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PubMed1981

Genetic counseling: a comparison of counselee's genetic knowledge before and after (Part III).

Forty-seven mothers of children with Down syndrome were evaluated on their knowledge of genetic facts pertaining to Down syndrome. We found that more knowledge of this disorder was acquired by counselees before counseling than from counseling. The data show that counseling is most effective in enhancing counselees' knowledge of general genetics, ie, the origin of the extra chromosome in a child with Down syndrome. In contrast, counselees had the most difficulty in learning the recurrence risks for others, including the risks for relatives, siblings, and the population in general. A finding of practical importance is that formal education is inversely related to the amount of information counselees learned from counseling. Mothers with less than a high school education acquired most of their genetic knowledge from counseling, while those with more than a high school education acquired most of this information before counseling.

Down Syndrome↗
PubMed2007

ACOG Committee Opinion No. 358: professional responsibilities in obstetric-gynecologic education.

Physicians must learn new skills in a manner consistent with their ethical obligations to benefit the patient, to do no harm, and to respect a patient's right to make informed decisions. Patients should be given the opportunity to consent to or refuse treatment by students. Students must hold in confidence any information they learn about patients. The relationship between teacher and student involves an imbalance of power and the risk of exploitation of a student for the benefit of the teacher. Students should not be placed in situations where they must provide care or perform procedures for which they are not qualified and not adequately supervised. Students have the obligation to be honest, conscientious, and respectful in their relationships with their teachers. They should act in ways that preserve the dignity of patients and do not undermine relationships between patients and their physicians. If a student observes unethical behavior or incompetent conduct by a teacher, the appropriate institutional authority should be informed. Institutions have an obligation to provide a work environment that enhances professional competence by ensuring that students and residents work reasonable hours, helping them balance education and patient care responsibilities; providing adequate support services; and, in the case of residents, providing reasonable salaries and benefits. With increasing numbers of women in education programs, special attention must be given to the parallel demands of pregnancy and career goals.

Education, Medical↗
PubMedDate not supplied

Neurobehavioural sequelae following cranial irradiation and chemotherapy in children: an analysis of risk factors.

Neurobehavioural deficits are commonly reported following treatment for childhood cancers. This study examined the impact of cranial irradiation (CRT) and chemotherapy in children, aiming to identify factors detrimental to long-term outcome. The study compared survivors of acute lymphoblastic leukemia (ALL), treated with CRT and chemotherapy (CRT group: n = 100), survivors of cancers treated with chemotherapy only (n = 50) and healthy controls (n = 100) for intelligence, academic achievement, information processing, learning, and executive function. CRT and chemotherapy in combination were associated with reduced intelligence, educational skill, immediate memory, processing speed, and executive function. Children treated with chemotherapy alone exhibited subtle information processing deficits. Within the CRT group, younger age at treatment was predictive of deficits in non-verbal ability, educational skills and executive functions. High dose CRT was associated with poorer information processing and lower arithmetic ability.

Achievement↗
PubMedDate not supplied

Using Web sites on quality health care for teaching consumers in public libraries.

More and more consumers are searching the Internet for health information. Health Web sites vary in quality, though, and not all consumers are aware of the need to evaluate the information they find on the Web. Nurses and other health providers involved in patient education can evaluate Web sites and suggest quality sites for patients to use. This article describes a project we implemented in 2 public libraries to educate consumers about quality health care and patient safety using Web sites that we had evaluated earlier. Participants (n = 103) completed resources on health care quality, questions patients should ask about their diagnoses and treatment options, changes in Medicare and Medicare options or ways to make their health benefits work for them, and tips to help prevent medical errors. Most consumers were highly satisfied with the Web sites and the information they learned on quality care from these resources. Many participants did not have Internet access at home or work and instead used the library to search the Web. Information about the Web sites used in this project and other sites on quality care can be made available in libraries and community settings and as part of patient education resources in hospitals. The Web provides easy access for consumers to information about patient safety initiatives and health care quality in general.

Adolescent↗
PubMedDate not supplied

A program for normal glycemic control of insulin-dependent diabetes.

A method of instruction enabling patients to control their diabetes is described. The patients learn through home glucose monitoring how their blood sugar levels vary with changes in diet, exercise, and insulin. They learn to chart accurately all the factors influencing their control in a manner that enables them, as well as the physician, to analyze them quickly. From this information they learn to anticipate the results of various changes in life-style and, thus, to live beyond the customary constraints of the disease without loss of glycemic control. Significant improvements in neuritis, impotence, and creatinine clearance rates are reported.

