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Results for “skill learning”

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PubMed1984

Exposure-effect and exposure-response relationships between occupational exposure to styrene and neuropsychological functions.

A neuropsychological test battery was administered to 50 workers exposed to styrene and to 50 sex-, intelligence-, and age-matched controls. The main styrene metabolites, ie, mandelic acid (MA) and phenylglyoxylic acid (PGA), were measured as exposure indices in the urine collected on Saturday mornings, just before neuropsychological testing. Exposure-response and exposure-effect relationships were found between the intensity of the exposure (as reflected by the sum of MA and PGA) and the scores of the neuropsychological tests. Verbal learning skills were significantly impaired in workers with a sum of MA and PGA higher than 150 mmole/mole creatinine, corresponding to styrene airborne concentrations higher than 25 ppm (mean daily exposure). Logical memory and visuo-constructive abilities were shown to be significantly affected in workers with MA and PGA higher than 300 mmole/mole creatinine, corresponding to exposure levels of more than 50 ppm of styrene in air.

Adult↗

PubMed2006

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as "incorrigible", but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their "most important" delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive-behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions?In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?

Cognitive Behavioral Therapy↗

PubMed2006

Medical student participation in surface anatomy classes.

Surface anatomy is an integral part of medical education and enables medical students to learn skills for future medical practice. In the past decade, there has been a decline in the teaching of anatomy in the medical curriculum, and this study seeks to assess the attitudes of medical students to participation in surface anatomy classes. Consequently, all first year medical students at the Guy's, King's and St Thomas's Medical School, London, were asked to fill in an anonymous questionnaire at the end of their last surface anatomy session of the year. A total of 290 medical students completed the questionnaires, resulting in an 81.6% response rate. The students had a mean age of 19.6 years (range 18-32) and 104 (35.9%) of them were male. Seventy-six students (26.2%) were subjects in surface anatomy tutorials (60.5% male). Students generally volunteered because no one else did. Of the volunteers, 38.2% would rather not have been subjects, because of embarrassment, inability to make notes, or to see clearly the material being taught. Female medical students from ethnic minority groups were especially reluctant to volunteer to be subjects. Single-sex classes improved the volunteer rate to some extent, but not dramatically. Students appreciate the importance of surface anatomy to cadaveric study and to future clinical practice. Computer models, lectures, and videos are complementary but cannot be a substitute for peer group models, artists' models being the only alternative.

Adolescent↗

PubMedDate not supplied

Emerging crisis of continuing professional education: becoming a dead letter between external pressure and personal incentive?

Continuing professional education (CPE) has been recognized as an effective tool for equipping health professionals with updated knowledge and skills for improving health services quality. However, there is globally increasing skepticism concerning the effectiveness of CPE. In developed countries, the major reasons for participation in CPE include compliance with employers' requirements and renewal of specialist qualifications and licences. In developing countries, CPE, frequently supported by development agencies, often provides subsistence support to participants and is possibly perceived as an extra income opportunity or tool for promotion among health professionals. The knowledge and skills learned are insufficiently applied in daily practice. This carrot-and-stick approach should be reduced and efforts should be made to increase the level of application of what has been learned. To deliver more effective and efficient CPE, it is critical to study this issue in more depth.

Developed Countries↗

PubMed2001

SHORT REPORT Competence unfurled: Developing portfolio practice.

In this report some of the characteristics of competence are explored. Learning is identified as a feature of competence. If occupational therapists are to survive and thrive in a changing world they need to develop and use their learning skills effectively to maintain competence and to develop proficiency and expertise. Occupational therapists should take steps to document evidence of evolving competence in order to demonstrate professional growth over time, and justify continued registration with their regulatory body.

Journal Article↗

PubMed1991

Cognitive deficits in long-term survivors of childhood brain tumors.

