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PubMed2005

Clinical electromyography and electrodiagnosis course at Keio University Hospital--a 7-year experience.

Although electromyography and electrodiagnosis (EMG-EDX) is one of the most fundamental skills in rehabilitation medicine, the number of residency programs that can provide comprehensive postgraduate EMG-EDX training is still limited in Japan. Under these circumstances, we started a 2-day primer course in EMG-EDX at Keio University Hospital in 1998. To review our 7-year experience with the course, we analyzed the number and specialty of the participants, their appraisal of the lectures and practical sessions, and the score distribution of the final examination. The number of participants totaled 288 during the past 7 years, and the mean number for each year was 41. The distribution by specialty for the whole period was 64.0% for rehabilitation medicine, 25.4% for orthopedic surgery, 5.1% for neurology, 1.0% for pediatrics, 0.5% for gerontology and 4.1% for physical therapists and occupational therapists. The difficulty levels of the lectures were judged as appropriate by 81 to 95.5% of the participants, and the presentation was judged as good by 34 to 67% of them. For the practice sessions, the difficulty levels were judged as appropriate by 88% of the participants, and the quality of the supervisors was judged as good by 64% of them. The mean score for the final examination was 56.0 (SD 15.2, median 60). In conclusion, our course has played an important role to promote EMG-EDX in our country by providing compact introductory exposure to EMG-EDX for beginners. A follow-up system for the course graduates is planned to support their EMG-EDX practice.

Diagnostic Techniques, Neurological↗
PubMed1997

Development of a computerized telecommunication system for in-training evaluation of residents in a laparoscopic educational program.

OBJECTIVE: To describe our initial experience with a computerized telecommunication system, termed the interactive voice-response system, to record resident performance of laparoscopic surgery. METHODS: After completing a laparoscopic procedure, the surgeon and resident telephone a toll-free number independently and respond to three prerecorded statements using a Likert scale of 1 to 5. The caller then is asked to describe the resident's response to critical incidents or elements of surprise that arose during the surgery. The ratings and verbal comments are compiled, transcribed, and forwarded to the respective resident. The resident (and program director) can hear the verbal comments by entering a four-digit code. RESULTS: Between May 1, 1995, and May 31, 1996, 430 cases were reported by 11 surgeons and 16 residents using the interactive voice-response system. One hundred ninety-five (45%) procedures were entered by both the resident and surgeon. A survey undertaken during the introductory phase of the project revealed that five of the seven residents exposed to the system found that it provided useful feedback and preferred the system to traditional in-service reporting methods. In addition, five residents thought that the system complemented the personal feedback they received in the operating room. CONCLUSION: The system has been accepted by both residents and surgeons and has addressed the important components of resident in-training evaluation, namely, evaluation on a case-by-case basis, timely feedback, and self-assessment of resident performance.

Computer-Assisted Instruction↗
PubMed1975

[Preparation, characterization and control of antiserums].

The development of radio immunoassay and its application to the estimation of new substances (e.g. drugs, enzymes, viral antigens, etc.) will shed further light on the various problems which we have discussed in this introductory report. For each group of substances there will no doubt be special difficulties. If these technics have become very popular, this seems to be for two main reasons: the potential selection of individual immune response, and better understanding of the role of the parameters which control the various stages of radio-immunoassay. I am sure that the reports programmed here will provide an important contribution to advances in our knowledge in this promising field.

Antibody Specificity↗
PubMed2006

Integrating simulation into a surgical residency program: is voluntary participation effective?

OBJECTIVE: Surgical training programs nationwide are struggling with the integration of simulation training into their curriculum given the constraints of the 80-h work week. We examine the effectiveness of voluntary training in a simulation lab as part of the surgical curriculum. METHODS: The ProMIS simulator was introduced into the general surgery residency at Boston University Medical Center. All categorical residents (28) and non-categorical residents (23) were offered a 2-h training session and curriculum review. After the introductory session, time spent in the lab was encouraged, but voluntary. Use of the simulator was tracked for all residents. Participation in the simulation curriculum was defined as three or more uses of the simulator. After 3 months, all residents completed a survey regarding the simulation lab and their simulator usage. RESULTS: Twenty-six (93%) categorical residents and three (6%) non-categorical residents completed the introductory simulator training session. Over a 3 month period, use of the simulator at least once was 31% among all eligible residents; 80% of postgraduate year (PGY)1, 40% of PGY2, 60% of PGY3, and 0% of PGY4 and PGY5. Four residents (14%) participated in the simulation curriculum. Overall, 70% of simulator usage was during working hours, and 30% was completed post-call or when the resident was off duty. Most residents agreed that the simulator was easy to use and that its use improved their operative skills, but they did not think it was a good substitute for actual operative experience. Reported reasons for not using the simulator included off-site rotation (44%), no time (30%), and no interest (11%). CONCLUSIONS: Voluntary use of a surgical simulation lab leads to minimal participation in a training curriculum. Participation should be mandatory if it is to be an effective part of a residency curriculum.

