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PubMed1996

Core curriculum for the training of pediatric invasive/interventional cardiologists: report of the Society for Cardiac Angiography and Interventions Committee on Pediatric Cardiology Training Standards.

Within the field of pediatric cardiology, a number of subspecialty fields are generally recognized. Some of these overlap. For example, most electrophysiologists also would consider themselves to be clinical cardiologists. Some fields, however, are relatively mutually exclusive. For example, most clinical pediatric cardiologists would not consider themselves to be electrophysiologists and would admit that there is a different knowledge, skill, and experience base that separates an electrophysiologist from other specialists within the broader field of pediatric cardiology. Likewise, it is our opinion that a separate knowledge, skill, and experience base exists among pediatric Invasive/Interventional cardiologists. The purpose of this report is to define the unique knowledge and skill base required for the training of an invasive pediatric cardiologist. The scope of this report is limited to the training of Invasive/Interventional cardiologists dealing with the treatment of pediatric patients and the cardiac diseases most often encountered in these patients. This report describes in detail the core curriculum suggested for the training of an invasive pediatric cardiologist. For these purposes, invasive pediatric cardiology encompasses all aspects of pediatric diagnostic cardiac catheterization, whether congenital or acquired. Additional curriculum regarding training for therapeutic or interventional procedures is also addressed because of today's needs: most pediatric cardiac catheterizations are performed to acquire specific data that cannot be obtained otherwise by non-invasive technologies and are required for the best medical or surgical management. However, more and more frequently the need for a cardiac catheterization entertains the possibility of having to proceed with an interventional procedure, and therefore, to conserve the vessels of pediatric patients as well as to consider costs, any invasive pediatric cardiologist should be well trained in most of the accepted interventional pediatric cardiology procedures. The curricula is divided here into five major sections followed by a bibliography keyed to those sections. Also included is a suggested format for the objective evaluation and documentation of the progress of invasive pediatric cardiology fellows. It is intended to complement the core curriculum and provide a means for standardizing the evaluation of invasive pediatric cardiology fellows.

Angiography↗

PubMed1999

The utility of trained arthritis patient educators in the evaluation and improvement of musculoskeletal examination skills of physicians in training.

OBJECTIVE: To determine the level of examination skills of internal medicine residents and to assess whether an intervention by trained persons with arthritis could have a greater impact on their examination skills than participation in an ambulatory care training experience. METHODS: Twenty-seven residents attended a 6-week ambulatory care rotation that included didactic teaching as well as attendance at an outpatient arthritis clinic with supervision by rheumatologists. Sixteen residents were randomly assigned to have a training encounter with an arthritis educator along with the standard experience in the arthritis clinic, whereas 11 residents received training in the arthritis clinic only. Arthritis educators evaluated the musculoskeletal examination skills of each resident during the first week of the rotation. The 16 residents in the intervention group received instruction on joint examination techniques by the arthritis educator immediately following their evaluation. At the end of the 6-week rotation, the groups were re-evaluated by a different arthritis educator. A group of 21 rheumatologists was also asked to perform a comprehensive musculoskeletal examination on individual arthritis educators. The arthritis educators assessed the examination of the rheumatologists using the same evaluation instrument that was used to assess the residents. RESULTS: Initially, internal medicine residents carried out the musculoskeletal examination poorly (34.2 +/- 0.09% correct, n = 27). By contrast, the rheumatologists carried out a significantly greater amount of the examination correctly (54.5 +/- 0.05%). The musculoskeletal examination skills of the residents who received additional training from an arthritis educator were significantly greater at the end of the rotation than the group who did not receive this intervention (50.5 +/- 0.10% versus 41.9 +/- 0.14% correct, P = 2.15 x 10(-5). CONCLUSION: Internal medicine residents carried out the musculoskeletal examination poorly. However, an intervention by arthritis educators improved the musculoskeletal examination skills of internal medicine residents significantly and more effectively than the standard clinical teaching in a rheumatology outpatient clinic. The impact of the arthritis educator intervention persisted for at least 5 weeks.

Arthritis↗

PubMed1992

Use of participatory training techniques in a right-to-know train-the-trainer course for New Jersey public employees.

