Biomedical subjects

Patricia S O'Sullivan

Publications and source records attributed to Patricia S O'Sullivan.

17 recordsLinked to original sources

PubMed2026

Nondominant Hand Training in Laparoscopy for Surgical Interns: Feasibility and Impact.

OBJECTIVE: Laparoscopy requires bimanual proficiency, yet early trainees demonstrate underdeveloped nondominant hand (NDH) performance. Although deliberate practice of NDH skill contributes to overall performance, NDH training is rarely incorporated into residency simulation curricula and has not been formally evaluated in surgical trainees. We assessed feasibility and impact of integrating structured NDH training with established laparoscopic curriculum for surgery interns. DESIGN: Prospective, single-institution randomized pilot study. Interns were assigned the standard 4-week curriculum of laparoscopic dominant hand and bimanual tasks (Control) or completed assigned NDH tasks in addition to the standard curriculum (Intervention). Feasibility was determined by assigned task completion, daily standard and NDH-specific self-reported practice time, and improvement in bimanual task performance. Performance was video recorded weekly and assessed by blinded evaluators using MISTELS and GOALS scoring. Cognitive workload during laparoscopic tasks was measured via NASA-TLX. Exploratory analyses were conducted within a Bayesian framework. SETTING: A single academic institution with a surgical simulation training program. PARTICIPANTS: General surgery interns on their 4-week simulation rotation. RESULTS: Eleven general surgery interns (6 intervention, 5 controls; all right-hand dominant) completed the study with 100% task completion and practice log compliance. Both groups improved in bimanual performance and perceived cognitive load. Reduction in cognitive workload during bimanual task performance was greater in the NDH group. Time spent on NDH practice over 4 weeks was associated with improved bimanual performance, independent of time spent on standard curriculum tasks. CONCLUSIONS: Structured NDH training is feasible to implement within an existing curriculum and reduces perceived cognitive workload during bimanual laparoscopic tasks. NDH practice demonstrates a beneficial dose-response relationship with performance, supporting its integration into early laparoscopic training.

Laparoscopy↗

PubMed2006

Impact of a teaching scholars program.

BACKGROUND: Researchers employ various approaches to evaluate teaching scholars programs (TSPs). We interviewed secondary beneficiaries of the TSP. METHOD: During an interview, TSP graduates identified individuals and/or groups whom they felt were affected as a result of their TSP participation. At least one individual from each type of these identified beneficiaries was interviewed. Quantitative results were summarized descriptively and qualitative comments coded through a consensus process. RESULTS: Thirty-six (88%) of TSP participants were interviewed. From their responses, 50 beneficiaries were interviewed. Sixty-eight percent of beneficiaries identified that, as a result of TSP, the scholars became better teachers and educational scholars and enhanced educational scholarship, programs, teaching, mentoring, and leadership in departments. Eighty-nine percent identified educational projects emanating from their contact with the scholar. CONCLUSION: Beneficiaries validated that the TSP produced better teachers and scholars. The impact in scholarship validated the importance of completing a project as part of the TSP. TSP also enhanced networking and educational resources for departments.

Arkansas↗

PubMed2006

Educational development program for residency program directors and coordinators.

BACKGROUND: Residency program directors and program coordinators have increasing demands placed on them by accrediting agencies and require educational development specifically tailored to their needs. DESCRIPTION: We created, piloted, and evaluated an educational development program consisting of 10 sessions spanning 1 year for program directors and a parallel set of sessions for program coordinators. EVALUATION: On average, more than half the residency programs participated in the sessions. Programs improved in residency activities related to their program's handbook, interviewing, evaluations, rotation descriptions, and program evaluation. They did not improve in educational scholarly activities. Program directors and coordinators indicated that the program improved their skills, and they would recommend the program for others. CONCLUSIONS: This 10-session program improved important elements of residency education and was favorably received.

Administrative Personnel↗

PubMed2005

Balance, mobility, and falls among community-dwelling elderly persons: effects of a rehabilitation exercise program.

OBJECTIVE: To assess the short-term effect of an exercise-based rehabilitation intervention on balance, mobility, falls and injuries. DESIGN: This randomized, controlled trial with repeated measures was performed at an outpatient rehabilitation center. Elderly, ambulatory, community-dwelling volunteers underwent 6 wks of supervised stretching, balance, endurance, coordination, and strengthening exercises. Controls attended seminars. Data were recorded for time and quality performance on a functional obstacle course and for self-reported falls and injuries. RESULTS: From baseline through 6-mo follow-up, participants in the exercise group (n = 122) significantly outperformed those in the control group (n = 83). The exercise group's functional obstacle course quality improved 2.3% postintervention and 1.57% at follow-up compared with 0.3% for the control group for each time period (P = 0.001). Functional obstacle course completion time improved 7.69% at postintervention and 8.35% at follow-up for the exercise group compared with 4.0% and 3.4% for the control group. Of baseline fallers in the intervention group, 87% (compared with 34.5% for the controls) reported no falls in the subsequent 6 mos. Of those reporting injuries in the 6 mos preintervention, 89.7% in the intervention group (compared with 55.6% for controls) reported no injury at 6 mos postintervention. CONCLUSIONS: Our intervention can improve functional performance and protect against falls and fall-related injuries.

