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PubMedDate not supplied

What have we learned from the large outcomes trials of COX-2 selective inhibitors? The rheumatologist's perspective.

The cyclooxygenase (COX)-2 selective inhibitors celecoxib and rofecoxib have been found to be more effective than placebo and comparably effective to nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of patients with osteoarthritis and rheumatoid arthritis. Two large outcome studies, the Celecoxib Long-term Arthritis Safety Study (CLASS) and Vioxx Gastrointestinal Outcomes Research (VIGOR) trial, were conducted to test the hypothesis that patients receiving a COX-2 selective inhibitor would have significantly fewer clinically important upper gastrointestinal events than patients taking nonselective NSAIDs. This article critically reviews the design and results of these trials. Both trials found that arthritis patients not taking low-dose aspirin (325 mg/day or less) who were randomized to receive COX-2 selective inhibitors had significantly fewer symptomatic and complicated ulcers than patients randomized to nonselective NSAIDs. A significant risk reduction was not demonstrated, however, in patients in the CLASS trial who were taking low-dose aspirin, itself an independent risk factor for the endpoint. These data validate the COX-2 hypothesis and support recommendations that a COX-2 selective inhibitor should be used in the treatment of patients at increased risk for symptomatic and complicated ulcers. Further studies are needed to determine whether COX-2 selective inhibitors are safer than nonselective NSAIDs when used in patients receiving low-dose aspirin. The COX-2 selective inhibitors have a similar profile of renal adverse events to nonselective NSAIDs. The increased rate of cardiovascular thromboembolic adverse events among patients randomized to rofecoxib compared to those randomized to naproxen in the VIGOR trial is consistent with the lack of an anti-platelet effect for this COX-2 selective inhibitor. This emphasizes the need for the use of low-dose aspirin in patients at risk for such events, especially myocardial infarction.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1999

Order of selection in vocational rehabilitation: implications for the transition from school to adult outcomes for youths with learning disabilities.

Interagency cooperation between special education and vocational rehabilitation (VR) is central to ensuring the continuity of services to young adults with disabilities who are in transition from school to adult living. However, the interface between special education and VR may be complicated by order of selection, an equally binding mandate in federal VR policy to provide priority services to individuals with the most severe disabilities. Because students with learning disabilities are typically perceived as having mild rather than severe disabilities, these youths are most at risk for falling through the cracks in the service landscape once they leave the school setting in states where the VR agency is implementing an order of selection procedure. This article identifies and discusses common impediments to collaborative transition planning for students with learning disabilities that may be intensified when the state VR agency is operating under an order of selection plan. Recommendations are provided to facilitate greater interagency cooperation among schools and VR agencies so that transition planning and implementation for students with learning disabilities is not subverted as a result of the order of selection mandate.

Journal Article↗
PubMedDate not supplied

[Observations on the outcome of children with learning disorders].

The learning disorders reach 10% of the school population. They are characterized through an abnormal and persistent difficulty to get the basic acquirements and skills for children without mental or physical heavy handicap. These disturbances may be relieved through the assistance at all levels which interfere in their origin and their persistence (emotional, neurologic, pedagogic or pertaining to family). After de follow-up study over 10 years regarding the children coming from a special scholarship (type 8) and having received all the adapted aids, it seems that a good adaptation has resulted to a good ulterior professional training college. A narcissic fragility and organizing troubles are remaining present and are the origin of an intense strain on the mind. They may generate affective regression and behavioral problems.

Attention Deficit Disorder with Hyperactivity↗
PubMedDate not supplied

Academic outcomes for students with learning disabilities in consultation and resource programs.

In this study, pretest and posttest achievement test data were collected for 67 children with learning disabilities assigned to one of four conditions: one period of resource room instruction per day; two periods of resource room instruction per day; consultative services combined with in-class instruction; and consultative services to classroom teachers. Analysis of pretest achievement measures indicated that students assigned to two periods of resource room per day differed significantly from the other groups and results from this group were analyzed separately. Students in the remaining three conditions made gains in standing relative to same-age peers from pretest to posttest. Students receiving a combination of consultation and direct services showed small, but significantly greater overall gains in achievement than did students placed in the resource room.