The New Jersey Department of Health, in conjunction with the Department of Personnel's Human Resources Development Institute, has developed a Right-to-Know Train-the-Trainer course. In this course, various participatory activities have been utilized since the course's inception in December 1989 to train future trainers who train public employees about recognizing, evaluating, and controlling hazardous substances in their facilities. These participatory training techniques have offered a means by which the trainers can encourage workers to become proactive in making their working conditions safer. With the use of various methods of evaluation, course participants learn the content and develop their skills in the use of participatory training techniques. Though evaluations indicate that participants have a favorable impression of the course, the extent to which these participants take the information back to their worksites has not been formally evaluated.

Hazardous Substances↗

PubMed1998

Self-management of fibromyalgia: the role of formal coping skills training and physical exercise training programs.

There has been growing interest in the use of formal self-management training programs for people with fibromyalgia (FM). In these programs, health care professionals serve as trainers and provide education about FM and guided instruction in specific self-management strategies. A review of the literature on formal self-management training programs for FM suggests that they can be divided into groups: 1) those emphasizing training in coping skills (e.g., relaxation, activity pacing, and problem-solving techniques), and 2) those emphasizing training in physical exercise (e.g., cardiovascular fitness, strength, and endurance training). In this article, we review studies that have tested the efficacy of both types of programs. In addition, we identify key individual and contextual variables that are related to outcome and highlight future directions in the research and development of self-management programs.

Adaptation, Psychological↗

PubMed1980

Education and training for computer-based reference services: review of training efforts to date.

This article raises several questions regarding training for computer-based reference services, including who is to be trained and who is responsible for training. It discusses these issues and then provides a summary of the training provided to date by search service suppliers, database suppliers, library schools and extension programs, library cooperatives, and professional organizations. The available training materials are also discussed. Some projections are made of likely future activities.

Information Systems↗

PubMed2004

Voices of the five doctoral training councils in psychology: seeking common ground on Combined-Integrated doctoral training in psychology.

Doctoral training programs in psychology are accredited by the American Psychological Association in four areas: Clinical, Counseling, School, and Combined-Integrated (C-I) psychology. Each area of doctoral preparation in psychology has its own council, which represents its interests within the field and to external constituents. Despite the fact that Combined-Integrated training programs have existed since the mid-1970s, the Consortium representing this area's interests only formed in the past two years. The purpose of this article was to obtain input from representatives of all five training councils regarding the role of the newly formed council in relation to the other councils and the role of Combined-Integrated training. We begin with a brief description of each of the five councils. We then summarize the representatives' responses to narrative questions regarding advantages and disadvantages associated with meeting to discuss the combined model. Finally, common and divergent themes across the councils in training psychologists are presented, and the future role for Combined-Integrated programs is discussed.

Accreditation↗

PubMed2003

Effect of the intensity of training on catecholamine responses to supramaximal exercise in endurance-trained men.

In this study we investigated whether plasma catecholamine responses to the Wingate test are affected by the intensity of training in endurance-trained subjects. To do this we compared plasma adrenaline (A) and noradrenaline (NA) concentrations in response to a Wingate test in three different groups: specialist middle-distance runners (MDR) in 800-m and 1,500-m races, specialist long-distance runners (LDR) 5,000-m and 10,000-m races, and untrained subjects (UT). The maximal power ( W(max)) and the mean power ( W) were determined from the Wingate test. Blood lactate (La), plasma A and NA concentrations were analysed at rest (La(0), A(0) and NA(0)), immediately at the end of the exercise (A(max )and NA(max)) and after 5 min recovery (La(max), A(5) and NA(5)). The ratio A(max)/NA(max )was considered as an index of the adrenal medulla responsiveness to the sympathetic nervous activity. At the end of the test, W(max) and W were similar in the three groups but La(max) was significantly greater in MDR compared to LDR and UT [15.2 (2.2) mmol l(-1), 11.7 (3.1) mmol l(-1), 11.6 (1.6) mmol l(-1), respectively, for MDR, LDR and UT; mean (SD)]. Concerning the plasma catecholamine concentrations in response to exercise, MDR and LDR A(max) values [3.73 (1.53) nmol l(-1), 3.47 (0.74) nmol l(-1), respectively, for MDR and LDR] were significantly greater than those of UT [1.48 (0.32) nmol l(-1)] who also exhibited the lowest NA(max) values [11.09 (6.58) nmol l(-1)] compared to MDR and LDR [20.43 (3.51) nmol l(-1); 15.85 (4.88) nmol l(-1), respectively, for MDR and LDR]. However, no significant differences were observed between the two trained groups either for A(max) or NA(max.) These results suggest that long-term endurance training can enhance plasma catecholamine concentrations in response to supramaximal exercise. However, as there were no significant differences between MDR and LDR A(max) and NA(max) values, the effect of the intensity of training remains to be clarified.

