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At least 73 records · Page 4Linked to original sources
PubMed2005

A new approach to rater training and certification in a multicenter clinical trial.

Recent evidence demonstrates that the quality of raters' applied clinical skills is directly related to study outcome. As such, the training and evaluation of raters' clinical skill in administering symptom-rating scales is essential before being certified to rate patients in clinical trials. This study examined a novel approach to rater training and certification that focused on both conceptual knowledge and applied skills. Forty-six raters (MDs = 14; PhDs = 7; MA = 5; BA/LPN/RN = 20) in a large multicenter depression study went through a 2-step Hamilton Rating Scale for Depression (HAMD) certification process: didactic training, administered online via an interactive Web tutorial, and live, applied training, where raters interviewed depressed patients while being remotely observed via 3-way teleconference. Raters' applied skills were evaluated using the Rater Applied Performance Scale (RAPS), designed specifically to evaluate critical rater behaviors associated with good clinical interviews. Raters received feedback immediately following the interviews; those receiving a failing score were given 2 more opportunities to pass. Each subsequent session was accompanied by feedback, and was conducted by a different trainer, who was blind to the results of the previous session as well as to which session number it was, to avoid bias. Raters who failed on the third attempt were excluded from rating patients in the trial. All training and testing occurred prior to the startup meeting. Results found a significant improvement pre-to-post Web training in raters knowledge of scoring conventions, P < 0.001. On the applied component, raters' RAPS scores improved significantly on the second attempt following feedback, from 9.05 to 11.58, P < 0.001, and from their second to their third session (from 9.00 to 11.00, P = 0.033. Three raters failed all 3 attempts and were excluded from the study. Results support the efficacy of the approach in improving both conceptual knowledge and applied interviewing skill.

Adult↗
PubMed2006

Educating physicians to treat erectile dysfunction patients: development and evaluation of a course on communication and management strategies.

PURPOSE: To describe the development and assess the outcome of a workshop on erectile dysfunction (ED) management based on participating physicians evaluations. METHOD: The study involved physicians who attended a workshop offered throughout the country, during a 3-year period. The workshop included tutorials, video-based dramatizations, and role-play sessions. A pilot study investigated the workshop's impact on physicians' attitudes toward patient-centeredness and sexual behavior issues; Patient-Practitioner Orientation Scale (PPOS) and Cross Cultural Attitude Scale (CCAS) were administered before and after the course. New knowledge acquisition, quality of presentation, and workshop's usefulness in their clinical practice were the dimensions used for workshop's evaluation. Analysis used quantitative and qualitative methods. RESULTS: A total of 194 questionnaires were administered during the pilot study and the response rate was 53.6%. A shift in attitudes toward patient-centeredness and less judgmental attitude toward patients' sexual attitudes were revealed (total PPOS score and Sharing subscale: P < 0.05, CCAS: P < 0.001). Six hundred physicians were asked to evaluate the workshops and the response rate was 62.3%. The tutorial session for "medical treatment of ED" (P < 0.001) and the role-play on sexual history taking (P < 0.05) received higher evaluation scores. Qualitative analysis showed that the most frequently reported category referred to the appropriateness of role-play as a teaching and awareness-raising technique (31.25%); a need for changes in clinical practice and communication patterns was identified by 20% of the participants who stressed the necessity for multidisciplinary approach, as well as the adoption of a nonjudgmental attitude toward patients. CONCLUSION: Training courses on ED management, using a combination of tutorial and interactive sessions, constitute an effective way of providing knowledge, enhancing physicians' communication skills with ED patients, and influencing attitudes toward patient-centeredness in sexual issues. Such results strongly support the establishment of sexual medicine courses at continuing medical education curricula.

Adult↗
PubMed2004

Learning on the Web. Case 6: aortic valve replacement in the elderly.

A 90 year old man was found at home by his daughter, slumped at the bottom of his stairs. He recalled quite severe tight central chest pain associated with breathlessness and sweating while going up stairs which was not relieved by taking a spray of sublingual glyceryl trinitrate (GTN). He sensed that he was "about to die" before collapsing with loss of consciousness. He was sent to the accident and emergency department (emergency room) of his local hospital by ambulance. The patient had a five year history of angina pectoris that limited him to one flight of stairs within the house and light housework only. Over the two weeks preceding his admission to hospital he had experienced increasing frequency of these symptoms and used his GTN spray more often than usual. He had not smoked for over 50 years and there were no other risk factors for cardiovascular disease. There was no other notable past medical history and he was otherwise fit, living completely independently. The significance of these signs and symptoms, the diagnosis, and the short and long term treatment of these problems are discussed in an interactive case presentation.

