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PubMed1993

Predictors of differences between Type A and B individuals in heart rate and blood pressure reactivity.

Past estimates of the magnitude of Type A-B differences in cardiovascular reactivity are probably overly conservative. In addition, it is unclear which situations are more likely to elicit excessive reactivity in Type As. The present meta-analysis found that, overall, Type As had greater heart rate (mean d = .22), diastolic blood pressure (d = .22), and especially systolic blood pressure responses (d = .33) than Type Bs; these effect sizes were small but relatively consistent. However, Type As showed especially greater cardiovascular reactivity in situations characterized as having (a) positive or negative feedback evaluation, (b) socially aversive elements such as verbal harassment or criticism, and (c) elements inherent in playing video games. Measures of time urgency, Type A assessment method, and gender were not found to be strongly related to A-B differences in cardiovascular reactivity. Future studies that use more "Type A-relevant" situations will probably find greater effects.

Adult↗

PubMed2005

The origin of exemplar effects in rule-driven categorization.

S. W. Allen and L. R. Brooks (1991) have shown that exemplar memory can affect categorization even when participants are provided with a classification rule. G. Regehr and L. R. Brooks (1993) argued that stimuli must be individuated for such effects to occur. In this study, the authors further analyze the conditions that yield exemplar effects in this rule application paradigm. The results of Experiments 1-3 show that interchangeable attributes, which are not part of the rule, influence categorization only when attention is explicitly drawn on them. Experiment 4 shows that exemplar effects can occur in an incidental learning condition, whether stimulus individuation is preserved or not. The authors conclude that the influence of exemplar learning in rule-driven categorization stems from the attributes specified in the rule or in the instructions, not from the stimulus gestalts.

Cognition↗

PubMed2001

Teaching sexual history taking to health care professionals in primary care.

OBJECTIVES: Although it is accepted that history taking is central to correct diagnosis, little work has been undertaken on the development of sexual history taking, particularly in a primary care context where sexual health may not occur to the patient. Embarrassment is recognized as one major problem. This paper reports on a series of teaching interventions designed to help primary health care professionals (doctors and nurses) to identify and deal effectively with sexual health issues in the consultation. METHODS: 141 participants took part in nine different courses, with 114 returning evaluations. All courses involved tutorial teaching on clinical and ethicolegal issues and role play with trained professional role-players; some involved video-based dramatizations to particularize principles in context. During role play sessions, which were followed by detailed, contextualized feedback, clinical issues, attitudinal issues (e.g. articulating a sense of personal embarrassment, and the risk of stereotyping), and ethicolegal issues were all discussed, as were examples of words and phrases which participants were invited to try out. OUTCOMES: The overall quality of the courses was rated by participants, on average, at 89.95 (maximum 100), and the relevance of the topic at 91.40. Free text comments centred on the power of the training as a consciousness raiser, on the need to alter communication strategies, the need to change existing clinical practice and the value of role play as a methodology. Interactive courses on sexual health are highly acceptable to participants.

Clinical Competence↗

PubMed1992

Improving the skills of established general practitioners: the long-term benefits of group teaching.

This study set out to determine the long-term benefits of teaching psychiatric interview skills. Nine established general practitioners, eight of whom were also trainers, took part some 18 months after attending a problem-based interviewing course. Interview skills were assessed by rating behaviour during 10-minute videorecorded simulated consultations with role-players, recorded before and after training and at follow-up. The finding of an earlier study that, in terms of the course model, training successfully modified the doctor's behaviour, was largely replicated. In addition, not only were acquired skills maintained but further change took place during the follow-up period, change that can be seen as improvement in terms of the course model.

Clinical Competence↗

PubMed1997

Interviewing skills: self-evaluation by medical students.

In an independent learning project, 52 third-year medical students carried out a structured self-assessment of two videotaped psycho-social interviews they had conducted with volunteer clients 1 year earlier, as part of a previous course. The interviews had been conducted in small tutorials with feedback from their clients, fellow students and tutors, facilitated by videotape playback. During the sequence of 16 tutorials each student had carried out an early and a late interview and had observed and participated in the discussion of the interviews of 14 peers. Students were asked to tally the frequencies of various interview behaviours, to evaluate the quality of their behaviours, and to establish priorities for future learning. The videotapes were also reliably rated by an independent observer. Students' overall self-assessments correlated 0.46 with those of the independent observer. This correlation was higher than is typically reported in studies of the validity of self-assessment. In absolute terms, the students' mean rating of interviewing performance was 3.2 (adequate plus) which was significantly lower than the observer's mean of 3.6 (adequate to good). Results are discussed in terms of Gordon's (1992) two recommendations for improving the validity of self-assessments and two further suggestions, for paired comparisons and low-threat learning environments, are added.