Improvements in survival for patients who had childhood brain tumors has led to an increasing emphasis on the quality of life for these long-term survivors. Initial survival studies relied on global descriptions of functional abilities to assess cognitive deficits and reported that from 20% to 40% of long-term survivors had obvious partial disability and less than 10% were severely disabled. Formal neuropsychological testing has revealed that from 40% to 100% of long-term survivors have some form of cognitive deficit in various intelligence quotients, visual/perceptual skills, learning abilities, and adaptive behavior. Prospective, controlled studies have found a younger age at diagnosis, radiotherapy, methotrexate chemotherapy, tumor location and time interval to testing to be important (alone or in combination) and related to a high risk of subsequent cognitive deficits. Some variables play an as yet unresolved role. However, despite the progress of the last decade, future prospective studies are needed to define the role of certain variables in the development of cognitive deficits that maximize survival while minimizing cognitive deficits.

Brain Neoplasms↗

PubMedDate not supplied

Aortic origin of the RPA: immediate resolution of severe pulmonary artery hypertension by surgical repair.

Aortic origin of the right pulmonary artery (AORPA) is a rare condition requiring a high index of suspicion for diagnosis as the usual signs of structural heart disease are often absent. Ultrasound examination can strongly suggest the condition but can easily be misinterpreted. Infants should be considered "operable" even when the resistance calculations predict otherwise as there appears to be a large component of immediately reversible pulmonary artery hypertension. With technical skills learned from arterial switch operations (for transposition of the great arteries), surgical repositioning of the RPA should be possible in nearly all cases without the use of a tube graft.

Angiocardiography↗

PubMed1994

Screening for lysosomal disorders.

Patients at any age who develop regression of learned skills, onset of dementia, loss of motor control and organ enlargement should be considered for lysosomal screening. Morphological and biochemical screening methods may reinforce the clinical suspicion, but they are not diagnostic. A widespread use of enzyme assays that appear to be related to the clinical problems is recommended.

Humans↗

PubMed2002

Improving access to primary health care for chronic drug users: an innovative systemic intervention for providers.

An intervention was designed to improve access to primary care for chronic drug users (CDUs) by enhancing health care providers' knowledge and skills. Using a case study method, three study sites were systematically selected for intervention implementation: a primary care clinic (PC), an emergency department (ED), and a drug treatment (DT) facility. Participants completed pre- and postintervention tests of knowledge, skills, and intentions to practice. Compared with pretest scores, participants had significantly higher posttest scores concerning knowledge of CDUs' health care needs. Postintervention evaluations indicated intentions to practice skills learned in the intervention. As hypothesized, the PC and ED subsequently instituted formal screening mechanisms to identify CDUs. This intervention revealed potential to build bridges between health care providers and CDUs. By overcoming provider resistance, primary care access can be realized for this and other disadvantaged populations.

Chronic Disease↗

PubMed1996

Cognitive remediation of persons with severe and persistent mental illness.

There is a vast psychiatric literature describing the nature and degree of cognitive deficits present in persons suffering from severe and persistent mental illness, particularly schizophrenic spectrum disorders. A smaller, more recent literature has emerged addressing non-pharmaceutical interventions developed to remediate those deficits. The Cognitive Remediation Program was developed to remediate cognitive deficits in such areas as the ability to sustain attention and concentration, memory processes, concept formation, organizing visual and auditory stimuli into recognizable patterns, and shifting cognitive sets. The program consists of three fifteen minute intervals or "loops" that each contain a different type of task designed to promote remediation of cognitive deficits. The Program also employs behavioral techniques, using a token economy to aid in shaping behavior and motivating patients. The loops consist of: 1) a group that focuses on training in attention, concentration and cognitive flexibility; 2) a computer group utilizing a combination of game software and programs designed for use with a head injured population; 3) a group promoting the generalization of skills learned in the Program to other social arenas. On a ten week pre- and post-measure, participants improved significantly on both a digits forward and digits backward task, both measures of concentration and attention.

Adult↗

PubMed1995

Implementing psychosocial rehabilitation in long-term inpatient psychiatric facilities.