Achievement↗
PubMed1994

Stroke rehabilitation. 5. Stroke outcome.

This self-directed learning module highlights outcome after stroke rehabilitation. Part of the chapter on stroke rehabilitation in the Self-Directed Medical Knowledge Program for practitioners and trainees in physical medicine and rehabilitation, this article contains sections on predictors of stroke outcome; the ability of stroke rehabilitation to achieve functional improvement, maintain functional gains, and reduce costs; and the efficacy of varying levels of rehabilitation services.

Activities of Daily Living↗
PubMed1998

Learning with technology: use of case-based physical and computer simulations in professional education.

This presentation will clarify contemporary ideas on the role of technology in education and how it can be employed to improve student learning experiences and outcomes. The paper will emphasise RMIT's role in providing quality education that is relevant to today's world and professional practice. It will examine a specific collaborative (RMIT & ACU), interdisciplinary project 'Pregnancy Simulator: Developing and Enhancing Student Learning of Assessment Skills'. This project consist of a physical pregnancy model connected to a multi-media computer-assisted learning package for the purpose of enhancing student learning of abdominal assessment skills. Our paper outlines an innovative technology-based teaching project and includes current educational issues or problems encountered in professional education, steps already taken to address these difficulties and how this project intends to facilitate learning. It identifies expected learning outcomes for midwives, nurses and medical students, and examines pedagogical principles applied to technological applications designed to provide guided discovery for allowing students to build confidence and competence in professional education. The case-based physical and computer simulations contextualise learning to assist transfer of learning to real world situations. This paper will also discuss how technology-based projects can be evaluated and integrated into university curricula to enhance student learning.

Computer Simulation↗
PubMed2004

Attitude formation through exploration: valence asymmetries.

The formation of attitudes toward novel objects was examined as a function of exploratory behavior. An initial experiment, in which participants played a computer game that required them to learn which stimuli, when sampled, produced favorable or unfavorable outcomes, demonstrated learning, attitude formation, and generalization to novel objects. The findings also revealed 2 interesting valence asymmetries: a learning asymmetry involving better learning for negatively valenced than positively valenced objects and a generalization asymmetry involving stronger generalization as a function of negative than of positive attitudes. Findings from 4 experiments led to an explanation of the learning asymmetry in terms of information gain being contingent on approach behavior and related the generalization asymmetry to a negativity bias that weighs resemblance to a known negative more heavily than resemblance to a positive.

Adult↗
PubMed2003

Does the learning phase influence the late outcome of patients with gastroesophageal reflux disease after laparoscopic fundoplication?

BACKGROUND: Although the degree of surgical experience clearly affects early outcome of laparoscopic antireflux surgery, its influence on long-term results has not been fully evaluated. The aim of this study was to verify whether the initial experience in laparoscopic antireflux surgery could also influence the late clinical outcome. METHODS: Clinical and endoscopic findings, together with quality of life, of the first 25 patients successfully submitted to laparoscopic fundoplication were compared with those of 25 matched controls operated on later. RESULTS: At more than 2 years', follow-up, reflux symptoms, endoscopic findings, use of antisecretory drugs, side effects, and quality of life were not significantly different in both groups, despite a high occurrence of major anatomical failures (three vs one) in the first set of patients. CONCLUSION: The late clinical outcome of patients with gastroesophageal disease operated on during the learning phase or after gaining experience is not different, provided the surgeon is adequately trained in laparoscopic surgery.

Adult↗
PubMed2001

Specificity of task constraints and effects of visual demonstrations and verbal instructions in directing learners' search during skill acquisition.