Boston↗
PubMed2004

Learning and living health: college students' experiences with an introductory health course.

Despite the Healthy People 2010 initiative and the national focus on promoting healthy lifestyle strategies, studies indicate that U.S. citizens are becoming more obese, and that rates of depression, diabetes, hypertension, homicide, and suicide are increasing. The college campus provides a microcosm of the health issues facing the nation, with college students' reports of increased risk behaviors evident in higher rates of smoking and binge drinking. Faculty in schools of nursing are in an ideal position to develop and provide health promotion and illness prevention programs, both for their own nursing students and for a broader campus-wide student population. This article describes a research study that course faculty conducted during the first year of implementation, designed to evaluate the extent to which participation in the "Introduction to Health" coursework and related activities influenced students' health-related behaviors.

Adaptation, Psychological↗
PubMed1993

[Electrical ablation with high frequency (radiofrequency) in patients with recurrent atrioventricular nodal reentrant tachycardia--introductory information].

In 10 patients (pts) with atrioventricular nodal reentrant tachycardia type slow/fast (AVNRT) refractory to the antiarrhythmic treatment, radiofrequency current catheter ablation was performed. Adult pts (mean age 31 years) suffered from paroxysms of AVNRT for 2 to 18 years (mean 8 years). Episodes of arrhythmia recurred from 2-3 times a week to 1 for several months during antiarrhythmic therapy. The mean rate of the tachycardia was 243/min. 3 pts had syncope and 5 fainted during the tachycardia. In 2 females mitral valve prolapse was diagnosed. Programmed stimulation of the right atrium on the basic rate 130/min revealed ERP of the slow pathway mean 238 ms and ERP of the fast one mean 346 ms. The tachycardia has been induced with right atrium stimulation--most often programmed or burst stimulation--200 and 220/min, sometimes with incremental pacing. Successful radiofrequency energy ablation was performed in all 10 pts. Average number of the impulses for one pt was 7.7 (from 1 to 18 impulses). The total average time of the ablation was 216 s. The temperature of effective ablation was average 65 centigrade. The effect of the ablation was evaluated during repeated electrophysiological study before and after intravenous injection of atropine. Ablation was considered successful when no tachycardia was induced. P-R interval did not change and no episodes of AVNRT was observed in the 1-3 months follow-up. No complications were observed during the ablation and after the procedure, especially no thromboembolism was noticed. The echocardiographic evaluation revealed no damage to the heart structure. The pts receive no antiarrhythmic treatment and they are systematically controlled.

Adult↗
PubMedDate not supplied

The health effects of worksite HIV/AIDS interventions: a review of the research literature.

PURPOSE: To examine the individual and organizational health effects of HIV/AIDS interventions conducted at the worksite. SEARCH METHODS: This review is part of a series of reviews that used search methods described in an introductory article. To supplement these methods, HIV/AIDS-specific periodicals were searched to include journals that might not be incorporated in the computerized databases. Twelve of the 20 articles identified through the Centers for Disease Control and Prevention and our own subsequent searches met the criteria and were included in this review. FINDINGS: Ten of the 12 studies reviewed reported positive effects of employee education programs on knowledge or attitudes. Nine of the studies involved health care workers or employees with potential occupational exposure to HIV, and nine lacked a comparison or control group. None of the studies however, examined the effects of policies, manager training, or family education on the organization or person. CONCLUSIONS: Methodologic weaknesses in many of the studies reviewed, coupled with the small number of studies, led us to conclude that the research literature on worksite HIV/AIDS interventions is weak. Impact is, however, plausible. Future research should be directed toward developing valid measures of key variables, controlling for confounding factors, and ultimately examining the impact of organizational factors.

HIV Infections↗
PubMed1997

Teaching introductory engineering: a problem based learning experience.

