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At least 307 records · Page 17Linked to original sources

PubMed1997

Stress-induced declarative memory impairment in healthy elderly subjects: relationship to cortisol reactivity.

A group of 14 healthy elderly subjects was submitted to a nonstressful (attentional task) and a stressful (public speaking task) condition. Declarative (conscious recollection of learned information) and nondeclarative (retrieved information without conscious or explicit access) memory as well as salivary cortisol levels were measured before and after each condition. The results showed that the stressful condition significantly decreased declarative memory performance, whereas the nonstressful condition did not. Nondeclarative memory performance was not affected by either condition. Further analyses separating the subjects into responders and nonresponders in terms of stress-induced cortisol changes revealed a very different pattern of cortisol secretion and declarative memory performance in both populations. We showed that the responders presented increased cortisol levels 60 min before the actual stressor, whereas the nonresponders presented increased cortisol levels 25 min before the actual stressor. Although the responders did not differ from the nonresponders in declarative memory performance before and after the nonstressful condition, they presented a lower declarative memory performance when measured before and after the stressful condition. The early increase in cortisol levels observed in the responder group suggests that the anticipation of the stress, rather than the actual stressor per se, may have played a more significant role in the stress-induced declarative memory deficits observed in this subgroup. Together, these results show that the cortisol response to anticipation of stress and/or to stress in the elderly specifically affects those memory functions that are dependent on hippocampal activity. They also suggest that an altered cortisol responsivity to acute and/or chronic stress, with its detrimental effects on memory, could be an important factor explaining the genesis of memory deficits in aged populations.

Aged↗

PubMed2003

Familial frontotemporal dementia: from gene discovery to clinical molecular diagnostics.

Genetic testing is important for diagnosis and prediction of many diseases. The development of a clinical genetic test can be rapid for common disorders, but for rare genetic disorders this process can take years, if it occurs at all. We review the path from gene discovery to development of a clinical genetic test, using frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17) as an example of a complex, rare genetic condition. An Institutional Review Board-approved multidisciplinary research program was developed to identify patients with familial frontotemporal dementia. Genetic counseling is provided and DNA obtained to identify mutations associated with FTDP-17. In some cases it may be appropriate for individuals to be given the opportunity to learn information from the research study to prevent unnecessary diagnostic studies or the utilization of inappropriate therapies, and to make predictive testing possible. Mutations identified in a research laboratory must be confirmed in a clinical laboratory to be used clinically. To facilitate the development of clinical genetic testing for a rare disorder, it is useful for a research laboratory to partner with a clinical laboratory. Most clinical molecular assays are developed in research laboratories and must be properly validated. We conclude that the transition of genetic testing for rare diseases from the research laboratory to the clinical laboratory requires a validation process that maintains the quality-control elements necessary for genetic testing but is flexible enough to permit testing to be developed for the benefit of patients and families.

Chromosomes, Human, Pair 17↗

PubMed2002

The experience of living with fibromyalgia: confronting an invisible disability.

Fibromyalgia (FM) is a complex, chronic, painful musculoskeletal syndrome which is characterized by extreme fatigue, disordered sleep, and other associated physical and cognitive problems. Because its etiology is unknown, and because no specific pathophysiological mechanisms have been found to underlie the syndrome, making a diagnosis is very difficult. FM adversely affects the quality of life, and the societal costs based on medical expenses, lost wages, lost tax revenue and compensation expenditures are very significant. The purpose of this phenomenological study was to describe and enhance the understanding of the experience of living with FM. The participants included nine women ranging in age from 30 years to 56 years who had been diagnosed with the condition for more than a year. Data were collected by means of unstructured interviews. Thematic analysis, using van Manen's (1990) methodology, identified eight themes: (a) pain-the constant presence, (b) fatigue-the invisible foe, (c) sleep-the impossible dream, (d) thinking of a frog (e) dealing with a flare-up, (f) longing for a normal life, (g) the power of naming-seeking a diagnosis, and (h) living within the boundaries. These themes were integral parts of the whole story, and through their interrelationships, the essence confronting an invisible disability was captured. The findings of this qualitative study have implications for nursing practice, education and research. It has become an increasing challenge for our health care system to adequately cope with the large numbers of persons diagnosed with chronic illnesses. Administrators of these systems can benefit from the information learned during this study.

Activities of Daily Living↗

PubMed2006

Improving the safety of medication administration using an interactive CD-ROM program.