Aged, 80 and over↗
PubMed2005

Learning on the Web. Case 8: systolic murmur in an asymptomatic 70 year old man.

A 70 year old man with hypertension underwent echocardiography for an asymptomatic murmur and was found to have aortic valve sclerosis. Over the next eight years, annual echocardiography showed progressive valve calcification with an increase in transaortic velocity and pressure gradient and a decrease in valve area. He eventually developed decreased exercise tolerance and was referred for aortic valve replacement. The purpose of this interactive case presentation is to illustrate the diagnosis and clinical implications of aortic valve sclerosis and the progression of sclerosis to significant stenosis, and its appropriate diagnosis and management.

Aged↗
PubMed2004

Learning on the Web. Case 7: recurrent pleural effusions, resistant atrial arrhythmias, and abnormal liver function tests: general medicine or cardiology?

A 65 year old man presented with recurrent pleural effusions. Repeated pleural fluid examination and pleural biopsy were unremarkable. Pericardial calcification was noted on admission and attributed to an uncomplicated episode of pericarditis 30 years previously. His symptoms and signs were not thought not to be associated with the heart. While awaiting an open pleural biopsy the patient was admitted with a further pleural effusion, jaundice, resistant atrial arrhythmias, and dyspnoea. Hepatic investigations including autoantibody screen and transjugular liver biopsy were normal. The significance of these signs and symptoms, the diagnosis, and the management of these problems are discussed in an interactive case presentation.

Aged↗
PubMed2004

Learning on the Web. Case 5: infective endocarditis.

A 70 year old man presented with microscopic haematuria and proteinuria and a fever five months after having a transurethral resection of the prostate (TURP). Initially urological review was arranged as the family doctor thought that a urinary infection was the most likely diagnosis. The patient was concerned that he was not getting better and he self-referred to a physician. He had continuing fever, weight loss, and malaise. The physician detected a mitral pan-systolic murmur that had not been heard before. On the basis of this finding infective endocarditis was suspected and investigations begun. His subsequent course and its management are discussed in an interactive case presentation.

Aged↗
PubMed2003

Learning on the Web. Case 1: syncope and palpitation in a patient following aortic valve replacement.

A usually very fit man aged 90 presented with syncope and angina of effort. He was found to have severe calcific aortic stenosis and associated coronary disease restricted to the left anterior descending (LAD) coronary artery. He underwent an aortic valve replacement with tissue prosthesis and a single coronary graft to the LAD. He came off bypass without difficulty but on the third postoperative period, when he had left the intensive care unit and was making excellent progress mobilising, he had further episodes of syncope and also developed palpitations. The significance of these symptoms and the diagnosis and treatment of these postoperative problems is discussed in an interactive case presentation.

Aged, 80 and over↗
PubMed2005

Learning on the Web. Case 9: a mother's heartache.

A 35 year old white woman presented with chest pain and breathlessness 10 days following an elective caesarean section. This was her second pregnancy, which had proceeded to term without complications. Up until then, she had been completely fit and well. Her ECGs were found to be abnormal, and the ultrasound study of her heart gave serious cause for concern. This interactive case report charts the evolution of the patient's clinical course and provides concise and up-to-date literature reviews on two cardiac conditions that share a predilection for women in the peripartum period.

Adult↗
PubMed1969

Time-shared computing. Implications for medical libraries.

Many library data processing systems are unresponsive to the needs of librarians because of the necessity to batch-process transactions in a computer center. Such systems tend to be reportoriented rather than information-oriented with resultant problems in the timeliness of information. Time-shared computing permits multiple users to process jobs simultaneously through on-line interaction with the computer. Such systems offer to the librarian the advantages of immediate access to information, costs shared with other users, and direct man-machine interaction. This tutorial paper describes time-shared systems with applications in the library. Problems concerning the cost and present state-of-the-art of time-sharing are discussed.

Cataloging↗
PubMed2001

Utilization of a pediatric emergency department education computer.

