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At least 757 records · Page 42Linked to original sources
PubMed1987

Ventilation performance using a self-inflating anesthesia bag: effect of operator characteristics.

Adequate ventilation is required for successful cardiopulmonary resuscitation (CPR). Operator characteristics that influence ventilation performance are not well defined. This study compared ventilation performance and operator characteristics in 74 medical personnel using a self-inflating anesthesia bag. Ventilation device, operator hand size, ventilation technique, average tidal volume, cumulative minute ventilation, and ventilation pressures were recorded during 3 minutes of ventilation. Ventilation volumes and airway pressures were not correlated with hand size or device type. Techniques that used one hand to squeeze the bag resulted in significantly lower average tidal volume than two-handed techniques, with no significant difference in peak or average airway pressure. There was no difference between emergency department and prehospital personnel in average tidal volume delivered. However, prehospital personnel ventilated at significantly higher airway pressures. Emergency department nurses delivered the greatest average tidal volume (923 cc), while emergency department physicians delivered the least (775 cc). Paramedics recorded the highest airway pressures (average, 53 cm H2O; peak, 72 cm H2O), while respiratory therapists recorded the lowest pressures (average, 34 cm H2O; peak, 54 cm H2O). Ventilation during CPR is a complex, learned skill. Large variation exists among different operators. However, appropriate tidal volumes can be delivered using safe airway pressures. Ongoing assessment and retraining of individuals performing ventilation during CPR are essential.

Adult↗
PubMed1984

Sensitizing radiation therapists to the psychological needs of cancer patients.

Radiation therapists are trained to focus on physiological and medical aspects of administering radiation therapy to cancer patients. They often ignore patients' psychological needs because they are inadequately prepared to understand and intervene in this area of patient care. We sought to remedy this educational gap by using a generic crisis-intervention training program as a method of sensitizing radiation therapists to the emotional and psychological concerns and problems of patients undergoing radiation therapy. After the training, radiation therapists were cognizant of the presence and effects of the special dependency needs of severely ill patients. Training helped them respond more empathically, to establish better rapport with their patients, and to provide more holistic and effective medical management as an integral part of radiation therapy. This included greater ease in knowing how, when, and where to make psychological referrals. A case vignette illustrates the usefulness and application of enhanced psychological awareness and interviewing skills learned by the physicians.

Counseling↗
PubMed2004

Criteria for an effective theory of consciousness and some preliminary attempts.

In the physical sciences a rigorous theory is a hierarchy of descriptions in which causal relationships between many general types of entity at a phenomenological level can be derived from causal relationships between smaller numbers of simpler entities at more detailed levels. The hierarchy of descriptions resembles the modular hierarchy created in electronic systems in order to be able to modify a complex functionality without excessive side effects. Such a hierarchy would make it possible to establish a rigorous scientific theory of consciousness. The causal relationships implicit in definitions of access consciousness and phenomenal consciousness are made explicit, and the corresponding causal relationships at the more detailed levels of perception, memory, and skill learning described. Extension of these causal relationships to physiological and neural levels is discussed. The general capability of a range of current consciousness models to support a modular hierarchy which could generate these causal relationships is reviewed, and the specific capabilities of two models with good general capabilities are compared in some detail.

Consciousness↗
PubMed2005

Do smokers with alcohol problems have more difficulty quitting?

This review compares nicotine dependence and the ability to stop smoking in smokers with no alcohol problems to smokers with current, past or lifetime (i.e., either current or past) alcohol problems. We searched computerized databases, meeting abstracts and made requests to listserves and grantees for comparisons of the above categories. We could not use meta-analyses and, thus, used consistency across studies to make conclusions. We located 17 articles on nicotine dependence, 12 on the ability to quit on a given attempt, 7 on lifetime quitting and 2 on quit attempts. Smokers with current and past alcohol problems were more nicotine dependent than smokers with no alcohol problems. Surprisingly, smokers with past problems were as able to quit on a given attempt as smokers with no problems. We hypothesize this may be because such smokers learned skills in resolving their alcohol problems that neutralized their increased nicotine dependence. Smokers with current or past alcohol problems appear to be less likely to quit in their lifetime. Given their equal ability to quit on a given attempt, this could be due to fewer quit attempts; however, whether this is actually so is unclear. Our results that smokers with past alcohol problems can quit as easily as those without alcohol problems suggest that smokers with past alcohol problems may respond to minimal treatments for smoking cessation.