PURPOSE: The impact of an interactive CD-ROM program on the rate of medication administration errors made by nurses was studied. METHODS: This randomized, controlled, nonblinded study was conducted at three community hospitals. Study participants included 30 registered nurses who had at least one year of nursing experience in acute care and who worked on medical or medical-surgical units. Nurses were randomized to an intervention group that completed an interactive CD-ROM program on safe medication practices or to a control group. Direct observation was used to determine the baseline (preintervention) and postintervention error rates for both study and control groups. Three categories of errors were defined: deviation from safe administration practices (core 1), preparation and administration errors (core 2), and deviations from prescribed therapy (core 3). An error rate was calculated for each nurse, and the error rates for the study and control groups were based on the average error rate for the nurses in each group. RESULTS: The majority of errors made were core 1 errors. The nurse-level data showed a significant decrease in core 1 error rates between baseline and postintervention periods. Core 2 error rates were higher in the postintervention period, but the increase was not significant. Very few core 3 errors were made by either group during either period. CONCLUSION: An interactive CD-ROM enabled nurses to apply the information learned to identify errors in medication administration and improved adherence to safe medication administration practices.

Adult↗

PubMed2004

QT prolongation with antimicrobial agents: understanding the significance.

Cardiac toxicity has been relatively uncommon within the antimicrobial class of drugs, but well described for antiarrhythmic agents and certain antihistamines. Macrolides, pentamidine and certain antimalarials were traditionally known to cause QT-interval prolongation, and now azole antifungals, fluoroquinolones and ketolides can be added to the list. Over time, advances in preclinical testing methods for QT-interval prolongation and a better understanding of its sequelae, most notably torsades de pointes (TdP), have occurred. This, combined with the fact that five drugs have been removed from the market over the last several years, in part because of QT-interval prolongation-related toxicity, has elevated the urgency surrounding early detection and characterisation methods for evaluating non-antiarrhythmic drug classes. With technological advances and accumulating literature regarding QT prolongation, it is currently difficult or overwhelming for the practising clinician to interpret these data for purposes of formulary review or for individual patient treatment decisions. Certain patients are susceptible to the effects of QT-prolonging drugs. For example, co-variates such as gender, age, electrolyte derangements, structural heart disease, end organ impairment and, perhaps most important, genetic predisposition, underlie most if not all cases of TdP. Between and within classes of drugs there are important differences that contribute to delayed repolarisation (e.g. intrinsic potency to inhibit certain cardiac ion currents or channels, and pharmacokinetics). To this end, a risk stratification scheme may be useful to rank and compare the potential for cardiotoxicity of each drug. It appears that in most published cases of antimicrobial-associated TdP, multiple risk factors are present. Macrolides in general are associated with a greater potential than other antimicrobials for causing TdP from both a pharmacodynamic and pharmacokinetic perspective. The azole antifungal agents also can be viewed as drugs that must be weighed carefully before use since they also have both pharmacodynamic and pharmacokinetic characteristics that may trigger TdP. The fluoroquinolones appear less likely to be associated with TdP from a pharmacokinetic perspective since they do not rely on cytochrome P450 (CYP) metabolism nor do they inhibit CYP enzyme isoforms, with the exception of grepafloxacin and ciprofloxacin. Nonetheless, patient selection must be carefully made for all of these drugs. For clinicians, certain responsibilities are assumed when prescribing antimicrobial therapy: (i) appropriate use to minimise resistance; and (ii) appropriate patient and drug selection to minimise adverse event potential. Incorporating information learned regarding QT interval-related adverse effects into the drug selection process may serve to minimise collateral iatrogenic toxicity.

Animals↗

PubMedDate not supplied

Family physicians and youth tobacco-free education: outcomes of the Colorado Tar Wars program.