OBJECTIVE: To describe the use of a computer education station placed within a pediatric emergency department. DESIGN: Prospective tracking of computer tutorial use. SETTING: A tertiary care pediatric emergency department. METHODS: A computer with two 30-minute multimedia computer tutorials was installed in the emergency department. The tutorials were designed for residents to use on a voluntary basis but were available to medical students and allied health professionals as well. Software tracked time, date, duration of use, and the user's path through each tutorial. Data were collected from July 15, 1996, through April 30, 1997. RESULTS: Twenty-eight residents interacted 71 times with the computer during the study. The mean duration of interactions was 22 minutes (SD, 18 minutes; range, 0-75 minutes), but many lasted less than 5 minutes (15 [21%] of 71). Twenty-four (34%) of the interactions led to tutorial completion. Residents were more likely to complete a tutorial during the day shift (22 [40%] of 55) compared with the evening shift (1 [7%] of 14) (P =.02). A third of the interactions were during evenings and weekends. The education station delivered 26.1 hours of instruction in total. Of 32 first-year pediatric and emergency medicine residents, 22 attempted the tutorials; 4 completed both, and 10 completed one. Allied health professionals were responsible for 28% of the total interactions. They were significantly more likely than medical trainees to have brief interactions, but they were no less likely to complete the tutorials (10 [22%] of 46 vs 31 [27%] of 115; P =.44). CONCLUSIONS: Pediatric residents are willing to use an educational computer placed in the emergency department. Choice of form and content should take into account the likelihood of short interactions and the demonstrated interest of allied health professionals.

Academic Medical Centers↗
PubMedDate not supplied

The AAPM/RSNA physics tutorial for residents. X-ray interactions.

The diagnostic information in a radiograph or fluoroscopic image is largely the result of the quantity of x rays that are not removed from the incident x-ray beam. The information content of the image is delivered by the percentage of noninteracting photons that are successfully recorded. There are four major x-ray interactions: Rayleigh (coherent) scattering. Compton scattering, photoelectric absorption, and pair production. The degree of attenuation and the predominant mechanisms involved in the interactions are influenced by the x-ray energy and tissue composition. In the diagnostic energy range, photoelectric absorption and Compton scattering are the predominant modes of attenuation. One of the challenges in diagnostic imaging is to optimize image acquisition by controlling x-ray attenuation to obtain the appropriate contrast between the tissues while minimizing patient dose and scattered radiation in the image. Imaging techniques such as use of contrast material and dedicated mammography equipment exploit the differences in these types of x-ray interactions to improve the quality and diagnostic utility of the examination. Rayleigh scattering and pair production are presented but do not occur to any significant degree in diagnostic radiography.

Scattering, Radiation↗
PubMed1995

Tutorial software for clinical chemistry incorporating interactive multimedia clinical cases.

We have developed computer-based clinical case histories incorporating multimedia elements to aid the learning of medicine in a problem-based manner. Topics have been developed in the specialty of Clinical Biochemistry but the approach used is suitable for any branch of clinical medicine. Each topic has material aimed at medical students and also postgraduate candidates for professional examinations. A browser program is also incorporated. Emphasis is made on interaction through the case and modeling of real-life decisions in diagnosis and treatment. Advantages of the program are self-paced learning, assessment of understanding, feedback, and emphasis on deep understanding of the basic physiological and biochemical processes underlying clinical problems.

Chemistry, Clinical↗
PubMedDate not supplied

Teaching clinical management skills for genetic testing of hereditary nonpolyposis colorectal cancer using a Web-based tutorial.

PURPOSE: To pilot and evaluate an interactive Web-based continuing medical education tutorial on clinical management of hereditary nonpolyposis colon cancer (HNPCC) and genetic testing. METHODS: Gastroenterology fellows and genetic counseling trainees were asked to read standard written materials before taking the tutorial. A pretest/post-test assessment was used to measure change in subjects' clinical management skills. RESULTS: Subjects made the correct management decision 63.9% of the time before the tutorial and 81.1% of the time after the tutorial (P < 0.001). CONCLUSIONS: Supplementing written materials with an interactive program may assist medical professionals in integrating their knowledge of HNPCC and genetic testing into clinical practice.

Adult↗
PubMed2005

A web-based tutorial to enhance student learning of activity analysis.

BACKGROUND: This paper describes the impact on learning of a web-based tutorial for the application of activity analysis, with occupational therapy students, at McGill University, Montreal, Quebec. This tutorial offers unique, interactive instructional strategies allowing for self-directed higher cognitive and reflective learning, which has not been possible, to date, in current web-based technology. SCOPE: Through repeated practice, students collaboratively (in dyads) apply concepts of activity analysis, and receive immediate feedback by comparing their answers to a standard. METHODS AND RESULTS: Comparisons of performance outcomes on summative exams before and after implementation of the tutorial are made, suggesting a decrease in variance scores indicating fewer students are falling below the class average. These results are attributed to opportunities to practice activity analysis and to receive immediate feedback. PRACTICE IMPLICATIONS: Web-based instruction can impact student learning if the instructional strategies ensure coherence with all other instructional components, match the learning outcomes, facilitate self-directed and collaborative learning, and allow for practice and feedback.

Canada↗