Accidental Falls↗

PubMed2005

Effect of individualized social activity on sleep in nursing home residents with dementia.

OBJECTIVES: To test the efficacy of an individualized social activity intervention (ISAI) on decreasing daytime sleep, improving nighttime sleep, and lowering the day/night sleep ratio and to determine its cost. DESIGN: Pretest/posttest randomized with an experimental and control group. SETTING: Seven nursing homes. PARTICIPANTS: One hundred forty-seven residents with dementia. INTERVENTION: One to 2 hours of individualized social activities for 21 consecutive days. MEASUREMENTS: Twenty-four-hour sleep/wake patterns using an Actigraph. RESULTS: The ISAI group had significantly less daytime sleep (P=.001) and a lower day/night sleep ratio (P=.03) than the control group, after adjusting for baseline values. Because 40% of the sample slept 7 or more hours at night, a secondary analysis was conducted. When only those residents with a sleep efficiency of less than 50% (n=50) were included, the ISAI group (n=20) had less daytime sleep (P=.005), a lower day/night sleep ratio (P=.02), fell asleep faster (P=.03), and were awake less at night (P=.04) than the control group (n=30), after adjusting for baseline values. The weekly cost of the ISAI was roughly $70 per participant. Initial training and supply costs were $1,944. CONCLUSION: The ISAI provides an alternative to medications, without side effects.

Aged↗

PubMed2005

Residents' perception of effectiveness of twelve evaluation methods for measuring competency.

OBJECTIVE: The authors assessed residents' perceptions of techniques used to evaluate competency. METHODS: Psychiatry residents from a single program rated 12 evaluation techniques for their effectiveness to measure resident competency. They rated each method for 25 selected skills reflecting the six general competencies. RESULTS: Sixteen residents (70%) completed the survey. Responses indicated that different methods were effective for different competencies. Residents saw objective structured clinical examinations and standardized patients as equally effective. They favored the 360 degrees evaluation method for all competencies except medical knowledge. Resident perception of the effective techniques differed from preferred techniques identified by measurement experts. CONCLUSIONS: Residency program directors using guidelines from the Accreditation Council for Graduate Medical Education (ACGME) to select preferred evaluations may find that residents do not have the same perceptions.

Adult↗

PubMed2004

Demonstration of portfolios to assess competency of residents.

Residency educators are identifying approaches to measure resident competence. Portfolios are well suited since they require work already completed as part of patient care where competency must be demonstrated. This paper describes assessment of the reliability and validity of portfolios in a psychiatry residency program. This was a cross-sectional study across 4years of residency education. Using guidelines, 18 residents assembled portfolios containing five entries chosen from 13 skills. Trained raters scored the portfolios. Residents and faculty were interviewed about their perceptions. Generalizability results indicated five entries and two raters were sufficient for relative decisions. Six entries or a third rater would be sufficient for absolute decisions. Portfolio scores tended to improve with years of training and correlated with psychiatric knowledge but not clinical performance. Residents and faculty identified benefits to assembling a portfolio. Portfolios incorporate tasks embedded in the residency to provide evidence of resident competency. The results support that the score is reliable and valid.

Clinical Competence↗

PubMed2004

Biopsychosocial formulation: recognizing educational shortcomings.

OBJECTIVE: Since Engel introduced the biopsychosocial model, it has been extensively examined. The authors expect psychiatrists to formulate cases using the biopsychosocial model. However, resident psychiatrists' ability to generate formulations using this model has received little attention. METHODS: The authors evaluated resident biopsychosocial formulations using biopsychosocial scores from trained, blinded raters across four institutions. Second, the authors determined if an intervention could improve biopsychosocial formulation. DESIGN: This study included non-experimental and pre-post components using resident portfolio scores to measure biopsychosocial. PARTICIPANTS/SETTING: Residents from four postgraduate years (PGY) in four different programs participated. In one institution, faculty made a concerted effort to improve biopsychosocial formulation. There were 33 entries in 2000-2001 and 46 entries in 2001-2002. RESULTS: Using the combined data from all institutions, no PGY level averaged a rating of 3.0 (competent) in either year. In the institution implementing an intervention, a significant improvement was noted. CONCLUSION: This pilot study indicates that we can improve resident competency in this area.