Using the focus group methodology, data were gathered from the initial experiences of Missouri's four long-term psychiatric facilities with psychosocial rehabilitation (PSR). Significant implementation factors include the establishment of a firm PSR philosophical base; extensive staff training in PSR values, technologies, and the skills necessary to implement the technologies; support for staff as their roles change with the adoption of PSR; adaptation of PSR for use with forensic clients; use of community resources while clients are still inpatients; maintenance of PSR values and skills learned after clients are released into the community; and the establishment of a program evaluation system that assesses both outcome and process. Clients residing in long-term, public psychiatric facilities also can receive substantial benefits from this approach to service delivery.

Community-Institutional Relations↗

PubMed1994

[Resuscitation skills of hospital nursing staff].

The hospital nursing staff represents a distinct group of cardiopulmonary resuscitation (CPR) providers. Differences in the success rates of resuscitation attempts inside or outside the hospital seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for prehospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. METHODS. During 53 CPR refresher courses offered to nursing staff members, their individual skills and competence in CPR procedures were examined according to the standards and guidelines of the German Medical Association (Bundesärztekammer). The efficacy of cardiac massage and artificial ventilation performed by each nurse was recorded. Quality criteria were defined, grouped and analysed statistically by the Chi-square test. RESULTS. Only 6.6% of the nursing staff were found to have good skills in artificial ventilation. The main faults observed were insufficient tilting of the head (24%) and failure to prevent leakage from the insufflation airway (35%). For 42.8% it proved impossible to insufflate a minimum ventilatory tidal volume of 400 ml. The attempts at resuscitation made by 58.6% were completely inadequate. Although 14.1% of the nurses carried out effective cardiac massage, the majority of the test group (44.7%) failed to do so. For 29.4% the appropriate position of their own upper body to allow adequate chest compression remained elusive. In 41.4% of the compression cycles, the rescuer's hands lost contact with the sternum. The compression period proved too long in relation to the decompression period in 21.4%. Only 4 individuals (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvers. The test results did not differ with respect to the nurses' educational or professional status, clinical CPR experience or work area within the hospital. CONCLUSION. Cardiopulmonary resuscitation skills of hospital nurses are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost after a relatively short time. These results, however, do not suggest completely inadequate handling of CPR procedures in the hospital setting. Indeed an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. In consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made obligatory for nursing staff every 2 years. Qualified nursing personnel routinely trained in CPR and supported by effective hospital logistics is essential if the life-saving benefits of modern CPR are to be provided to our patients.

Humans↗

PubMed2005

Psychological treatment strategies for rapid ejaculation: rationale, practical aspects, and outcome.

The landscape has dramatically changed for patients seeking treatment for rapid ejaculation. Previously, psychotherapy or behavioral treatment was considered to be the treatment of choice for this troubling sexual dysfunction. Since the early 1990s, an efficacious alternative treatment has emerged-the off-label administration of SSRI medications. Currently, several short-acting SSRI compounds are in phase III clinical trials and are likely to receive approval as the first medical treatment for rapid ejaculation. Given the presumed efficacy of these new compounds and the off-label use of the current SSRIs, one might conclude that psychotherapy\behavior therapy for rapid ejaculation is an obsolete and antiquated intervention. On the contrary, psychotherapy is now more relevant than ever. The two aims of this paper are to review psychological/behavioral therapies for rapid ejaculation and to discuss the important role of combined psychological and medical treatment. In the new age of SSRI treatment for rapid ejaculation, some form of psychological/behavioral intervention is essential to help patients/couples make better use of medical therapies, to learn skills to delay ejaculation once off medication, to bolster sexual confidence, and to enhance patient and partner sexual satisfaction.

Ejaculation↗

PubMed1992

The influence of flight experience on midair collision risk perception.

Although successful collision avoidance is presumed a learned skill, midair collision accidents typically involve highly experienced pilots. It is hypothesized that pilot complacency, arising from a history of incident-free flights, plays a role in the midair collision process. Pilot risk perception is explored using Laplace's Law of Succession, and the resulting perceived collision probability compared to reality. The two converge at around 5,000 hours of flight experience.

Accidents, Aviation↗

PubMed1990

Brain structures participating in mental simulation of motor behavior: a neuropsychological interpretation.