In the present study, the efficacy of visual demonstrations and verbal instructions as instructional constraints on the acquisition of movement coordination was investigated. Fifteen participants performed an aiming task on 100 acquisition and 20 retention trials, under 1 of 3 conditions: a modeling group (MG), a verbally directed group (VDG), and a control group (CG). The MG observed a model intermittently throughout acquisition, whereas the VDG was verbally instructed to use the model's movement pattern. Participants in the CG received neither form of instruction. Kinematic analysis revealed that compared with verbal instructions or no instructions, visual demonstrations significantly improved participants' approximation of the model's coordination pattern. No differences were found in movement outcomes. Coordination data supported the visual perception perspective on observational learning, whereas outcome data suggested that the modeling effect is mainly a function of task constraints, that is, the novelty of a movement pattern.

Adult↗
PubMed2005

Web-enhanced and face-to-face classroom instructional methods: effects on course outcomes and student satisfaction.

Web-enhanced courses are increasingly popular for providing rich learning experiences and greater flexibility in achieving course outcomes. As technology emerges as an adjunct to face-to-face teaching methodologies, nursing educators are compelled to determine to what extent students are able to meet course objectives when technology is used to enhance the classroom experience. Graduate nursing students enrolled in face-to-face and web-enhanced sections of a course were evaluated on technical ability, learning style, learning outcomes, and course satisfaction. There was no difference on technical ability and learning outcomes. Overall, students in the web-enhanced section were more satisfied with the course, and reported advantages such as greater flexibility in scheduling, less travel, and greater independence and self-pacing of content. The data suggest that web-enhanced courses can provide a valid alternative to more traditional face-to-face classroom formats, and may remove some of the barriers to pursuing advanced nursing degrees.

Adult↗
PubMed2002

A report on the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Initiative: what have we learned and what is its potential?

INTRODUCTION: The Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Outcomes Initiative established a national database in 1999. The goal was to provide a vehicle whereby surgeons could accumulate meaningful data about their surgical activity and procedure outcomes. METHODS: Through a secure Internet site, participants entered core data at the time of operation on all patients undergoing any laparoscopic or open procedure. Procedure-specific data was accumulated for cholecystectomy, inguinal hernia, and fundoplication. A second data set was collected at the time of follow-up evaluation. Individual data and a summary of national data were available through the Web site for contemporaneous review. RESULTS: Between May 1999 and December 2001, 4,100 cases were entered by 73 surgeons, including data for 1070 cholecystectomies, 1,070 antireflux procedures, and 300 hernias. The remaining cases encompassed all other procedures. Perioperative and follow-up data showed many interesting findings. For example, 30% of cholecystectomies were first-assisted by a nonphysician. The rate of conversion from laparoscopic cholecystectomy to open surgery was 3%. In the gastroesophageal reflex disease (GERD) report on fundoplications, 21% of the patients had a previous fundoplication. This report contains a summary of the data collected during this period in the national database. CONCLUSIONS: The SAGES Outcomes Initiative allows surgeons to be involved in data collection about their practice. It provides data on the general practice of surgery, which are more useful for setting benchmarks than published data from the surgical elite.

Benchmarking↗
PubMed2007

Stimulus-outcome interactions during instrumental discrimination learning by rats and humans.

The associative structure mediating goal-directed action was investigated using congruent and incongruent conditional discriminations. The stimulus was the same as the outcome in each component of the congruent discriminations, whereas the stimulus of one component of the incongruent discriminations was the same as the outcome of the other component. Humans, but not rats, learned the congruent discrimination more rapidly than the incongruent discrimination, a difference that the authors attribute to the fact that outcome-response associations caused response conflict in the incongruent discrimination. Moreover, responding was resistant to outcome devaluation following incongruent, but not congruent, training, suggesting that both humans and rats adopted a stimulus-response strategy to resolve the incongruent discrimination.

Adult↗
PubMed2006

Student outcomes associated with service-learning in a culturally relevant high school program.