Adolescent↗

PubMed2005

Adaptation of left ventricular morphology to long-term training in sprint- and endurance-trained elite runners.

Long-term studies on left ventricular (LV) adaptation have not been reported. The echocardiograms of 41 top-class runners (8 males and 6 females sprint-trained, 15 males and 12 females endurance-trained) were recorded at the beginning and after 1, 2, and 3 years of training. A one-way ANOVA and a linear regression analysis were conducted to determine changes and association between performance and LV values. Training resulted in an increase in performance and LV internal diameter at end-diastole (LVIDd) and decreases in end-diastolic interventricular septal wall thickness, and posterior wall thickness (PWTd). There were no significant differences in LV mass and LV ejection fraction (LVEF, %). The changes in PWTd were linked to enlargement of the LV. In athletes with unusual LV dilatation (>60 mm), LVIDd was related to performance and LVEF was >50%. Maximal wall thickness was <13 mm in all athletes. LV adaptations were independent of sex and type of training and related to the initial level of performance. We believe that LV enlargement in elite runners is a physiological adaptation and that the LVIDd is a predictor of running performance.

Adaptation, Physiological↗

PubMed2005

Effect of concentric or eccentric weight training on the expression of heat shock proteins in m. biceps brachii of very well trained males.

Increased HSP expression in response to acute exercise is well documented in animal studies, and there is growing evidence that similar responses occur in man. In general, many human exercise studies have investigated the HSP response to low force continuous activity, while the knowledge about the HSP response to high force intermittent type of activity, like weight training, is so far sparse. In addition, most studies have used untrained subjects, and a common observation is that acute low force continuous activity in untrained individuals increases the HSP expression in these individuals. The main scope of this study was to investigate the HSP response in very well trained males subjected to longitudinal high intensity exercise, and if this response was dependent on exercise modality [i.e. eccentric (ECC) or concentric (CON) contractions]. Very well trained males performed progressive strength training consisting of either high force ECC or high force CON elbow flexions 2-3 times a week for 12 weeks. Compared with pre-exercise levels, HSP72 expression decreased by 46.1% (P<0.05) after CON contractions. GRP75 expression was unchanged after ECC or CON contractions, while ubiquitin expression decreased by 19.9% (P<0.02) after ECC contractions. These findings imply that chronic, intensive exercise may attenuate the HSP response in well-trained males.

Adult↗

PubMed2006

Usefulness of a virtual reality simulator or training box for endoscopic surgery training.

This study investigated whether the use of a simulator for endoscopic surgery training improves the performance of actual operations. For the study, 16 medical students were divided into three groups: a virtual reality (VR) simulator group (n = 6), a training box (TB) group (n = 6), and a control group (n = 4). The VR and TB groups received 2 h of training per day for 5 days, after which they were requested to perform intestinal dissection, to close a gastric perforation, and to perform cholecystectomy in pigs. Performance was assessed on the basis of the operating time and the error score. Although there were no differences between the three groups in terms of the total operating time or error score, the VR and TB groups required less time for closure of the gastric perforation than the control group. In addition, the operating time decreased as actual operating experience increased in the VR group. In the TB group, the time for closure of a gastric perforation was shorter when the supervisor had seen the operation before training. These findings demonstrated that a simulator is useful for acquiring psychomotor skills, but does not immediately enable clinical performance of an operation. More actual experience and good supervision are essential for increasing the effectiveness of training with the VR and TB simulators, respectively.

Adult↗

PubMed1999

Physical training as an adjunct therapy in patients with congestive heart failure: patient selection, training protocols, results, and future directions.