BACKGROUND: Tar Wars is a national school-based tobacco-free education program operated by the American Academy of Family Physicians. The Tar Wars lesson uses an interactive 45-min session taught by volunteer family physicians in 4th- and 5th-grade classrooms and focuses on the short-term image-based consequences of tobacco use. In this study, we evaluated the effectiveness of the Tar Wars program in Colorado with both quantitative and qualitative measures. METHODS: Students participating in the quantitative evaluation were tested before and after a Tar Wars teaching session using a 14-question test covering the short-term and image-based consequences of tobacco use, cost of smoking, tobacco advertising, and social norms of tobacco use. Qualitative evaluation of the program included guided telephone interviews and focus groups with participating students, teachers, and presenters. RESULTS: Quantitative evaluation showed statistically significant improvement in correct responses for the 14 questions measured with an average increase in correct responses from 8.95 to 10.23. Three areas recommended by the Centers for Disease Control (CDC) for youth tobacco prevention showed greater change in correct responses, including cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. Qualitative evaluation found that the overall message of the session was well received, that previously known tobacco information was reinforced by its presentation in a novel format, and that new information learned included cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. CONCLUSIONS: The Tar Wars lesson plan is effective in increasing students' understanding about the short-term consequences of tobacco use, cost of tobacco use, truth of tobacco advertising, and peer norms. Tar Wars meets the CDC guidelines as one component of effective comprehensive youth tobacco prevention.

Child↗

PubMed2005

Genetic characterization of commonly used glioma cell lines in the rat animal model system.

OBJECT: Animal models have been used extensively to discern the molecular biology of diseases and to gain insight into treatments. Nevertheless, discrepancies in the effects of treatments and procedures have been encountered during the transition from these animal models to application of the information to clinical trials in humans. To assess the genetic similarities between human gliomas and four cell lines used routinely in animal models, the authors used microarray technology to characterize the similarities and differences in gene expression. METHODS: To define the changes in gene expression, normal rat astrocytes were compared with four rat glioma cell lines (C6, 9L, F98, and RG2). The data were analyzed using two different methods: fold-change analysis and statistical analysis with t statistics. The gene products that were highlighted after intersecting the lists generated by the two methods of analysis were scrutinized against changes in gene expression reported in the literature. Tumorigenesis involves three major steps: the accumulation of genetic alterations, uncontrolled growth, and selected survival of transformed cells. The discussion of the results focuses attention on genes whose primary function is in pathways involved in glioma proliferation, infiltration, and neovascularization. A comparative microarray analysis of differentially expressed genes for four of the commonly used rat tumor cell lines is presented here. CONCLUSIONS: Due to the variances between the cell lines and results from analyses in humans, caution must be observed in interpreting as well as in the translation of information learned from animal models to its application in human trials.

Animals↗

PubMed2004

Exploring pathways from television viewing to academic achievement in school age children.

The author's purpose in this study was to test 4 hypotheses that proposed different paths for the influences of children's television viewing on their academic achievement. Data were drawn from the 1997 Child Development Supplement (CDS) to the Panel Study of Income Dynamics (PSID). The population for this study included 1,203 children between the ages of 6 and 13 years from the CDS-PSID data set. The author used structural equation modeling to test pathways from children's television viewing to their academic achievement. The author assumed that children's television viewing hindered their academic achievement by reducing certain traits that related to academic achievement. Results showed that 3 hypothetical models fit the data--the time-displacement hypothesis, the mental effort-passivity hypothesis, and the attention-arousal hypothesis. A 4th hypothetical model, the learning-information hypothesis, which proposed that children's television viewing practices stimulate their academic achievement, was not supported. In sum, children who watched more television tended to spend less time doing homework, studying, and reading for leisure. In addition, their behaviors became more impulsive, which resulted in an eventual decrease in their academic achievement.

Achievement↗

PubMed1999

Automatically deriving readers' knowledge structures from texts.

Latent semantic analysis (LSA) serves as both a theory and a method for representing the meaning of words based on a statistical analysis of their contextual usage (Foltz, 1996; Landauer & Dumais, 1997). In experiments in the domains of psychology and history, we compared the representation of readers' knowledge structures of information learned from texts with the representation generated by LSA. Results indicated that LSA's representation is similar to readers' representations. In addition, the degree to which the reader's representation is similar to LSA's representation is indicative of the amount of knowledge the reader has acquired and of the reader's reading ability. This approach has implications both as a model of learning from text and as a practical tool for performing knowledge assessment.

Humans↗

PubMed1997

Need probability affects retention: a direct demonstration.