The Hawaiian Studies Program (HSP) integrates the learning of Hawaiian culture with more traditional secondary curriculum in science, social studies, and English. Students also participate in weekly community service-learning sessions. Fifty-five HSP students and 29 peers (who were not involved in the program), completed a survey measuring: students' connection to, pride in, and responsibility for their community; civic attitudes; and career knowledge and preparedness. HSP teachers, community members, and students were also interviewed about program outcomes. Compared to other peers, HSP students tended to report feeling more connected to their community and school and to agree that they had career-related skills. Participants believed that service- learning contributed to these outcomes by making connections between school and community life and by exposing students to a variety of careers.

Adolescent↗
PubMed2005

Dissociation between judgments and outcome-expectancy measures in covariation learning: a signal detection theory approach.

A number of studies using trial-by-trial learning tasks have shown that judgments of covariation between a cue c and an outcome o deviate from normative metrics. Parameters based on trial-by-trial predictions were estimated from signal detection theory (SDT) in a standard causal learning task. Results showed that manipulations of P(c) when contingency (deltaP) was held constant did not affect participants' ability to predict the appearance of the outcome (d') but had a significant effect on response criterion (c) and numerical causal judgments. The association between criterion c and judgment was further demonstrated in 2 experiments in which the criterion was directly manipulated by linking payoffs to the predictive responses made by learners. In all cases, the more liberal the criterion c was, the higher judgments were. The results imply that the mechanisms underlying the elaboration of judgments and those involved in the elaboration of predictive responses are partially dissociable.

Attitude↗
PubMed2006

Context switch effects on acquisition and extinction in human predictive learning.

Four experiments tested context switch effects on acquisition and extinction in human predictive learning. A context switch impaired probability judgments about a cue-outcome relationship when the cue was trained in a context in which a different cue underwent extinction. The context switch also impaired judgments about a cue trained in a context different from the extinction context, whenever this training was concurrent with extinction of another cue. After extinction, new cue-outcome relationships learned, even in a different task, became context specific. Moreover, renewal was consistently observed. It is suggested that context switch effects result from a process by which ambiguity leads participants to attend to the contexts.

Adolescent↗
PubMed1995

Forms of inhibition in animal and human learning.

Forms of inhibition were identified in human predictive learning that are qualitatively similar to those identified by P.C. Holland (1984) in rats. When P (positive) signaled the outcome and PN (N = negative) signaled the absence of the outcome, participants learned the discrimination, but the negative cue did not suppress responding to a transfer cue. Post-learning reversal training, in which N was followed by the outcome, did not abolish the original discrimination. These 2 results imply a configural form of inhibition. Negative transfer, which indicated a 2nd, elemental form of inhibition, was observed when neither PN nor N were reinforced during the discrimination stage. Under these conditions, negative transfer and the original discrimination were both abolished by individually pairing N with the outcome. Empirical parallels and differences with the animal conditioning literature are discussed.

Adult↗
PubMed1997

Visual outcome and complications of residents learning phacoemulsification.

The increasing popularity of phacoemulsification in our country raises important training issues. We prospectively analyzed the incidence of complications and visual outcomes in the initial 70 phacoemulsifications (70 patients) performed by the first two residents learning phacoemulsification in our training programme. Both were experienced in standard (manual) extracapsular cataract extraction. Postoperative follow up of 6 weeks or longer was available in 59 eyes. The 11 patients (11 eyes) lost to follow up did not have any intra-operative complications. The overall incidence of vitreous loss was 10%, similar to the frequency of this complication (determined retrospectively) in the first 70 standard extracapsular cataract extractions performed by the same residents. Intraocular lenses (IOL) were successfully implanted in 62 eyes, as planned. One IOL dislocated into the vitreous was successfully repositioned. Other complications encountered included superior corneal edema (3 eyes), iris damage inferiorly (7 eyes) and clinical cystoid macular edema (5 eyes). A best corrected visual acuity of 6/12 or better was obtained in 56 (94.8%) of the 59 eyes available for the six week follow up. In the eyes with vitreous loss, 6 out of 7 had visual acuity better than 6/12. No nuclei were lost into the vitreous. The rate of surgical complications for residents learning phacoemulsification in a supervised manner can be acceptably low.

Clinical Competence↗