Exercise intolerance in patients with chronic heart failure (CHF) shows no correlation to the degree of left ventricular dysfunction. This surprising finding has directed attention to peripheral changes in CHF: reduced endothelium-dependent vasodilation and altered skeletal muscle metabolism. Physical exercise training has evolved as an important therapeutic approach to influence these noncardiac causes of exercise intolerance. It has been shown to enhance the oxidative capacity of the working skeletal muscle, to attenuate ergoreflex activity, to correct endothelial dysfunction, and to improve ventilation. All exercise-induced adaptations converge to increase peak oxygen uptake by up to 2 mL/kg.min(-1). Uncertainty remains concerning optimal patient selection, training protocol, and long-term effects on cardiac function. For patients experiencing stable CHF while on optimal cardiac medication, a combination of in-hospital and home-based aerobic endurance training in combination with local muscle strength training seems most promising. Although exercise training offers no causal treatment of CHF, it has great potential as an adjunct therapy directed at improving exercise tolerance and expanding the physical limits of CHF patients.

Arrhythmias, Cardiac↗

PubMed2005

Public health training online: the National Center for Suicide Prevention Training.

BACKGROUND: Suicide is a serious public health problem, and training in suicide prevention has not kept pace with recent rapid growth of the field. METHODS: To address this concern, the Harvard Injury Control Research Center and Education Development Center, Inc., launched the National Center for Suicide Prevention Training (NCSPT) with funding by the Maternal and Child Health Bureau of the Health Resources Services Administration. NCSPT offers an online professional development workshop series for public officials, service providers, and community-based coalitions involved in suicide prevention. RESULTS: Using a public health framework of prevention, the three workshops implemented to date have drawn over 1200 participants nationally and internationally over the past 3 years. Workshop participants completing the post-test and evaluation show consistent improvement in their knowledge of suicide, rate their online training experience positively, and report that they would take additional online courses if offered. A barrier to objective evaluation of the courses, however, is the high attrition rates of the courses, an expected feature of free online courses. CONCLUSIONS: Online training is a valuable option to help meet suicide prevention training needs employing flexible, easy-to-use, and inexpensive Internet technology. With its growing presence in the field, NCSPT will continue to develop new courses to improve the ability of professionals and community-based coalitions to reduce suicide and its devastating impact on public health.

Adolescent↗

PubMed2005

[Radiation oncology training in France: demography, analysis of motivations of the young specialists, evaluation of the training].

During the 5 past national courses organised by the French society of radiation oncology (SFRO), three different types of survey were performed to analyse demography, motivations and quality of training of the young specialists. During the 5 past years, 50 radiation oncologists were training for the whole country (about 15 per year were graduated). A recent increase the number of young specialists is observed with a total number of 50 in 2000 to 75 in 2005. Nevertheless, the number of young specialists is dramatically insufficient and exposes for the future to an important demographic crisis. Analysis of motivations of choice for radiation oncology confirms the influence of a practical stage of oncology during the second cycle of the medical studies for 60% of the young specialists. Analysis of practical and theoretical training was performed according to the point of view and living experiences of the students. On the other hand, informations from teachers were less complete. Some needs are emphased as: 1) the quality of the follow during the training (importance of the recent implementation of a logbook); 2) importance of theoretical and practical training at the radiotherapy department; 3) help and incentive for research and scientific publication.

Demography↗

PubMed2007

Triple board training and new "portals" into child psychiatry training.

Originally an experiment in medical training, the triple board program has established itself as a permanent and successful training program. It offers a viable 5-year alternative to the traditional 7 to 8 years of residency training required for board eligibility in pediatrics, general psychiatry, and child and adolescent psychiatry. One primary objective of this course was to address for workforce shortage of child psychiatrists by recruiting medical students who may otherwise have pursued general pediatrics. The second objective was to bridge the gap between child psychiatry and pediatrics by training physicians proficient in the culture, language, and content of both specialty fields. Although the shortage crisis continues, both objectives were met. The success of the triple board experiment has facilitated further consideration and support for the development of other novel training portals into child psychiatry.

Adolescent↗

PubMed2004

Association of fat-free mass and training status with left ventricular size and mass in endurance-trained athletes.

