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PubMed2000

Current issues in rehabilitation outcome measurement: implications for audiological rehabilitation.

OBJECTIVE: This paper will describe several key issues current in rehabilitation outcome measurement that should be considered in the establishment or choice of any new outcome measurement system or tools. DESIGN: The paper is a concept piece based on a review of literature rather than on experimental design. RESULTS: Social and political forces of the 1990s are affecting the need for outcome measurement and management: consumerism, or empowerment of the end user of services; the global Internet and information age; and the pervasiveness of the concept of quality improvement. In this context, several underlying concepts are important in effective outcome management approaches. Rehabilitation's focus on the person served provides a frame for measurement. Measurement in terms of the domains of the World Health Organization's International Classification of Impairments, Activities and Participation reflects meaningful dimensions of rehabilitation for people with hearing loss. Activities in the arena of rehabilitation performance indicator development are summarized and challenges in developing outcome management systems are discussed. CONCLUSIONS: The paper proposes that choice is a key outcome of interest in rehabilitation. Persons served in audiological rehabilitation and providers alike can benefit from systematic outcome measurement, but more can be learned about outcomes. Attention to consistent and uniform outcome measurement in audiological rehabilitation is consistent with the trends in the rehabilitation community at large.

Community Health Services↗
PubMed2001

Disavowal of the behaviorist paradigm in nursing education: what makes it so difficult to unseat?

The literature is replete with calls for disavowal of the behaviorist paradigm in nursing education, a paradigm charged with producing successive generations of passive learners who are incapable of instigating much needed and long overdue reforms within the health care system. Only rarely has this call been challenged by nurse educators. In this article, the role of a paradigm in delineating the nature of and solutions to significant problems within a scientific community is explored. I posit that the current eschewal of behaviorism by nurse educators stems not from its failure to solve significant problems in nursing education but rather from an apparent shift in value orientation--a shift from effecting learning (and health) outcomes to effecting social change. Despite this seeming shift in values, effecting learning outcomes is still held to be an essential aspect of nursing education, and it is because of this, I argue, that the behaviorist paradigm is so difficult to unseat.

Behaviorism↗
PubMed2003

Problem-based learning: effects on standard outcomes.

Dental students at the Harvard School of Dental Medicine (HSDM) participate fully in the first two years of the curriculum with the Harvard Medical School (HMS) while also taking parallel dental classes. HSDM students were first exposed to problem-based learning (PBL) in 1987 when the "New Pathway" curriculum was introduced at HMS in the first two years of the medical school curriculum (the HSDM courses remained traditional lecture-based classes). In 1994, HSDM incorporated PBL into the first, second, and third (clinical year) year dental courses, and the curriculum shifted from a five-year curriculum to a four-year curriculum. The purpose of this study was to evaluate the effect of PBL and program length on measurable outcomes for dental education: NBDE Part I scores, attrition and graduation rates, and percentage of graduates entering postdoctoral training programs. This study was designed as a retrospective analysis of outcomes data from 1980 to 2002. Univariate linear regressions were computed for each measure against each outcome. Subsequent bivariate regression analyses revealed that the implementation of PBL has markedly affected NBDE Part I scores, graduation rates, attrition rates, entrance into postdoctoral plans, and percentage of graduates entering GPR/AEGD programs, while program length has had an effect on graduation rates, attrition rates, entrance into postdoctoral programs, and percentage of graduates entering GPR/AEGD programs. The findings of this report suggest that the implementation of PBL combined with a change in program length has been successful for all outcomes measured and that PBL alone has contributed to the rise in NBDE Part I scores among HSDM graduates.

Boston↗
PubMedDate not supplied

Camp Can-Do. Outcomes of an experiential learning experience.

Because the most effective way to learn is by doing, faculty need to develop experiential learning experiences for students. The authors discuss one such experience, a multiple sclerosis camp where nursing students lived with and cared for their clients for 6 days. The camp experience illustrates how educators can partner with community organizations to the benefit of both.