Adolescent↗

PubMed2005

[Educative effect of feedback after medical interview in objective structured clinical examination].

OBJECTIVE: Objective Structured Clinical Examination (OSCE) is widely used to assess the core competency of dental residents. However, the educative effect of feedback in OSCE has not been fully examined. Therefore, we investigated the educative effect of formative feedback in a medical interview station. METHODS: The subjects were 51 residents in the clinical training course of our dental hospital. After completing the medical interview station, residents were individually given formative feedback by evaluators and standardized patients. Two months later, residents were asked to fill in a questionnaire about the contents of feedback and self-rating mental strain level during OSCE. Videotaped performance and feedback were reviewed by investigators to check the answers to the questionnaire. RESULTS: Evaluators provided an average of 3.1 feedback items, and standardized patients provided an average of 1.6 feedback items for each resident. However, each resident remembered an average of 1.3 feedback items from evaluators and 0.9 from standardized patients. The lower the score of residents in the medical interview station, the more feedback items were given to residents. A significant negative correlation was found between the score of evaluators and self-rating mental strain level (Spearman rho = -0.326, p = 0.019). CONCLUSION: For effective feedback, evaluators or standardized patients should focus on 2 to 3 items of essential points in OSCE. Repetition of feedback using videotaped performance may be useful to improve communication skills for medical interview.

Education, Dental↗

PubMed2000

Video camera and light system for application in magnetic resonance scanners.

The direct observation and simultaneous recording of subject behavior, e.g. facial movements, during MR imaging is necessary for a variety of functional imaging studies involving phenomena such as emotions, humor, mood, etc. Such observation is also valuable for the monitoring of very ill or young patients. We describe a color video camera and light system which works within the functioning scanner. The camera acquires high resolution video sequences during conventional T(1)-weighted and functional T(2)*-weighted imaging. When fixed to the head coil artefacts during the MRI-acquisition were insignificant. The video allows observation of the face detailed enough to permit FACS scoring of facial expressions. We therefore propose that it can be applied for a wide variety of studies needing visual feedback of subject behavior.

Artifacts↗

PubMed1990

Age-related differences in timing of position and velocity identification.

The aim of this investigation was to study age-related differences in timing of position and velocity identification in a laboratory task. The skills required for performing this task are thought to be similar to those needed in real traffic situations. From this perspective, the results of this study may be taken into account in studies on accident analysis and prevention. To control for differences in the conscious experience of time and for simple reaction time to visual stimuli, young (25-34) and old (58-70) adults had to produce timed periods of 20 seconds and to time the arrival of a visible moving object at its goal. In these simple tasks no differences were found between young and old subjects. In the proper, more complex experiment, timing of position and velocity identification of a moving object were assessed with or without feedback on timing and velocity in the same old and young group. The object, moving from left to right at a constant velocity, was shown on a video screen during the first 40% of its trajectory. The moving object could have any of four (fixed) velocities which were presented in blocks with a regular or a mixed order. By pushing a button subjects estimated at which time the object would have reached the marked end of a trajectory. In a condition without feedback on timing of position, the timing error of older adults was higher than that of young adults and particularly with higher object velocities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

Perception of self-generated movement following left parietal lesion.

Three apraxic patients with lesions in the left parietal cortex were required to execute finger movements with either hand, while the visual feedback they received about the movement was manipulated systematically. We used a device which allowed us to present on a video monitor either the patient's hand or the examiner's hand simultaneously performing an identical or a different movement. In each trial, patients were required to decide whether the hand shown on the screen was their own or not. Hand movements produced in response to verbal command included simple (single-finger extension) and complex gestures (multi-finger extension). Ownership judgements were analysed and compared with those produced by six normal controls and two non-apraxic neurological patients. Apraxic patients and controls accurately recognized their own hand on the screen (own movement condition) and correctly identified the viewed hand as the examiner's when it performed a movement different from their own movement (incongruent movement condition). However, when the viewed hand was the examiner's hand executing their own movement (congruent movement condition), apraxic patients were significantly more impaired than controls. When the results were analysed as a function of gesture type, the number of correct responses was significantly lower for apraxic patients with respect to controls only for complex gestures. Interestingly, when patients executed the finger gestures inaccurately, they still failed to recognize the examiner's hand as alien, and claimed that the correct movement presented on the screen was their own. These results confirm that parietal lesions alter the representational aspects of gestures, and suggest a failure in evaluating and comparing internal and external feedback about movement. We conclude that the parietal cortex plays an important role in generating and maintaining a kinaesthetic model of ongoing movements.