OBJECTIVES: We sought to study the relationship between left ventricular (LV) size and body composition in male endurance athletes and age-matched control subjects. BACKGROUND: Endurance training is associated with increases in both left ventricular mass (LVM) and left ventricular end-diastolic dimension (LVEDD) in athletes. In other populations, LVM is independently predicted by fat-free mass (FFM). We hypothesized that the increase in LV size and mass observed with training may be a normal response to increased FFM. METHODS: Twelve young and 18 older male endurance athletes and 10 young and 18 older untrained men underwent exercise testing, echocardiography, and dual-photon x-ray absorptiometry body composition analysis. Univariate correlates (Spearman) and multivariate determinants of LVM and LVEDD were sought from: height, height(1.4), height(2.7), height(3.0), body surface area (BSA), FFM, weight, and body mass index. Un-indexed and indexed LVM and LVEDD were then compared. RESULTS: Athletes were of a similar age, weight, and height, but had higher FFM and maximum oxygen uptake than untrained men. Both LVM and LVEDD were correlated with body size, including FFM, BSA, weight, and height (all p < 0.05). On multivariate analysis, FFM was the only independent predictor of both LVM (R(2) = 0.36, p < 0.001) and LVEDD (R(2) = 0.35, p < 0.001). Furthermore, LVM and LVEDD (un-indexed and indexed to BSA and height) were different between athletes and non-athletes, but not when indexed to height(2.7) or FFM. CONCLUSIONS: Both LVM and LVEDD are predicted by FFM in endurance athletes, and when indexed to FFM, no training-related differences were observed. Thus, the extent of LV remodeling (athletic heart) in trained individuals may reflect a normal physiologic response to increased FFM induced by training.

Absorptiometry, Photon↗

PubMed2004

Do highly trained monkeys walk like humans? A kinematic study of bipedal locomotion in bipedally trained Japanese macaques.

In this study, we examined the kinematics of bipedal walking in macaque monkeys that have been highly trained to stand and walk bipedally, and compared them to the kinematics of bipedal walking in ordinary macaques. The results revealed that the trained macaques walked with longer and less frequent strides than ordinary subjects. In addition, they appear to have used inverted pendulum mechanics during bipedal walking, which resulted in an efficient exchange of potential and kinetic energy. These gait characteristics resulted from the relatively more extended hindlimb joints of the trained macaques. By contrast, the body of the ordinary macaques translated downward during the single-limb stance phase due to more flexed hindlimb joints. This resulted in almost in-phase fluctuations of potential and kinetic energy, which indicated that energy transformation was less efficient in the ordinary macaques. The findings provide two insights into the early stage of the evolution of human bipedalism. First, the finding that training considerably improved bipedal walking a posteriori may explain why the very first bipeds that might not yet have been morphologically adapted to bipedal walking continued to walk bipedally. The evolutionary transition from quadrupedalism to bipedalism might not be as difficult as has been envisioned. In addition, the finding that macaques, which are phylogenetically distant from humans and in which bipedal walking is unlike human walking, could develop humanlike gait characteristics with training, provides strong support for the commonly held but unproven idea that the characteristics of the human gait are advantageous to human bipedalism.

Animals↗

PubMed1997

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training.

OBJECTIVE: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. DESIGN: Pretest, posttest. SETTING: Academic medical center. PARTICIPANTS: Subjects with chronic neurologically complete paraplegia. INTERVENTION: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. OUTCOME MEASURES: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). RESULTS: Significant effects of training on CSA (p < .0001), FVI (p < .05), computed PV (p < .001), and computed AIV (p < .01) were observed. Resting HR was lower following training (p < .05). The change for resting PSV approached but did not reach significance (p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status (p values < .01), postcompression time (p values < .0001), and their interaction (p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV (p values < .05). CONCLUSION: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

Adult↗

PubMed1967

Neuronal spike trains and stochastic point processes. I. The single spike train.

In a growing class of neurophysiological experiments, the train of impulses ("spikes") produced by a nerve cell is subjected to statistical treatment involving the time intervals between spikes. The statistical techniques available for the analysis of single spike trains are described and related to the underlying mathematical theory, that of stochastic point processes, i.e., of stochastic processes whose realizations may be described as series of point events occurring in time, separated by random intervals. For single stationary spike trains, several orders of complexity of statistical treatment are described; the major distinction is that between statistical measures that depend in an essential way on the serial order of interspike intervals and those that are order-independent. The interrelations among the several types of calculations are shown, and an attempt is made to ameliorate the current nomenclatural confusion in this field. Applications, interpretations, and potential difficulties of the statistical techniques are discussed, with special reference to types of spike trains encountered experimentally. Next, the related types of analysis are described for experiments which involve repeated presentations of a brief, isolated stimulus. Finally, the effects of nonstationarity, e.g. long-term changes in firing rate, on the various statistical measures are discussed. Several commonly observed patterns of spike activity are shown to be differentially sensitive to such changes. A companion paper covers the analysis of simultaneously observed spike trains.

Action Potentials↗