This paper reviews findings from cognitive and sport psychology, as well as from neurophysiology, concerning mental simulation of movement. A neuropsychological hypothesis is advanced to explain why mental practice can improve motor skill learning. Mental practice activates certain brain structures selectively as shown by measurements of regional cerebral blood flow. It appears likely that this activation improves the subsequent control of execution of movements. It is pointed out that the study of simulation of movements may not only be of value for sport training but also have importance for the rehabilitation of patients with motor disturbances following lesions of the central nervous system.

Brain↗

PubMed1993

Lack of evidence for Huntington's disease-like cognitive dysfunction in obsessive-compulsive disorder.

Cognitive deficits in patients with structural lesions of the basal ganglia (e.g., Huntington's disease) commonly include slowed processing, reduced verbal fluency, difficulty switching set, impaired egocentric spatial ability, poor recall, and impaired acquisition of motor skills. The goal of this study was to determine if patients with obsessive-compulsive disorder (OCD) would have a similar pattern of cognitive dysfunction. A battery of neuropsychological tests, including reaction time-based measures of cognitive processing speed and a test of procedural, motor-skill learning, was administered to 17 unmedicated OCD patients and 16 age-and education-matched normal controls. Eleven individuals with trichotillomania, matched with the OCD patients on age, education, age at symptom onset, depression, and anxiety were also tested. Contrary to expectation, neither the OCD nor trichotillomania patients were impaired on any of the measures in the battery. The essentially normal performance by these patients suggests that the brain regions responsible for cognitive dysfunction in patients with Huntington's disease may differ from those associated with OCD.

Adolescent↗

PubMedDate not supplied

Aged monkeys exhibit behavioral deficits indicative of widespread cerebral dysfunction.

To determine whether the decline of behavioral abilities with aging in monkeys is selective or widespread, we examined 18 monkeys ranging from 3 to 34 years of age on a wide variety of tests with the ultimate goal of correlating behavioral deficits with age-related changes in the brain. In our initial study we found impaired visual recognition ability in the aged monkeys (43). In the present study, we assessed the same animals on tests of spatial memory, visual habit formation, visuospatial orientation, visually guided reaching, motor skill learning, and reaction time, these categories having been chosen to test the integrity of different cerebral systems. There were three major findings. First, age-related impairments were observed in nearly all test categories, though often not on easy versions of the tests, suggesting that the deficits observed were in the specific abilities measured and not an artifact of lowered motivation or other general disability. Second, the behavioral decline began in the late teens for certain spatial abilities but did not affect other abilities until the late 20's, suggesting that although the cerebral dysfunction eventually becomes widespread, the cerebral systems underlying spatial abilities are compromised by aging earlier than others. Finally, the finding of correlations between scores of aged animals primarily within test categories as opposed to across categories suggests that different animals have different patterns of cerebral involvement.

Aging↗

PubMed1990

Childhood amnesia and distinctions between forms of memory: a comment on Wood, Brown, and Felton.

Recently, Wood and his colleagues (1989) presented a case of childhood amnesia as evidence against the distinction between declarative and procedural memory that has sometimes been applied to human amnesia. Their argument was based on the observation that their patient showed some progress in school over the years, i.e., acquired some declarative knowledge, despite severely impaired day-to-day memory ability. We briefly review their case, together with a carefully studied second case of childhood amnesia not mentioned by Wood et al. Their argument is wrong in several ways. First, the utility of the declarative/procedural distinction for amnesia, or the utility of any other distinction between memory systems, depends on whether or not one kind of memory is impaired selectively, not on the severity of the impairment. In particular there is no requirement that one kind of memory be totally absent. Second, they have not provided the data necessary to support their argument; namely, data showing that the amount of declarative knowledge accumulated during years in school was better than would have been expected given the capacity for moment-to-moment or day-to-day memory. Indeed, the patient's moment-to-moment memory ability is better than represented, and the patient's progress in school was abnormally slow. Third, it is not clear that academic achievement scores provide a direct measure of declarative memory abilities (skill learning and recovery of function may also have contributed). We conclude that the evidence from childhood amnesia is fully consistent with the proposal that amnesia reflects a selective impairment in the formation of long-term declarative memory.

Achievement↗