Adolescent↗
PubMed2001

Learning from a nurse anesthetist perspective: a qualitative study.

This study explored the learning and problem-solving experiences of Certified Registered Nurse Anesthetists (CRNAs) using a qualitative case study design. Through interviewing and observation techniques, 5 expert CRNAs provided information on learning and problem solving in daily clinical practice. Data were analyzed using the Tesch 8-step model. Three themes emerged from the data. In their learning, expert CRNAs first desire to know the pharmacological, physiological, or pathophysiological ("basic") principles needed to understand clinical situations. Once they are comfortable with their grasp of the basic principles, CRNAs will then "try out" the new agent or technique in their clinical practice. As experiences accumulate, CRNAs create complex practice structures and demonstrate increased levels of confidence, comfort, and expertise in practice. In understanding how expert nurse anesthetists learn and develop, perhaps educators and students will be more able to identify and design learning activities that prepare students for competent and successful anesthesia practice.

Clinical Competence↗
PubMed2000

Dynamic topology representing networks.

In the present paper, we propose a new algorithm, namely the Dynamic Topology Representing Networks (DTRN) for learning both topology and clustering information from input data. In contrast to other models with adaptive architecture of this kind, the DTRN algorithm adaptively grows the number of output nodes by applying a vigilance test. The clustering procedure is based on a winner-take-quota learning strategy in conjunction with an annealing process in order to minimize the associated mean square error. A competitive Hebbian rule is applied to learn the global topology information concurrently with the clustering process. The topology information learned is also utilized for dynamically deleting the nodes and for the annealing process. Properties of the DTRN algorithm will be discussed. Extensive simulations will be provided to characterize the effectiveness of the new algorithm in topology preserving, learning speed, and classification tasks as compared to other algorithms of the same nature.

Algorithms↗
PubMed2002

Blind mice are not impaired in T-maze footshock avoidance acquisition and retention.

The processing of visual information during learning and memory is considered to be a vital function of the hippocampus. Some researchers believe that the sole purpose of the hippocampus is to process visuo-spatial information, whereas other investigators believe that the hippocampus integrates cues from multiple sources. In the current studies, we tested the effects of vision loss on a hippocampal task, acquisition and retention with T-maze footshock avoidance conditioning. Acquisition and retention, in adult-blinded mice, were not significantly impaired in T-maze footshock avoidance. Blindness did not affect activity, footshock startle or motivation to avoid shock. The same doses of memory enhancing drugs that improve memory in sighted mice improved memory in blind mice. Electrolytic lesions in blind mice, which destroyed 31+/-4% of the hippocampus, significantly impaired acquisition and retention for T-maze footshock avoidance and so demonstrated that the hippocampus retained its integrative role in blind mice. The current findings show that blind mice are as capable of learning T-maze footshock avoidance as sighted mice and that the hippocampus retains its important role in blind mice in learning and memory processing. It is concluded that the T-maze footshock avoidance conditioning task is a spatially but not visually dependent task that is hippocampally dependent.

Acoustic Stimulation↗
PubMed2001

[Neuronal networks and memory: role of the hippocampus].

Learning and memory are related both to cognitive processes and to neurobiological mechanisms. The human pathology focused on the role of the hippocampus and animal experiments have analyzed its implications. The most usually admitted hypothesis is that memories are underlied by distributed specific neural networks defined through the strengthening of certain synapses, under the action of the flow of information during learning. The best candidate for this strengthening of the synapses is a change in synaptic plasticity similar to the artificial phenomenon of long-term potentiation. During memory processes, the hippocampus would play a particular role in information processing (analyzing novelty and significance of the information) and would allow the specification of the neural network, mainly in the cortical territories. We report data in olfactory learning in rats comforting these hypotheses. Considering neurochemistry of memory processes, specific synaptic changes and neuromodulatory processes must be distinguished. We report data about vasopressin illustrating both kinds of mechanisms in the hippocampus.

Animals↗
PubMedDate not supplied

An adult developmental study of the encoding of spatial location.