A freshman introductory engineering course is being taught on an experimental basis to approximately 40 cadets per semester at the United States Air Force Academy. The purpose of the course is to better address seven educational outcomes desired in Academy graduates. Problem Based Learning is used to present engineering as a problem solving process that involves a variety of interdisciplinary issues. The setting is an Air Force System Program Office responsible for planning a manned mission to Mars. Students are guided by a mentor to identify the relevant engineering requirements. Traditional instruction is used only to present skills and tools that enhance students' learning. An integrated assessment program is being used to evaluate this instructional approach and how well the educational outcomes are being met. The quantitative assessment findings are inconclusive and indicate further work is needed to develop reliable assessment instruments. Qualitative findings, however, show that the students learned important engineering fundamentals, liked the course, and enjoyed the Mars scenario. They also developed an appreciation for the interdisciplinary nature of engineering, developed confidence in their ability to make decisions for problem-solving, and they acquired self esteem not usually obtained from traditional engineering courses. This paper presents highlights from the three years this course has been offered.

Engineering↗
PubMed1991

Neurosurgery image manager.

Computer technology has become standard in many areas of medical practice, but computer-assisted instruction has not replaced standard textbooks and didactic lectures. This paper describes the development of a computer image-based educational system designed for neurosurgical instruction. The advantages and applications of this system for both clinical and academic use and the required software and hardware requirements are delineated. This computerized tutorial can organize and manipulate large amounts of data. The Neurosurgery Image Manager system contains an introductory help section, a self-assessment test in neurosurgery, and a data base of images from the video disc "The Slice of Life," produced at the University of Utah. Questions are taken from the Self-Assessment in Neurological Surgery series. Additionally, the system contains a reference index for all material in the tutorial, a scored clinical problems section, and a several hundred word glossary. The system is programmed using the Macintosh Hypercard authoring system. Large data bases can be manipulated and linked with graphics, text, and peripherals. Images are stored using the MacVision II digitizing system. The hardware necessary to operate the system and the method of implementation of Neurosurgery Image Manager are described. The prototype Neurosurgery Image Manager has been accepted by the Joint Committee on Education of the American Association of Neurological Surgeons and Congress of Neurological Surgeons as one of the computer formats for the next self-assessment tests.

Computer Graphics↗
PubMed1999

Tracking changes in behavioral health services: how have carve-outs changed care?

This special issue of the Journal of Behavioral Health Services & Research on mental health carve-outs brings together some of the latest research on recent policy and market changes affecting behavioral health services. This introductory article provides background information about carve-outs and the managed behavioral health care industry. This article also reviews prior research in the mental health carve-out field.

Behavior Therapy↗
PubMed1998

Cyclofem/Cyclo-Provera: emerging countries' perspective.

Cyclo-Provera, the original name of the combination of 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate, later known as Cyclofem and hereafter referred to MPA/E2C, has proven its use-effectiveness (pregnancy rate less than 1%) in routine service delivery conditions. Overall, the life-table discontinuation rates at 1 year ranged from 33.5% to 71.8%. Only a third of total discontinuations were attributable to the injectable contraceptive method, thus raising the importance of service delivery issues related to its continued use. The results of introductory trials in Mexico, Indonesia, Thailand, Tunisia, Jamaica and, more recently, Brazil, Colombia, Chile and Peru have demonstrated that MPA/E2C is a highly effective contraceptive that could be offered as an alternative to current fertility regulation methods for many women around the world. In addition, the results of studies were the basis for the approval of MPA/E2C by local health authorities and its inclusion in the Ministries of Health Family Planning Programs.

Contraceptive Agents, Female↗
PubMed2005

Problem Based Learning: an introduction and overview of the key features of the approach.

Problem Based Learning (PBL) has been adopted in educational programs in a variety of disciplines, including veterinary medicine. There is a voluminous literature on the subject, but it often remains unclear just what is being done in the name of PBL, and different accounts highlight different, often contradictory, positions on the key features of the approach. Similarly, despite the many claims made for the advantages of PBL, the evidentiary basis of such claims is often questionable. This article provides an introductory overview of what appear to be the key features of the approach and a brief summary of empirical evidence on its effectiveness.

Education, Veterinary↗
PubMedDate not supplied

Education issues in disaster medicine: summary and action plan.

INTRODUCTION: Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration, (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis. DISCUSSION: Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences. CONCLUSIONS: The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.

Clinical Competence↗
PubMed1986

Skills development by medical students and the influence of prior experience: a study using evaluation by students and self-assessment.