Activities of Daily Living↗
PubMed1983

Learning to nurse the elderly: outcome measures.

This study explores the impact of a planned learning experience with the elderly on BScN students' level of knowledge about aging. Data were gathered by means of Palmore's 'Facts on Aging Quiz', an instrument which has been validated as a measure of knowledge. Findings revealed that a learning experience requiring that students have contact and planned experience with essentially well older people who were living and functioning relatively independently was effective in increasing their level of knowledge about aging as well as lessening negative stereotypes associated with the aged.

Aged↗
PubMedDate not supplied

A vision for doctoral research training in health behavior: a position paper from the American Academy of Health Behavior.

OBJECTIVE: To establish and disseminate the position of the American Academy of Health Behavior (The Academy) on doctoral research training. METHODS: A collaborative process involving the Work Group on Doctoral Research Training with input from The Academy membership led to the development of the guidelines described herein. RESULTS: A set of guidelines is provided that describe the process of learning to be a scholar/researcher and the outcomes of learning the practice of health behavior research. CONCLUSIONS: The doctoral students who are to become the stewards of our field should be prepared to engage in scholarship that creates new knowledge, uses research to transform practice, and effectively communicates research findings.

Behavioral Research↗
PubMed2006

Asthma end points and outcomes: what have we learned?

In spite of the wide prevalence of asthma and its substantial consequences, the diagnosis and assessment of asthma has not been standardized, and the goals of therapy currently are not being achieved. Our purpose is to help delineate what the most important asthma end points are and what kinds of strategies we should use to guide therapy. Comparison of numerous studies reveals that asthma measures used routinely in the clinic, such as spirometric lung function, do not uniformly correlate with asthma control. We cannot improve outcomes until we determine which measures reveal the underlying disease process most clearly and at the same time offer ease of performance during routine office visits. We propose that by standardizing the way we collect and analyze data from our daily practice, we can better define which measures reflect true asthma control. Such measures most likely address a spectrum of changes occurring in the pathophysiology of asthma, notably distal airway inflammation and hyperresponsiveness. Inflammation may provide the best opportunity for assessment and treatment, because if it is adequately addressed, airway sensitivity may improve, thereby reducing airway obstruction and subsequently minimizing exacerbations. The fraction of exhaled nitric oxide as a measure of inflammation is suggested as offering the best combination of disease evaluation and practical implementation for improved asthma outcomes.

Anti-Asthmatic Agents↗
PubMed1996

One and two year outcomes for adults with learning disabilities discharged to the community.

BACKGROUND: Long-stay patients with learning disabilities (n = 214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation. METHOD: Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation. RESULTS: There was little or no change in people's low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P < or = 0.01) 12 months after discharge (N = 119) and were more satisfied (P < or = 0.05) with their new 'homes' (n = 108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge. CONCLUSIONS: The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of 'ordinary' accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.

Activities of Daily Living↗
PubMedDate not supplied

Differential outcomes training facilitates memory in people with Korsakoff and Prader-Willi syndromes.

This article presents evidence that a teaching procedure called differential outcomes training enhances learning and memory. Differential outcomes training reinforces correct responses with outcomes that are unique and specific to the stimuli that are to be remembered. Teaching with this method enhances performance in people with Korsakoff syndrome and people with Prader-Willi syndrome, populations known to have learning and working memory deficits. This initial evidence that persons with learning and memory deficits benefit from differential outcomes training should encourage future work on the development of an intervention using this type of training to aide daily functioning by people with learning and memory impairments.

Cognition↗
PubMed1990

The role of information about the response-outcome relation in instrumental discrimination learning.

In 4 instrumental learning experiments, the hierarchical organization among responses (R), outcomes (O), and stimuli (S) was examined. Each experiment explored the possibility that S becomes associated with the R-O relation by providing information about that relation. In each case, an analogy was developed to a paradigm that has been important for concluding that informational relations affect Pavlovian conditioning. Experiments 1 and 2 found an effect of the information that S provides about the R-O relation, using paradigms analogous to blocking and contingency experiments. Experiments 3 and 4 demonstrated a similar result, using a paradigm like that of relative validity. In each case, the experiments pointed to the importance of the information that S gives about the R-O relation, rather than about the individual R and O elements.