Aged↗

PubMed2001

Cerebellar lesions impair context-dependent adaptation of reaching movements in primates.

To produce accurate movements when conditions change suddenly, the brain must be capable of learning multiple versions of a given motor task and must be able to access the appropriate program using sensory information linked to the context of the movement. The neural basis for context-dependent motor learning is uncertain, but the cerebellum is thought to play a fundamental role. In this study, we examined the effect of lesions of the dorsal vermal and paravermal cerebellar cortex on the adaptation of reaching movements produced by modified visual feedback and accessed with a visual cue. Two rhesus monkeys were trained to point to targets displayed on a video monitor while viewing monocularly with either eye. During the experimental sessions, visual information received by one eye (the "modified" eye) was displaced horizontally, while the information received by the other ("normal") eye remained unaltered. In the first set of experiments (noncontextual paradigm), the animals pointed to targets while viewing with the modified eye. This paradigm resulted in a gradual improvement in pointing accuracy when viewing with that eye, but also produced a shift in pointing responses of equivalent size when viewing with the normal eye. In the second set of experiments (contextual paradigm), the animals alternated six blocks of reaches while viewing monocularly with the modified eye with six blocks viewing with the normal eye. This paradigm improved the pointing accuracy when viewing with the modified eye, but produced only a small shift in pointing responses when viewing with the normal eye. After the dorsal vermal and paravermal cerebellar cortex were resected, no change occurred in the pattern of adaptation produced by the noncontextual paradigm. The contextual paradigm, however, no longer selectively adapted pointing responses for each eye, but rather produced a pointing shift of equivalent size when viewing with either eye. The results indicate that pointing responses can be differentially adapted for each viewing eye, which is a form of context-dependent motor learning. This capability was lost after focal lesions of the dorsal vermal and paravermal cerebellar cortex, suggesting that these regions of cerebellar cortex are required to learn or store multiple representations of a movement, or to retrieve the appropriate motor program in a given sensory context.

Adaptation, Physiological↗

PubMed2003

Prehension in young children with Down syndrome.

Prehension was examined in 3-year old children with Down syndrome (DS, n = 3) and in typically-developing children matched in chronological age (3-year olds; n = 3) or mental age and motor experience (2-year olds; n = 3). The task required reaching to grasp dowels. Video-based movement analysis yielded temporal and kinematic measures. Children with DS were hypothesized to have deficits in feedback-dependent components of prehension (anticipatory grip-closure and deceleration of reach), whereas feedforward components (reach's acceleration phase; grasp's preshaping) were assumed to be unimpaired [Latash, 1993, Control of human movement, pp. 283-292; Latash, 1994, What is clumsiness? In: Motor Control and Down Syndrome II Proceedings of the second international conference, pp. 68-71]. The findings supported these hypotheses. In comparison to control groups, children with DS had significantly: (a) less time in deceleration of reaching, (b) fewer anticipatory grip-closures, and (c) longer movement times for dowel-lift. Young children with DS appeared to use dowel-contact to decelerate the limb and initiate grip-closure. In contrast, reach-acceleration time and grasp-preshaping did not differ across groups. These findings suggest that children with DS display qualitative differences in motor capabilities rather than simply a delayed rate of typical developmental progression.

Child, Preschool↗

PubMed2004

A suite of objective biomechanical measurement tools for personal load carriage system assessment.

For application to military and civilian needs, Defence Research and Development Canada--Toronto contracted Queen's University, Kingston to develop a suite of biomechanical assessment and analytical tools to supplement human-based load carriage system assessment methods. This suite of tools permitted efficient objective evaluation of biomechanical aspects of load-bearing webbing, vests, packs and their components, and therefore contributed to early system assessment and a rapid iterative design process. This paper is a summary of five assessment and analytical tools. A dynamic load carriage simulator was developed to simulate cadence of walking, jogging and running. The simulator comprised a computer-controlled pneumatic platform that oscillated anthropometrically weighted mannequins of varying dimensions from which measures of skin contact pressure, hip reaction forces and moments and relative pack-person displacements were taken. A stiffness tester for range of motion provided force-displacement data on pack suspension systems. A biomechanical model was used to determine forces and moments on the shoulders and hips, and validated using a static load distribution mannequin. Subjective perceptual rating systems were used gather soldier feedback during a standardized mobility circuit. Objective outcome measures were validated by means of other objective measures (e.g., Optotrak, video, Instron, etc.) and then compared to subjective ratings. This approach led to development of objective performance criteria for load carriage systems and to improvements in load carriage designs that could be used both in the military and in general.