Research was carried out into the effectiveness of an innovative, problem-based introductory course which was designed to help medical students, within a traditional curriculum, to bridge the gap between theoretical study during the first 4 years and inservice training during the next 2 years. Comparison of exit and entry self-assessment ratings of students showed a marked rise for history-taking and physical examination and a smaller rise for diagnosis and patient management. Cross-study of these self-assessment ratings and the background variable of past medical training showed that prior active experience within the health care system appeared to have a favourable influence on both history-taking and more intellectual skills, notably diagnosis and patient management. History-taking, however, could be taught as effectively during the introductory course. This was not so for the more intellectual skills. The results of this research plead for early active experience within the health care system during the medical curriculum, in order to give the students more insight into the clinical relevance of their theoretical studies. Evaluation by the students of the teaching formats used to reach the learning objectives was favourable, especially of those formats related to concrete practical skills such as live simulated (programmed) patients. It was rather unfavourable to self-study facilities which provide more theoretical knowledge.

Clinical Competence↗
PubMed2006

Cooperative dementia care clinics: A new model for managing cognitively impaired patients.

Cooperative health care clinics (CHCCs), or shared medical appointments, are a healthcare innovation that can improve access and expand physicians' capacity to manage common geriatric conditions. This report describes a pilot program and working model for extending CHCCs to patients with dementia. Three cooperative dementia care clinics (CDCCs) met monthly for up to 1 year, drawing participants from a dementia clinic roster of patients and caregivers who had required continued specialty care for at least 3 months. Twenty-six of 33 eligible patient-caregiver dyads expressed interest, and 21 enrolled; five whose clinical status changed during the year withdrew and were replaced with new members. Brief introductory socialization, individualized clinical management, and an educational focus selected from problems of patients and caregivers were common to all sessions. Most participants required several types of clinical intervention and educational support. One group ended after reaching a natural termination point, and two others are ongoing at the request of participants. CDCCs can be a viable approach to increasing dementia care capacity in health systems. Formal service intervention trials to evaluate the generalizability and comparative effectiveness and economic viability of this model versus usual care are an appropriate next step.

Aged↗
PubMed1990

Calcium measurements with electron probe X-ray and electron energy loss analysis.

This paper presents a broad survey of the rationale for electron probe X-ray microanalysis (EPXMA) and the various methods for obtaining qualitative and quantitative information on the distribution and amount of elements, particularly calcium, in cryopreserved cells and tissues. Essential in an introductory consideration of microanalysis in biological cryosections is the physical basis for the instrumentation, fundamentals of X-ray spectrometry, and various analytical modes such as static probing and X-ray imaging. Some common artifacts are beam damage and contamination. Inherent pitfalls of energy dispersive X-ray systems include Si escape peaks, doublets, background, and detector calibration shifts. Quantitative calcium analysis of thin cryosections is carried out in real time using a multiple least squares fitting program on filtered X-ray spectra and normalizing the calcium peak to a portion of the continuum. Recent work includes the development of an X-ray imaging system where quantitative data can be retrieved off-line. The minimum detectable concentration of calcium in biological cryosections is approximately 300 mumole kg dry weight with a spatial resolution of approximately 100 A. The application of electron energy loss (EELS) techniques to the detection of calcium offers the potential for greater sensitivity and spatial resolution in measurement and imaging. Determination of mass thickness with EELS can facilitate accurate calculation of wet weight concentrations from frozen hydrated and freeze-dried specimens. Calcium has multiple effects on cell metabolism, membrane transport and permeability and, thus, on overall cell physiology or pathophysiology. Cells can be rapidly frozen for EPXMA during basal or altered functional conditions to delineate the location and amount of calcium within cells and the changes in location and concentration of cations or anions accompanying calcium redistribution. Recent experiments in our laboratory document that EPXMA in combination with other biochemical and electrophysiological techniques can be used to study, for example, sodium and calcium compartmentation in cultured cardiac cells. Such analyses can also be used to clarify the role of calcium in anoxic renal cell injury and to evaluate proposed ionic defects in cells of individuals with cystic fibrosis.

Animals↗
PubMed2001

Design and implementation of an introductory course for computer applications in molecular genetics. A case study.

Formal training in computational biology was initiated at Wayne State University in 1990 to meet the needs of the faculty. This was still at a time when the molecular databases and analysis tools could be housed in what is now equivalent to a modern but dated desktop computer. In 1995 the course was expanded to include graduate students to provide these senior students with a foundation in computational biology. This course has armed our students with a requisite set of basic skills that are necessary for a successful career in molecular genetics. It is now an integral component of the graduate program of the Center for Molecular Medicine and Genetics and our experiences in course delivery have been detailed (BioInformatics Methods and Protocols, S. Misener and S. A. Krawetz, eds., Humana Press, Totowa, NJ, 2000.). The course was expanded to a campus-wide unlimited enrollment program for the summer of 2000 to address the needs of our student body. In this review we present our experience with delivering a multidisciplinary campus-wide computational biology course to a new and widely diverse student body.

Computational Biology↗