Alcoholism↗
PubMed2006

Of bedpans and ivory towers? Nurse academics' identities and the sacred and profane: a Bernsteinian analysis and discussion paper.

AIM: In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics' identities. BACKGROUND: The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it. METHOD: Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated. FINDINGS: Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics' attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills. CONCLUSIONS: To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.

Attitude↗
PubMed2005

Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance.

BACKGROUND: Several studies have investigated the transfer of surgical trainees' skills acquired on surgical simulators to the operating room setting. The purpose of this study was to compare the effectiveness of two laparoscopic surgery simulators by assessing the transfer of skills learned on simulators to closely matched surgical tasks in the animal laboratory. STUDY DESIGN: In this post-test-only Control group study design, 46 surgically naive medical student volunteers were randomly assigned to one of three groups: Tower Trainer group (n = 16), LapSim group (n = 17), and Control group (n = 13). Outcomes measures included both time and accuracy scores on three laparoscopic tasks (Task 1: Grasp and Place; Task 2: Run the Bowel; Task 3: Clip and Cut) performed on live anesthetized pigs, and a global rating of overall performance as judged by four experienced surgeons. RESULTS: The Tower Trainer group performed significantly better than the Control group on 1 of 7 outcomes measures-Task 3: Time (p < 0.032), although the LapSim group performed significantly better than the Control group on 2 of 7 measures-Task 3: Time (p < 0.008) and Global score (p < 0.005). In comparing the two simulators, the LapSim group performed significantly better than the Tower Trainer group on 3 of 7 outcomes measures-Task 2: Time (p < 0.032), Task 2: Accuracy (p < 0.030) and Global score (p < 0.005), although the Tower Trainer group did not perform significantly better than the LapSim group on any measure. CONCLUSIONS: This study demonstrated that naive subjects trained on a virtual-reality part-task trainer performed better on live surgical tasks in a porcine model as compared with those trained with a traditional box trainer. These findings could aid in selection of appropriate training methodologies.

Adult↗
PubMedDate not supplied

Neural dynamics of psychotherapy: what modeling might tell us about us.

A neural network theory is proposed for some of the effects of verbal psychotherapy in individuals who are not seriously disturbed but seeking to function more effectively. The network theories are built on a combination of the supervised ARTMAP network and competitive attractor dynamics. The modeling exercise leads to some guidelines for psychotherapists that involve both cognitive and emotional reinforcement in a climate closer to skill learning than to medical treatment.

Humans↗
PubMed2005

Brain activations during letter-by-letter reading: a follow-up study.

Lesions affecting the ventral cortex of the left temporal lobe commonly yield a selective reading impairment known as pure alexia. It is thought to result from the disruption or deafferentation of the Visual Word Form Area (VWFA), a region in the left lateral occipitotemporal sulcus activated whenever normal subjects are viewing alphabetic strings. Most pure alexic patients retain the ability to identify single letters, and develop a strategy of letter-by-letter (LBL) reading. We recently studied fMRI activations in LBL readers and clarified the underlying mechanisms. However, LBL reading is a dynamic process which may improve over months or years of practice, although the cerebral bases of this continuing improvement are currently unknown. We had the opportunity to run the same behavioural testing and fMRI experiment a second time in an alexic patient, 8 months after collecting the data reported by Cohen et al. [Cohen, L., Henry, C., Dehaene, S., Molko, N., Lehéricy, S., Martinaud, O., Lemer, C., and Ferrieux, S. (2004). The pathophysiology of letter-by-letter reading. Neuropsychologia, 42, 1768-1780]. We analyze the changes that occurred over this period in the pattern of reading-related activations, while the patient's LBL reading improved. The activation level decreased in most of the overall network between the two sessions. This general trend contrasted with a focal increase restricted to specific left frontal and parietal areas. When studying the contrast between words and consonant strings, which may be taken as a correlate of LBL reading, we also found a general decrease, except for similar left frontal and parietal regions, which showed a significant increase. We suggest that the pattern of evolution fits with the minimal hypothesis of normal strategic abilities and skill learning, associated with perceptual tuning in right-hemispheric structures able to substitute the disrupted VWFA.

Adult↗
PubMed2004

Teaching public access defibrillation to lay volunteers--a professional health care provider is not a more effective instructor than a trained lay person.