Clinical Competence↗

PubMed2004

Can one portfolio measure the six ACGME general competencies?

OBJECTIVE: To determine that portfolios, useable by any program, can provide needed evidence of resident performance within the ACGME general competencies. METHODS: Eighteen residents constructed portfolios with selected entries from thirteen psychiatric skills. Two raters assessed whether entries reflected resident performance within the general competencies. They indicated no (0), some (1), or definite evidence (2) for each competency. Median scores were reported by competency and psychiatric skill. RESULTS: Eighty entries were rated: 100% of the psychiatric skills reflected some evidence for medical knowledge; 92% provided some evidence for patient care, communication and interpersonal skills, and professionalism; 77% provided some evidence for systems-based practice, and 31% provided some evidence for practice-based learning. Ten of the 13 skills reflected evidence for at least five of the competencies. CONCLUSIONS: Any combination of five entries reflects all competencies with the exception of practice-based learning. This deficit can be corrected with revision of portfolio guidelines.

Adolescent↗

PubMed2003

Oximeter's acquisition parameter influences the profile of respiratory disturbances.

STUDY OBJECTIVES: Pulse oximetry (Sp02) is a key parameter monitored during polysomnographic studies, and different acquisition settings can be employed to obtain this data. The purpose of this study was to determine if the use of different settings would significantly influence scoring of respiratory disturbance events (RDE). DESIGN: Prospective study SETTING: Sleep Disorders Center - community PATIENTS: 30 patients had three identical oximeters simultaneously attached to the digits during polysomnography, each placed in a different recording setting: 3, 6 and 12 seconds. INTERVENTIONS: None. MEASUREMENTS: RDEs were identified by changes in snoring and flow then sub-categorized as RDE0, RDE1-2 and/or RDE3 if less than 1%, greater than 1 but less than 3%, and 3% or greater oxyhemoglobin desaturation occurred. Each event was given three labels according to the level of desaturation seen on each oximetry tracing. RESULTS: Significant differences in the mean frequency of RDE types at each recording setting were noted (p < .001). A survey of sleep practitioners revealed changes in clinical behavior when presented examples of such differences. CONCLUSION: These data confirm the impact of different oximetric recording settings on the profile of RDEs and the importance of reporting such acquisition settings in studies of sleep disordered breathing.

Electroencephalography↗

PubMed2002

Predictive validity of the Medical College Admissions Test Writing Sample for the United States medical licensing examination steps 1 and 2.

Despite the amount of published research on the predictive validity of the Medical College Admissions Test (MCAT) taken as a whole, few published reports separate the individual predictive validity of the Writing Sample. The purpose of this study is to provide data on the predictive validity of the Writing Sample for the national licensing exam used in the United States. Subjects consisted of 1992-1995 matriculants from a publicly owned medical school in the Southeastern United States. Independent variables were undergraduate grade point average, and four section scores on a required admissions test (Biological Sciences, Physical Sciences, Verbal Reasoning, and Writing Sample). The dependent variables were Steps 1 and 2 on the three step licensing examination. Steps 1 and 2 of the examination are taken during medical school. Multiple regression models calculated additional variance accounted for by the addition of the Writing Sample to a model containing grade point average and the other admissions test section scores. In multivariate analyses, when grade point average and all admissions test scores were considered as predictors of licensing exam scores, the Writing Sample variable did not add to the ability to predicting the Step 1 or Step 2 scores. The results of this study suggest that the Writing Sample has limited predictive validity for assessing success on a national licensing exam. However, as others suggest, the value of the Writing Sample and other surrogates of communication probably lie in predicting performance in the clinical years of medical school and beyond. Additional work should include evaluating the predictive validity of the Writing Sample and other pre-medical school measures of communication with widely acceptable measures of performance in clinical settings, including physician-patient communication.

Adult↗

PubMed2002

Portfolios as a novel approach for residency evaluation.

The authors describe the development process for a portfolio that programs may use for evaluating psychiatry residents. A committee carefully developed the portfolio requirements for 13 necessary skills in psychiatry. Psychiatrists were trained to rate portfolios. Review of the development and training process suggested that portfolios provided information both on individual residents and on the residency program itself. The process requires orientation of both residents and faculty, attention to time demands, and availability of examples and resources.

Journal Article↗

PubMed2002

Oximeter performance: the influence of acquisition parameters.