Animals↗
PubMed1993

Surfactant therapy in respiratory distress syndrome: the effect of a learning curve in improving outcome.

A retrospective study of all premature neonates who received artificial surfactant (Curosurf) at the Rotunda Hospital was performed. The period from October 1990 to June 1992 (n = 48) was compared with the initial experience from June 1987 to January 1988 (n = 15). In the initial period mortality rate was 67% in surfactant treated infants, and use of surfactant was not associated with an improvement in outcome compared with the previous six years. In the more recent period overall mortality was 21%. Overall survival in normally formed very low birthweight infants improved from 59% in 1986 to 86% in 1991-1992. Improvement in survival rates was most noticeable in infants with birthweight 750-999 grams, with survival increasing from 44% (before introduction of surfactant treatment) to 91% (in 1991-1992). It is probable that a certain level of experience with use of surfactant is required before optimal effects can be obtained.

Female↗
PubMed2006

Negativity bias in attitude learning: a possible indicator of vulnerability to emotional disorders?

Negativity biases, i.e., tendencies for negative features and interpretations to predominate over positive, are known to play a role in the etiology and maintenance of emotional disorders. Both depression and anxiety have been associated with such negative cognitive styles. Recently, Fazio, R.H., Eiser, J.R., and Shook, N.J. [(2004). Attitude formation through exploration: Valence asymmetries. Journal of Personality and Social Psychology, 87, 293-311] have observed similar valence asymmetries in the domain of attitude formation and generalization. The present research examined the possibility that the extent to which individuals display a learning bias in attitude formation is related to negative cognitive style and emotional disorder symptoms. Participants played a computer game that required learning whether novel stimuli produced positive or negative outcomes. Poorer learning was associated with more negative cognitive style, greater depression, and a tendency toward greater anxiety. Interestingly, these relations were most evident with respect to the learning of the positive stimuli, suggesting that an under-appreciation of positive objects and events may underlie vulnerability to emotional disorders. The potential value of various indices of negativity bias that can be assessed when examining attitude formation and generalization is discussed.

Affective Symptoms↗
PubMed1999

Learning to listen: serendipitous outcomes of a research training experience.

Experience gained in a qualitative research-training project led a group of clinical nurse specialists to discover the value of using research interview strategies in their clinical work. Clinical interviews, designed to garner data sufficient to decide on interventions, narrow the focus of the interviewer to information deemed relevant to that end. Research interview strategies involve a temporary suspension of the search for intervention, encourage a full description of the respondent's story and experience, and emphasise really listening to that story. In this case it is the respondent who decides what the story is and what information is relevant. This leads the interviewer to a fuller understanding of the context and perceptions of the respondent. The understanding and knowledge thus obtained comprise a better foundation for devising interventions which are individualised and specific to the individual and family.

Communication↗
PubMed2005

Selected lessons learned from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of the relationships between hemodialysis (HD) patient outcomes and HD treatment practices. The DOPPS began in 1996 in the United States, expanding to France, Germany, Italy, Japan, Spain, and the United Kingdom in 1998-1999, and then to Australia, Belgium, Canada, New Zealand, and Sweden in 2002. More than 300 dialysis units have participated in the DOPPS since 1996, with mortality data collected from nearly 90,000HD patients and detailed longitudinal data from nearly 30,000 HD patients. Large sample size and the large treatment practice variation observed in the DOPPS--given its international scope of participation--provide strong statistical power to investigate many different HD practices. Furthermore, the detailed patient data collected in the DOPPS allow relationships to account for differences in a large number of patient characteristics. More than 55 papers have been published from the DOPPS; here we provide a summary of selected DOPPS findings regarding nutrition, mineral metabolism, anemia management, vascular access, depression, and use of multivitamins and statins.

Anemia↗