BACKGROUND: Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). METHODS: Eight instructors, including four lay persons and four health care professionals, were given a basic course and an instructor course in CPR-D by the same instructor. All newly trained instructors trained 38 lay volunteers (19 pairs) who had no previous training in the use of a defibrillator. The lay volunteers performed the OSCE 2-3 weeks after the course. The OSCE comprised two scenarios with a manikin: the first, a patient in cardiac arrest with ventricular fibrillation, and the second, an imminent cardiac arrest with asystole as the initial rhythm. The same OSCE was performed by a group of lay first aiders practicing every 2 weeks who served as the control group. RESULTS: No statistical difference was present between the two groups of lay volunteers in the OSCE. All were able to use the AED and follow instructions. They identified patients with ventricular fibrillation and cardiac arrest, but had difficulties identifying cases with imminent cardiac arrest. The control group of trained first aiders performed significantly more effectively than the newly trained lay persons. CONCLUSIONS: No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.

Cardiopulmonary Resuscitation↗
PubMed1999

Assessment of technical skills transfer from the bench training model to the human model.

BACKGROUND: This study examines whether technical skills learned on a bench model are transferable to the human cadaver model. METHODS: Twenty-three first-year residents were randomly assigned to three groups receiving teaching on six procedures. For each procedure, one group received training on a cadaver model, one received training on a bench model, and one learned independently from a prepared text. Following training, all residents were assessed on their ability to perform the six procedures. RESULTS: Repeated measures analysis of variance revealed a significant effect of training modality for both checklist scores (F(2,44) = 3.49, P <0.05) and global scores (F(2,44) = 7.48, P <0.01). Post-hoc tests indicated that both bench and cadaver training were superior to text learning and that bench and cadaver training were equivalent. CONCLUSIONS: Training on a bench model transfers well to the human model, suggesting strong potential for transfer to the operating room.

Cadaver↗
PubMed2003

Development of human brain functions.

Aspects of postnatal human brain development are reviewed. The development of brain function has commonly been characterized in terms of the unfolding of a maturational sequence. In contrast, we argue that postnatal functional brain development occurs through a dynamic process of emerging patterns of interactions between different brain regions. Some of these processes may also be characteristic of perceptual and motor skill learning in adults. Possible implications of these views for our understanding of developmental disorders are raised.

Brain↗
PubMed2000

Differential effect of short-term REM sleep deprivation on NGF and BDNF protein levels in the rat brain.

It is well known that REM sleep is associated with memory consolidation, especially, procedural skill learning. Neurotrophic factors are known to be involved in synaptic plasticity. We therefore investigated the effects of selective REM sleep deprivation (RSD) on NGF and BDNF proteins in the hippocampus, cerebellum and brainstem in the rat. NGF and BDNF were detected by an ELISA. Our findings show that 6 h RSD affected the NGF and BDNF protein levels in different manner. In the cerebellum and brainstem, BDNF was significantly decreased, while NGF was not changed. Conversely, in the hippocampus, NGF was significantly decreased while BDNF was not changed. This study indicates that REM sleep may be associated with the secretion of neurotrophic factors and thus contribute to the memory functions.

Animals↗
PubMed1999

Crossed apraxia: implications for handedness.

Liepmann posited that right hand preference relates to left hemisphere dominance for learned skilled movements. Limb apraxia, impairment of skilled movement, typically occurs in individuals with left hemisphere (LH) lesions. The occurrence of apraxia in right-handed individuals following right-hemisphere lesions appears to refute Liepmann's hypothesis. We studied the apraxia of a right-handed man, RF, following a right frontal lesion to determine whether his apraxia paralleled the apraxia seen following LH lesions. Results of behavioral testing indicated that, like individuals with apraxia following left frontal lesions, RF was better at gesture recognition than gesture production which was significantly impaired across tasks. Kinematic motion analyses of movement linearity, planarity, and the coupling of temporospatial aspects of movements substantiated the parallel impairments in RF and patients with LH apraxia. The impairment seen in our patient with crossed apraxia provides evidence for the fractionation of systems underlying hand preference and skilled movement.

Aged↗
PubMed1998

Focal retrograde amnesia associated with vascular headache.