STUDY OBJECTIVE: This study was designed to determine whether different desaturation indexes (DIs) would be obtained in patients with sleep-disordered breathing by systematically altering two acquisition parameters: the recording setting and the display mode. DESIGN: Prospective clinical study. SETTING: Community sleep-disorders center. PATIENTS: The study included 75 patients who were suspected of having sleep-disordered breathing. INTERVENTIONS: Each patient had simultaneous pulse oxyhemoglobin saturation (SpO2) traces at three recording settings (3 s, 6 s, and 12 s) during the diagnostic phase of split-night polysomnography. On-line and memory displays of those data at each recording setting were obtained. DIs for > or = 3% desaturation events per hour were calculated for each of the six traces. RESULTS: The mean on-line DIs significantly differed from each other, with slower (longer) recording settings resulting in lower values than faster (shorter) settings. The memory DIs all significantly underestimated the on-line DIs. Pearson correlations ranged from 0.82 to 0.90 between the on-line/memory DI pairs, but Bland-Altman analysis detected disagreement at higher levels of disordered breathing. CONCLUSIONS: These findings confirm that significantly different SpO2 data are obtained at various acquisition options. The recording setting and display mode parameters should be disclosed in all reports employing oximetry with the fastest recording setting and on-line display mode preferable for case finding of sleep-disordered breathing.

Adult↗

PubMedDate not supplied

Demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency.

This study determined the differences in demographic and sleep characteristics in cognitively impaired nursing home residents with and without severe sleep/wake pattern inefficiency. Identification of characteristics associated with severe sleep/wake pattern inefficiency will allow health care providers to make the best cost effective use of finite resources because they can target interventions towards those most likely to need them. This article reports the baseline characteristics of the total sample, compares the demographic and sleep characteristics of the subgroups with and without severe sleep/wake pattern inefficiency, and reviews related literature.

Activities of Daily Living↗

PubMedDate not supplied

Sustaining a best-care practice in a nursing home.

This study tested whether an action research organizational intervention fostering participatory management practices would sustain a nursing best-care practice protocol in a nursing home. An experimental nursing home (EH) and a control nursing home (CH) with similar characteristics were studied over a 4-year period. A pretest/posttest quasi-experimental design was used. Baseline data were co[lected on residents, families, and the staffs at the EH and the CH. Staff turnover rates, demographics of participant groups, and surveys concerning job stress, nursing care, family involvement, and satisfaction of residents and family members served as proximal outcomes to indicate whether organizational changes had occurred in the EH. Sustaining best practices in a nursing home requires not only significant organizational change but also changes in regulatory support for quality care, sufficient staff resources to implement and monitor the practices, and a change coordinator with sufficient formal or informal influence.

Benchmarking↗

PubMedDate not supplied

Psychosocial effects of an exercise program in older persons who fall.

Falling is associated with psychosocial sequelae that may influence functional performance and fall risk. Exercise can improve psychosocial factors. To address the research questions (1) Do psychosocial variables differ among persons with and without falls? and (2) Among persons who fall, can exercise improve psychosocial variables? we evaluated psychosocial and functional performance variables in older persons with and without recent falls. A pretest and posttest design with a nonequivalent control group was used. Community-residing elderly individuals participated, 66 had falls in the past year (fallers) and 77 had no falls (nonfallers). Participants completed measures of self-esteem, depression, psychological impact, and functional performance at baseline and 6 weeks. Baseline descriptive characteristics for fallers and nonfallers were similar. Fallers then completed a 6-week exercise program. Exercise benefited fallers' self-esteem, depression, mobility, social role, social activity, and anxiety. Nearly 40% of fallers were clinically depressed before exercise and 24% were depressed after (p = 0.04). Psychosocial variables correlated significantly with quality of functional performance (p < 0.019). Among fallers, moderate exercise produced a significant improvement in psychosocial variables and functional performance (p < 0.045).

Accidental Falls↗

PubMedDate not supplied

Predictors of patient education by bone densitometry technologists.

OBJECTIVE: This study investigated which factors predict the likelihood of densitometry technologists counseling their patients about osteoporosis prevention. METHOD: Predictors of osteoporosis prevention patient education by bone densitometry technologists were analyzed in a sample of 417 radiologic technologists with ARRT advanced certification in bone densitometry and 158 densitometry technologists, none of whom were ARRT certified in bone densitometry. RESULTS: The regression model accounted for 41% of the variation in reports of bone health counseling. Densitometry technologists with high internal motivation and low personal barriers reported educating their patients about osteoporosis prevention. CONCLUSION: Recommendations for increasing bone health promotion include increasing personal interest through sensitivity training, expanding delivery by promoting models for clinical implementation and creating educational opportunities to strengthen counseling skills.

Absorptiometry, Photon↗