Biomechanical Phenomena↗

PubMed2005

Dissection efficiency during laparoscopic oesophageal dissection.

Advanced techniques in laparoscopic surgery have led to an increased need for appropriate training in instrument handling and dissection. Recent developments in computer video technology have facilitated critical analysis of surgical technique. Video deconstruction of oesophageal hiatal dissection during six laparoscopic fundoplication procedures was undertaken. The procedures were performed by surgeons with a wide range of surgical experience, and the investigators analysing performance were blinded to their level of training. Sequential five-second video segments were analysed in detail by 3 investigators. A taxonomy list was developed to describe individual types of movement. The number and time per movement was assessed and a degree of efficiency was assigned. An efficient movement was defined as one that advances the dissection towards a recognised goal. The total oesophageal dissection time varied from 10 minutes (min) to 25 min (mean 16 min). The mean number of actions performed was 173 (range 120-272). A mean of 7 min was spent separating tissues (range 5-13), with 6 min spent grasping and positioning tissue (range 3-8). The amount of time spent in inefficient movement varied from 3 to 14 min (mean 7 min). The greatest variation between operators was seen in the efficiency of tissue separation when using dissecting instruments. Inexperienced operators spent a lot more time performing additional movements such as scope cleaning, observation and instrument exchange. This technique of video deconstruction can identify key areas for improvement. This could be used for trainee assessment and to provide constructive feedback. Future development in this area could enhance training in advanced laparoscopic techniques.

Journal Article↗

PubMed2004

Increasing the use of arteriovenous fistulas (AVF): a network QI project.

In 2002, the Intermountain End-Stage Renal Disease Network Inc., Network 15, initiated a quality improvement project, "Increasing Arteriovenous Fistulas Within Network 15." The primary objective of this project was to maximize the placement of arteriovenous fistulas (AVF) within the adult in-center hemodialysis population in Network 15. A closely related objective was to ensure policies and procedures were in place at each facility to encourage placement and maintenance of fistulae after they had been placed. Based on the facility-specific percentage of adult patients reported to have a fistula in January 2001, eight facilities were selected to participate in the project. Approximately 100 project partners (facility staff, nephrologists, and surgeons) collaborated to improve AVF rates for incident and prevalent patients. The interventions for this project were multifaceted and included face-to-face meetings with project partners, dissemination of a National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) summary paper on vascular access, video materials and written information for patient and staff, post-operative "Fistula Care Packages" educational meetings, and data feedback to facility staff nephrologists and surgeons. Of the seven indicators selected for this project, the predicted improvement was met in four. Overall improvement was noted in six of the seven process/outcome measures. A statistically significant (p=0.05) improvement was noted in the rate of fistulas used for treatment for prevalent (all) hemodialysis patients. This rate increased by about one-third from baseline to remeasurement.

Arteriovenous Shunt, Surgical↗

PubMed2006

Pressure ulcer prevention in black and white nursing home residents: A QI initiative of enhanced ability, incentives, and management feedback.

OBJECTIVE: To determine if educating nursing home staff about pressure ulcer prevention reduces the differential risk of pressure ulcer development in black and white nursing home residents. DESIGN: Subanalysis of a study designed to monitor the emergence of all pressure ulcers in nursing home residents during 12-week baseline and intervention periods. PARTICIPANTS: All residents and staff of a not-for-profit, 136-bed nursing home in urban western Pennsylvania. MAIN OUTCOME MEASURE: The quality improvement intervention, featuring a computer-based interactive video education program on pressure ulcer prevention and early detection, consisted of 3 components: (1) staff ability enhancement, (2) staff financial incentives, and (3) real-time management feedback. Three specific outcome measures were monitored for differential risk of pressure ulcer development in black and white nursing home residents: (1) the rate of emergent Stage I-IV pressure ulcers identified, (2) the rate of emergent Stage II-IV pressure ulcers identified, and (3) the rate of individual residents developing at least 1 pressure ulcer (Stages II-IV). RESULTS: At baseline, black residents demonstrated a higher rate of Stage II-IV pressure ulcer emergence. Black residents with any pressure ulcer were also more likely to have multiple Stage II pressure ulcers compared with white residents. During the baseline period, 31.8% of the pressure ulcers detected in white residents were Stage I, whereas no Stage I pressure ulcers were detected in black residents. During the intervention period, the rate of emergence of all pressure ulcers declined for both groups in similar trends. CONCLUSION: Black residents were more likely to have multiple Stage II-IV pressure ulcers and were less likely to have Stage I pressure ulcers identified at baseline compared with white residents. The education intervention effectively reduced the rate of pressure ulcers for all residents and eliminated the racial disparity noted during the baseline period.