We report the case of a 42-year-old man with repeated attacks of headache associated with retrograde amnesia. Neuropsychological tests before and after the major episode of amnesia showed mild neuropsychological deficits but with spared anterograde memory and learning functions. The amnesia was dense for a period of 15-20 years and included people and events (public and private). There was also a suggestion of amnesia for learned skills. Neurologically he had mild clinical signs and focal EEG-abnormalities in the left fronto-temporal region, but CT, MRI, and SPECT showed no abnormality. Five years after the onset of amnesia there was no recovery of the retrograde memory deficit, but a PET (glucose) scan was normal and neuropsychological testing showed no deficits. An association with migraine has been reported for some non-classical amnesias, but this is the first case of selective retrograde amnesia in a patient with headache as a primary neurological diagnosis.

Amnesia, Retrograde↗
PubMed1999

Effects of aging on cerebellar noradrenergic function and motor learning: nutritional interventions.

Aging is associated with a decline in motor coordination and the ability to learn new motor learning skills. This loss of function is correlated with a decline in cerebellar beta-adrenergic receptor function. We have examined the role of oxidative stress on this system by exposing young rats to normobaric hyperoxia. This exogenous oxidative insult results in a decline in cerebellar beta-adrenergic receptor function that resembles what is observed in normal aged rats. This effect of hyperoxia is blocked by antioxidants. We have also examined the effects of nutritional supplementation of aged rats with diets high in antioxidant capacity. Foods such as blueberries and spinach can prevent and/or reverse age-related declines in cerebellar noradrenergic receptor function.

Action Potentials↗
PubMed1991

Effectiveness of renal fellowship training for subsequent clinical practice.

To assess whether nephrologists perceive disparities between the skills learned during fellowship training and those necessary for clinical subspecialty practice, we surveyed the perception of board-certified American nephrologists regarding the effectiveness of their clinical training. A questionnaire was sent to all Diplomates of the American Board of Internal Medicine in the subspecialty of Nephrology who successfully passed the qualifying examination in 1974, 1980, and 1986, regarding the effectiveness of academic instruction within the clinical fellowship program as regards traditional academic subject matter, patient management, performance of procedures, and interpretation of laboratory data. Questionnaires were returned by 42.1%. Although respondents were generally satisfied with training in academic nephrologic subject matter, dissatisfaction with training in pediatric nephrology, transplant immunology, nephrolithiasis, nutrition, and renal function and disease in pregnancy was evident. Training was thought to be ineffective in theoretical and practical aspects of management of end-stage renal disease. In addition, respondents were dissatisfied with the effectiveness of their training in interpretation of radiologic tests and procedures such as gaining access to the circulation. More recently trained nephrologists were dissatisfied with training in outpatient management and interpretation of radiographic tests. Differences between perceptions of older and younger nephrologists were most marked regarding their preparation for gaining access to the circulation, interpretation of intravenous pyelography, and training for continuous ambulatory peritoneal dialysis (CAPD). To prepare fellows in training for the exigencies of clinical practice. Nephrology training programs will have to emphasize the teaching of the cognitive and manual bases of performing procedures, and provide more outpatient experience for trainees.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed1998

The use of 3D conformal radiotherapy (3D CRT) to spare the cochlea in patients with medulloblastoma.

PURPOSE: Radiation therapy in combination with cis-platinum chemotherapy is associated with ototoxicity due to destruction of cochlear hair cells. This is a significant problem, especially in pediatric patients, because it may lead to difficulties with communication, speech, language, and development of learning skills. The use of 3D conformal radiotherapy (3D CRT) may be useful in sparing auditory structures. This paper discusses a technique using 3D CRT to spare the cochlea in patients with medulloblastoma. METHODS AND MATERIALS: Five pediatric patients with medulloblastoma were planned using 3D CRT. All had MRI and CT obtained specifically for treatment planning. Multiple structures were contoured, including the cochlea and posterior fossa, and conformal beams designed in beam's eye view and dose distribution analysis were edited to provide 3D dose coverage to the target while sparing the inner ear. Patients received 36 Gy to the craniospinal axis followed by an 18-20 Gy boost to the posterior fossa. RESULTS: A 3D CRT cochlear sparing technique was designed, using an axial pair of posterior oblique fields to treat the posterior fossa while sparing the cochlea for all patients in this analysis. Dose-volume information, obtained from 3D calculations, demonstrates that the average dose received by the cochlea was 65% of the prescribed dose using the cochlear sparing plan, as compared to 101% using standard opposed-lateral beams. Both plans delivered > or = 100% of the prescribed dose to the posterior fossa. CONCLUSION: 3D CRT allows for cochlear sparing in the treatment of medulloblastoma. Further follow-up is necessary to determine the long-term benefit in these patients.

Cerebellar Neoplasms↗