The present study was designed to test the hypothesis that there is a differential deficit in the ability to encode contextual information with increasing age. Young, middle-aged, and elderly adults were shown target words in various quadrants of a computer screen (contexts) and were told to either (a) remember the words and their locations, (b) remember the words, or (c) tell whether the words referred to something that was alive or not. Following presentation of the words, subjects were given a recognition test for the words and were asked to identify the quadrant in which each word had been presented. If older adults have a contextual encoding deficit, than an interaction between age and instruction condition would be expected in memory for quadrants. Older adults would be expected to perform better relative to younger adults when the locations were target information (intentionally learned) than when they were contextual (not intentionally learned). Since such an interaction was not obtained, the results provide no support for the hypothesis that the elderly have an encoding deficit that is specific to contextual information.

Adolescent↗
PubMed2000

Professionalism and professional values in orthopaedics.

During a consensus conference in Fall, 1998, the Academic Orthopaedic Society identified the values and qualities of professionalism as defined by its members. One hundred eighty-six respondents rated 20 characteristics and values describing professionalism, based on the extent to which they believed each item was appropriate. The five items receiving highest average ratings were: integrity, trustworthiness, responsibility, reliability, and accountability. Principal components analysis yielded five factors that captured 62% of the total variability. These factors were labeled respect and relationships, altruism, accountability and reliability, integrity, and excellence. The authors anticipate that the Academic Orthopaedic Society will find these data useful, and incorporate this information into their decisions concerning evaluation of current residents and applicants to their programs. An additional challenge will be to develop a values curriculum (formal curriculum) and a learning environment (informal curriculum) that will encourage residents and faculty to aspire to the highest in professional values and professional conduct.

Curriculum↗
PubMed1999

Memory strength affects reporting of misinformation.

A model of long-term retention was used to examine whether and how the strength of original information (differences in learning and testing time) and the strength of misleading information (differences in timing and frequency) influence 3- to 5-year-olds' memory for an event. In three experiments, preschoolers viewed a slide presentation depicting an event, some of them were asked misleading questions, and memory for event details was tested. There was little evidence of memory impairment, but exposure to misleading information encouraged reporting of this information. Differences in learning influenced reporting in that children exposed to the event once reported more misled details than those who saw the event multiple times. Furthermore, preschoolers who saw the event once were just as susceptible to misleading information whether exposed to misinformation once or three times; however, preschoolers who had seen the event multiple times were susceptible only to repeated presentations of misinformation. Given that the reporting of misinformation is determined by the degree of integrity of both the original and misleading information, it is important to control for differences in trace strength for both types of information in future research.

Analysis of Variance↗
PubMed1993

Functional aspects of calcium-channel modulation.

Associative learning is accompanied by a number of changes in the brain, many mediated by calcium. We have used eyeblink conditioning, a well-controlled learning task in animals and humans, to elucidate these changes. Our studies have focused on the hippocampus, a temporal lobe structure known to be important for storage of new information during learning in mammalian brain. Hippocampal neurons show an enhanced firing rate during learning correlated with behavioral acquisition; they also show reduction in a calcium-mediated after-hyperpolarization (AHP), a likely mechanism for their enhanced activity. Aging animals and humans exhibit learning deficits; aging hippocampal neurons show increased AHPs and altered calcium buffering, which contribute to the behavioral learning deficits. Intravenous administration of the calcium antagonist nimodipine causes aging rabbits to learn the eyeblink conditioning task as quickly as young controls. Oral nimodipine enhances learning rates in aging rabbits, rats, and monkeys. In each case, the type of learning task analyzed is dependent on hippocampal processing for acquisition and is impaired with aging. Nimodipine also reverses aging-related alterations in open field behavior of both rats and rabbits. We have done a series of physiological studies focused on the possible role of nimodipine in enhancing neuronal activity in the hippocampus of aging rabbits. The purpose of these studies was to determine how nimodipine may be functioning at a cellular level to increase the learning rate. Four major conclusions may be drawn from our data: (a) Nimodipine strongly enhanced the firing rate of single hippocampal pyramidal neurons recorded in vivo in an aging- and concentration-dependent fashion. Other calcium-channel blockers, such as nifedipine and flunarizine, given to control for cerebral blood flow changes, had essentially no effect on the hippocampal firing rate. (b) The slow AHP, mediated by an outward calcium-activated potassium current, was markedly larger in pyramidal neurons in hippocampal slices prepared from aging rabbits. Nimodipine, at concentrations as low as 100 nM, reliably reduced the AHPs of aging pyramidal cells. Aging neurons also showed more spike frequency adaptation, or accommodation, than young neurons. Nimodipine partially blocked accommodation at concentrations as low as 10 nM in aging neurons. (c) The calcium action potential was larger in aging neurons. Nimodipine modulated the calcium action potential in an age- and concentration-dependent fashion; concentrations as low as 100 nM reduced the calcium action potential in aging CA1 neurons without effects on young cells. (d) Nimodipine blocked the high threshold, noninactivating calcium current (L-type calcium current) in acutely dissociated hippocampal pyramidal neurons.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1981

Organization and learning of visual-motor information during different orders of limb movement: step, velocity, acceleration.