Recent memory theory has emphasized the concept of need probability--that is, the probability that a given piece of learned information will be tested at some point in the future. It has been proposed that, in real-world situations, need probability declines over time and that the memory-loss rate is calibrated to match the progressive reduction in need probability (J.R. Anderson & Schooler, 1991). The present experiments were designed to examine the influence of the slope of the need-probability curve on the slope of the retention curve. On each of several trials, subjects memorized a list of digits, then retained the digits in memory for 1, 2, 4, 8, or 16 sec. Some trials ended with a recall test; other trials ended with the message, "no test." In Experiment 1, the likelihood of encountering a memory test (i.e., the need probability) was made to either increase or decrease as the retention interval increased; in Experiment 2, need probability either was flat (invariant across retention intervals) or decreased as the retention interval increased. The results indicated that the shape of the need-probability curve influenced the slope of the retention curve (Experiment 1) and that the effect became larger as the experimental session progressed (Experiment 2). The findings support the notion that memory adapts to need probabilities and that the rate of forgetting is influenced by the slope of the need-probability curve. In addition, all of the forgetting curves approximated a power function, suggesting that need probability influences the slope but not the form of forgetting.

Educational Measurement↗

PubMed1999

Analogical encoding facilitates knowledge transfer in negotiation.

Information learned in one situation often fails to transfer to a similarly structured situation. However, prior findings suggest that comparing two or more instances that embody the same principle can promote abstraction of a schema that can be transferred to new situations. In two lines of research, we examined the effects of analogical encoding on knowledge transfer in negotiation situations. In Experiment 1, undergraduates were more likely to propose optimal negotiation strategies and less likely to propose compromises (a suboptimal strategy) when they received analogy training. In Experiment 2, graduate management students who drew an analogy from two cases were nearly three times more likely to incorporate the strategy from the training cases into their negotiations than were students given the same cases separately. For both novices and experienced participants, the comparison process can be an efficient means of abstracting principles for later application.

Adult↗

PubMedDate not supplied

A case study of the use of telemedicine by advanced practice nurses in rural Missouri.

BACKGROUND: Telemedicine aims to increase access to health care through the use of technology, but its impact on rural health care has had limited study. The purpose of this study was to evaluate the impact of newly implemented telemedicine systems on rural practice and patient care in the Missouri Telemedicine Network. METHOD: Telemedicine equipment and hook-ups were provided to satellite clinics and nonaffiliated clinics, nursing homes, hospitals, and health departments in three rural counties. Qualitative research methods were used to elicit data and develop a case study report of the experience of the rural nurse practitioner's use of telemedicine technology. Results were then compared with those of three other counties without telemedicine technology. RESULTS: Advanced practice nurses reported professional development and connectedness with telemedicine capability. Those with telemedicine access reported both current and potential applications of technology to practice. Both formal and informal learning opportunities were cited. Those without telemedicine access viewed telemedicine as potentially supportive of enhanced patient care and professional satisfaction. CONCLUSION: This preliminary study provides support for the role of telemedicine in augmenting the role of the advanced practice nurse in a variety of rural settings.

Adult↗

PubMed2005

How do junior doctors working in a multicultural context make sense of somatisation?

BACKGROUND: Physicians' explanatory models of commonly encountered clinical problems reflect not only formal medical training, but also personal and professional experience. In situations where formal training is absent, the clinical context of informal learning is likely to have an important influence on junior doctors' evolving knowledge and practice. OBJECTIVES: The purpose of this study was to explore junior doctors' explanatory models of somatisation in the absence of formal training, and in particular the influence of working with a large proportion of immigrants (asylum seekers and refugees) on their understanding and practice. METHODS: Semi-structured interviews were conducted with all 14 junior doctors working at the Geneva University Hospitals general medicine outpatient clinic. Interviews explored junior doctors' definitions, understanding and management of somatisation. Interviews were tape-recorded, transcribed verbatim and analyzed for key themes. RESULTS: In the absence of formal training, somatisation evoked considerable uncertainty and frustration in terms of diagnosis and management. Junior doctors' understanding of somatisation was heavily influenced by their contact with immigrant patients. They primarily attributed somatisation to psychosocial stresses related to migration and tended to label certain socio-cultural groups as more prone to somatisation than others. CONCLUSION: It is important to recognize that contextual factors have an important influence on physicians' evolving explanatory models for commonly encountered problems, especially in the absence of formal training. Results from this study suggest that formal training in management of somatisation should be offered in order to broaden junior doctors' understanding of somatisation and avoid cultural stereotyping.

Cultural Diversity↗

PubMed1986

Evaluation and management of the patient with acute back pain.

