entire cohort was 25 years. Designation of RP multiple sclerosis did identify a more rapidly progressive subgroup. To realign these natural history data with consensus recommendations, these patients were reassigned to secondary progressive (SP) or to primary progressive (PP) multiple sclerosis, with progression defined as at least 1 year of progressive deterioration. PP multiple sclerosis patients with relapses after a year were designated as having PR multiple sclerosis. Relapses in primary progressive multiple sclerosis occurred in 27.8% of patients at some point even two to three decades after onset. In general these relapses were mild and remitting, but served to blur the distinction between progressive and relapsing-remitting disease. The long-term outcomes of time to Kurtzke disability scores (DSS) of 3, 6, 8 and 10 were compared among the progressive subtypes. Times to these disability end-points and to death were not different between PR and PP multiple sclerosis. Survival curves for progressive patients have been amended to incorporate the reassignment of PR multiple sclerosis patients into the PP group and the RP multiple sclerosis patients into the PP and SP subgroups. The time to reach DDS 3, 6, 8 and 10 for a population-based cohort of primary and secondary progressive patients resulting from the elimination of the categories of RP multiple sclerosis and PR multiple sclerosis has been established. These results provide justification for retaining only PP and SP multiple sclerosis as the subgroups of progressive disease.

Adult↗
PubMed1999

A randomised controlled trial of specialist health visitor intervention for failure to thrive.

AIMS: To determine whether home intervention by a specialist health visitor affects the outcome of children with failure to thrive. METHODS: Children referred for failure to thrive were randomised to receive conventional care, or conventional care and additional specialist home visiting for 12 months. Outcomes measured were growth, diet, use of health care resources, and Bayley, HAD (hospital anxiety and depression), and behavioural scales. RESULTS: Eighty three children, aged 4-30 months, were enrolled, 42 received specialist health visitor intervention. Children in both groups showed good weight gain (mean (SD) increase in weight SD score for the specialist health visitor intervention group 0.59 (0.63) v 0.42 (0.62) for the control group). Children < 12 months in the intervention group showed a higher mean (SD) increase in weight SD score than the control group (0.82 (0.86) v 0.42 (0.79)). Both groups improved in developmental score and energy intake. No significant differences were found for the primary outcome measures, but controls had significantly more dietary referrals, social service involvement, and hospital admissions, and were less compliant with appointments. CONCLUSIONS: The study failed to show that specialist health visitor intervention conferred additional benefits for the child. However, the specialist health visitor did provide a more coordinated approach, with significant savings in terms of health service use. Problems inherent to health service research are discussed.

Child Behavior↗
PubMed1999

Validation of the Hospital Anxiety and Depression Scale for use with adolescents.

BACKGROUND: The Hospital Anxiety and Depression Scale (HADS), developed for use with adults, has potential with adolescents. AIMS: To test the HADS's validity with adolescents. METHOD: The HADS was given to 248 schoolchildren and to 48 psychiatric out-patients and 38 deliberate self-harm in-patients aged 12-17, and validated against ICD-10 diagnoses for the out-patients. RESULTS: The HADS has adequate test-retest reliability and factor structure, and discriminates between adolescents diagnosed with depressive or anxiety disorders and those without these diagnoses. CONCLUSIONS: The psychometric properties of the HADS and its shortness make it useful for screening and in clinical settings with adolescents.

Adolescent↗
PubMed1997

Psychological disturbance in atopic eczema: the extent of the problem in school-aged children.

Although psychological factors are widely considered to be important in atopic eczema, there have been few controlled studies to assess the extent of disturbance in affected children and the problems experienced by their parents. This study was designed to find out the degree of psychological difficulty experienced by children with atopic eczema, whether their mothers show higher levels of mental distress than a comparison group, and whether the families of children with atopic eczema have less social support than the comparison group. We investigated 30 school-aged children with atopic eczema for psychological problems using the Rutter parent scale and compared them with 30 children with relatively minor skin lesions such as viral warts. Mental distress in mothers was assessed using the General Health Questionnaire. The Family Support Scale was used to get a measure of the social support experienced by the families. We found twice the rate of psychological disturbance in children in the eczema group compared with the control group. This difference was statistically significant for children with moderately severe eczema and severe eczema, but not for children with very mild eczema. Levels of mental distress were no greater in mothers of children with eczema than in parents of the control group and there was no difference in the degree of social support experienced by their families. These findings indicate that school-aged children with moderate and severe atopic eczema are at high risk of developing psychological difficulties, which may have implications for their academic and social development.

Adolescent↗
PubMed1996

Self directed learning.

The ability to acquire skills in self directed learning may be the key link between undergraduate education, postgraduate training, and continuing professional development. If future and current practitioners are to adopt an ongoing reflective and critical approach to practice, we should aim to provide learning opportunities that promote self confidence, question asking and reflection, openness and risk taking, uncertainty and surprise. Teaching techniques that encourage these skills are being introduced widely and have been shown to be at least as effective as traditional methods of education while promoting more enjoyment and enthusiasm among both staff and students.

Education, Medical, Continuing↗
PubMed1994

Child and adolescent mental health services: purchasers' knowledge and plans.

All purchasers in the North East Thames Regional Health Authority were contacted by telephone and questioned systematically about their purchasing plans for child and adolescent mental health. Purchasers' knowledge of the services they were purchasing was very limited. They had made little or no attempt to set quality standards or to monitor them. It is concluded that information about these services is so limited that purchasers would be unable to make informed decisions concerning changes in service patterns.

Adolescent↗
PubMed1989

Family therapy influences on general adult psychiatry.

Case notes of all patients admitted from two adjacent catchment areas with a diagnosis of schizophrenia, schizoaffective disorder, or psychosis were examined for information concerning the patient's family. On average, case notes contained only 9-25% of the basic information looked for. Family trees were rarely drawn. A record was made of contact with families of only half the sample. It is suggested that information concerning families is not considered of major importance in the management of such cases.

Adolescent↗
PubMed1988

Factors influencing non-attendance at child psychiatry out-patient appointments.

The clinic attendance of 100 consecutive referrals to child psychiatry is described. Only 47 cases ended in agreed discharge. Different factors were found to be associated with attrition at different stages in the treatment-uptake process. Of referrals offered an appointment, 16% failed to attend at all; this was significantly associated with parents being against referral. Of cases offered a subsequent appointment, 40% dropped out. Continued attendance was associated with a presenting problem of general anxiety and with consultation to the referrer. Dropping out was associated with parents who were separated.

Adolescent↗
PubMed1985

British opiate addicts: an 11-year follow-up.

A cohort of 83 British addicts from one clinic was followed-up after 11 years; Home Office records and medical notes were personally searched to trace current status. Twenty-nine were still using drugs, 37 were not known to be using drugs, and 17 had died. The group still using drugs had become markedly more stable on parameters of drug use, criminality, and social stability over the follow-up period.

Adult↗