Theoretical use of the tracking paradigm as a means of understanding perceptual-motor organization has been influenced by ambiguous assumptions concerning the relation of time orders of force production to the learning and performance of time orders of limb movement. This study provides both a conceptual framework for clarifying these assumptions, and empirical data for testing them. The independent variables were (a) target motion (step, velocity, acceleration); (b) stick loading (elasticity, damping, mass); and (c) practice. The dependent variables were absolute terror for step and time-integrated squared error for velocity and acceleration. The hypothesis was that proficiency of tracking is inversely related to mathematical complexity of reactive forces, within constraints imposed by familiarity with required types of transfer functions. Five subjects were assigned to track one type of target motion in each of the three loading conditions, respectively. Cursor-present "training" trials were alternated with cursor-absent "test" trials. Thereby, a premium was placed on attention to proprioceptive feedback, at least at the start of training. The hypothesis could not be rejected.

Adult↗
PubMed1989

Changes in Regional Cerebral Oxidative Metabolism Induced by Tactile Learning and Recognition in Man.

We measured the regional cerebral oxidative metabolism (rCMRO2) with positron emission tomography in normal healthy volunteers in three different stages: rest, tactile learning, and tactile recognition of complicated geometrical objects. The frequency of manipulatory movements during tactile recognition was twice that of tactile learning. Tactile recognition with the right hand increased rCMRO2 in six prefrontal cortical areas, bilaterally in the supplementary motor areas, the premotor areas and supplementary sensory areas, in the left primary motor and primary sensory area, in the left anterior superior parietal lobule, bilaterally in the secondary somatosensory area, the anterior insula, lingual gyri, hippocampus, basal ganglia, anterior parasagittal cerebellum, and lobus posterior cerebelli. These structures have in other studies been found to participate in manipulatory movements and analysis of somatosensory information. Tactile learning increased rCMRO2 in the same structures as did tactile recognition. Thus we found no differences in the anatomical structures participating in storage and retrieval. However the rCMRO2 increases in the left premotor cortex, supplementary motor area, and left somatosensory hand area were larger during tactile recognition in accordance with the higher frequency of manipulatory movements and higher flux of somatosensory information from the periphery during recognition. Despite this the rCMRO2 was significantly higher in the neocerebellar cortex during tactile learning. Since there were no learning effects on the manipulatory movements, this extra metabolic activity in the lateral cerebellum was attributed to energy demanding processes associated with climbing fibre activity during storage of somatosensory information.

Journal Article↗
PubMed1981

Effect of informed consent and educational background on patient knowledge, anxiety, and subjective responses to cardiac catheterization.

Thirty-four patients undergoing elective cardiac catheterization were followed linearly with three questionnaires during their hospitalization to study some of the effects of informed consent. Patients learn about catheterization from the informed consent session conducted by a cardiology fellow. Several areas of knowledge deficiency were found. The emotional experience of hospitalization and the amount of knowledge about catheterization determined at the end of hospital stay is shown to be dependent on the educational level of the patient. Several recommendations are made for the conduct of the informed consent sessions to improve the knowledge of the less educated.

Adult↗
PubMed1987

A computer data base for information on cancer treatment.

The Physician Data Query (PDQ) system is a clinically oriented computer data base developed to make recent information on cancer treatment widely available to the medical community. It represents an effort by the National Cancer Institute to promote diffusion of information about the treatment of cancer throughout the country, facilitate access to clinical trials, and accelerate the practical application of advances in research. The computer system provides information about state-of-the-art cancer treatment, which is updated monthly by an editorial board. It also includes a file of active cancer-research protocols and a directory of physicians and organizations providing cancer care to which physicians can gain access by geographic location as well as other features. PDQ was designed for physicians who may not be familiar with computers, to permit them to search for and display information without learning a specialized search language. PDQ uses a computer mainframe, which allows a large amount of data to be stored and made available to physicians rapidly and accurately. Transmission of information about cancer over commercial telecommunication networks gives health professionals access to PDQ by means of a computer terminal and local telephone lines.

Directories as Topic↗