Patients with low back pain are among the largest group of health care consumers today. During an episode of acute back pain the patient may be hospitalized for diagnostic workup and medical management, processes to which occupational therapists can contribute. The occupational therapist's evaluation includes assessment of the patient's activities of daily living and understanding of back protection and pain behaviors. The therapist involves the patient in managing his or her back problem by teaching problem-solving skills and identifying appropriate life-style changes. Instruction is provided in proper body mechanics, anatomy of the spine, work simplification, relaxation, and adaptive methods of performing daily activities. Given the short hospitalization period, outpatient follow-up may be provided to facilitate the application of information learned in the hospital to home and work settings. The goal of occupational therapy is to help the patient with low back pain return to a productive life-style.

Activities of Daily Living↗

PubMed1994

Helping factors in a peer-developed support group for persons with head injury, Part 2: Survivor interview perspective.

OBJECTIVES: A follow-up study of the support group discussed in Schwartzberg's 1994 study was conducted to determine participants' perceptions of helping factors in the group. METHOD: Subjects were given a semistructured interview; follow-up interviews were held to ensure accuracy. RESULTS: Eleven helping factors were spontaneously generated from group members' data. These factors were socializing; finding out other people's perspectives and attitudes; expressing thoughts and feelings; receiving support; feeling something in common with other group members; gaining understanding, empathy, and acceptance through listening and sharing; getting perspective by learning about other people's limitations and strengths; helping others; getting help with problem solving; feeling hope, and learning information about brain injury. Members ranked expressing thoughts and feelings as the most helpful factor and finding out other people's perspectives and attitudes as the least helpful. CONCLUSIONS: These results support Schwartzberg's earlier findings, with some exceptions. The factor titles in this study have a broader scope than those in Schwartzberg's study, and not all of the factors determined in this study are completely comparable to Schwartzberg's factors. These findings may indicate that some differences in perspective exist between the participant observer and the survivors in the group studied.

Adult↗

PubMedDate not supplied

Lessons learned from the Uniontown Community Health Project.

OBJECTIVE: To compile lessons learned from the Uniontown Community Health Project. METHODS: Lessons-learned information was gathered from project staff and community volunteers. RESULTS: Analysis led to the identification of 6 lessons: (a) Establish personal working relationships in communities; (b) find a local community coordinator to lead efforts; (c) be patient in implementing a community health advisor (CHA) model; (d) be flexible and emphasize simplicity when implementing community activities; (e) recognize that meeting research goals requires compromise; and (f) plan transfer of project activities to the community from the beginning. CONCLUSION: These lessons may benefit others implementing CHA programs.

Adult↗

PubMedDate not supplied

Managing human resources in a changing health-care environment.

Managing human resources in this era of precipitous change poses one of the most difficult challenges and opportunities for leaders in the clinical laboratory. Shifts in health systems integration, cost control, patient-focused managed care, and provider changes have led to trends which fundamentally alter the way in which clinical laboratory services are organized, provided, and funded. To be successful change agents, laboratory managers must understand the cycle of human resource development and how people adopt change. They must embrace a systems thinking perspective and develop strategic leadership skills to share a vision of what the laboratory of the future will be. These new, advanced human resource management skills can be acquired through a variety of formal and informal learning experience.

Clinical Competence↗

PubMed1998

Assessing a VR-based learning environment for anatomy education.

The purpose of the research proposed herein is to develop an empirical, methodological tool for the assessment of visual depth perception in virtual environments (VEs). Our goal is to develop and employ a behaviorally-based method for assessing the impact of VE design features on the perception of visual depth as indexed by the performance of fundamental perceptual-motor activities. Specifically, in this experiment we will assess the affect of two dimensions of VE system design--(1) viewing condition or "level of immersion", and (2) layout/design of the VE--on the performance of an engaging, game-like task. The characteristics of the task to be employed are as follows--(1) it places no demands on cognition in the form of problem solving, retrieval of previously learned information, or other analytic activity in order to assure that (2) variations in task performance can be exclusively attributed to the extent to which the experimental factors influence visual depth perception. Subjects' performance will be assessed in terms of the speed and accuracy of task performance, as well as underlying dimensions of performance such as workload, fatigue, and physiological well being (i.e., cybersickness). The results of this experiment will provide important information on the effect of VE immersion and other VE design issues on human perception and performance. Further development, refinement, and validation of this behaviorally-based methodology will be pursued to provide user-centered design criteria for the design and use of VE systems.

Anatomy↗