Black or African American↗

PubMed2000

Distance education. Part 3. Assessment of and feedback to students at a distance.

INTRODUCTION: Assessment of students at distance, in a course with over 20 units (subjects), provides special challenges in providing timely, accurate and detailed feedback both formatively and summatively. METHOD: A description of assessment practices including reflective journals, essays, critical appraisal of literature, case studies or teaching presentations in video and written format, clinical audits, and large research projects is provided. The impact of a multitude of criterion-referenced methods of students, teachers and administrative services as well as quality assurance issues are measured. CONCLUSION: Students preferred multiple levels of formative and summative assessment using criterion referencing to exams. These methods were thought to be contextually relevant to clinical practice and examined knowledge, cognition and performance appropriately. Length of assessment task, difficulty with English as a second language and lack of detail or clarity on written feedback posed problems for a number of students. Quality assurance procedures have been put into place to rectify some of these problems.

Clinical Competence↗

PubMed2006

Reducing video-quality fluctuations for streaming scalable video using unequal error protection, retransmission, and interleaving.

Forward error correction based multiple description (MD-FEC) transcoding for transmitting embedded bitstream over the packet erasure networks has been extensively studied in the past. In the existing work, a single embedded source bitstream, e.g., the bitstream of a group of pictures (GOP) encoded using three-dimensional set partitioning in hierarchical trees is optimally protected unequal error protection (UEP) in the rate-distortion sense. However, most of the previous work on transmitting embedded video using MD-FEC assumed that one GOP is transmitted only once, and did not consider the chance of retransmission. This may lead to noticeable video quality variations due to varying channel conditions. In this paper, a novel window-based packetization scheme is proposed, which combats bursty packet loss by combining the following three techniques: UEP, retransmission, and GOP-level interleaving. In particular, two retransmission mechanisms, namely segment-wise retransmission and byte-wise retransmission, are proposed based on different types of receiver feedback. Moreover, two levels of rate allocations are introduced: intra-GOP rate allocation minimizes the distortion of individual GOP; while inter-GOP rate allocation intends to reduce video quality fluctuations by adaptively allocating bandwidth according to video signal characteristics and client buffer status. In this way, more consistent video quality can be achieved under various packet loss probabilities, as demonstrated by our experimental results.

Algorithms↗

PubMedDate not supplied

Suturing efficiency during hiatal repair for laparoscopic fundoplication.

BACKGROUND: An increasingly important part of general surgical training is the development of skills in advanced laparoscopic surgery. However, this aspect of laparoscopy is not always well taught, and there is scope for improving both training and the assessment of performance. Recently, the improved affordability and accessibility of digital video technology and supporting computer systems has enabled critical analysis of operative techniques in laparoscopic surgery to be carried out inexpensively. The aim of the present project was to develop a method for the objective analysis of a laparoscopic suturing task in the real clinical environment, so that surgeon-in-training performance could be objectively evaluated. METHODS: Eight videos of laparoscopic fundoplication procedures were used and the process of posterior hiatal repair was specifically analysed. The procedures were carried out by three operators, each with a different level of advanced laparoscopic experience. Two blinded assessors independently analysed the videos in 5-s intervals at two separate sittings. Analysis concentrated on the types of movements as well as their efficiency in progressing the task. RESULTS: The total time taken for the posterior hiatal repair varied between 165 and 350 s (mean 240), and the mean number of actions was 42 (range 25-55). The mean percentage of efficiency (actions deemed 'very efficient' and 'efficient'vs actions deemed fair or inefficient) was 44% overall. More experienced surgeons took less time to complete the hiatal repair and had a higher percentage of efficiency of actions than inexperienced surgeons. Inefficient or unnecessary movements could be identified; these were less common for the more experienced surgeons. CONCLUSION: Video deconstruction enabled critical analysis of hiatal suturing in advanced laparoscopic surgery, highlighting inefficient actions. This offers a method for objectively assessing technique using readily available equipment. The method could be used to provide constructive feedback to surgical trainees.

Clinical Competence↗