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PubMed1993

The child with developmental disabilities grown up: adult residua of childhood disorders.

A clinic specializing in learning disabilities and willing to assess adults receives referrals that parallel the three major reasons for referral in the pediatric and adolescent school-aged population: (1) "Is this patient dyslexic"; (2) "Does this patient 'have' ADHD residual type"; (3) "Does this patient have some kind of learning disability?" The third is the most difficult and least well understood, the NVLD or so-called right-hemisphere group, most likely to be referred by mental health facilities and professionals. The first, dyslexia, has the most secure neuroscientific background and in some ways the most straightforward conceptualization yet is still controversial in terms of the subtle and well-masked ways in which its manifestations may be seen. Aptly placed in the second and hence middle position, straddling both dyslexia and NVLD, is that sprawling and emphatically heterogeneous collection of observations agglomerated under the title ADHD and affiliated with the pharmacotherapy of stimulants. Yet for all its sprawl, ADHD stands in relation to its cognitive overlap zone, executive dysfunction, as symptoms do to signs; and executive dysfunction, especially in adults, appears to be a cognitive-deficit cluster of special importance to the persistence of uncompensated or clinically significant learning disabilities. That is, the real question to be answered about adults with learning disabilities is why have they not compensated for cognitive deficits; or, if they have acquired basic academic skills, why have they not been able to use these skills? Unless linguistic or spatial deficits are extremely severe, academic skills can usually be acquired by compensatory strategies and, once acquired, can be used. Ability to compensate (and to generalize the compensation) are crucial determinants of adult learning disabilities outcome. Less is understood about nonacademic skills, of which the social domain seems least optional, i.e., most pervasively important. Spatially based skills are the least difficult to avoid or circumvent. Absent severe linguistic or spatial cognitive deficits, the most central neuropsychologic issues in adult learning-disability studies are executive dysfunction and social imperception/ineptitude. At present, executive dysfunction is the one of these two that can be evaluated in a behavioral neurology clinic.

Adult↗

PubMed1995

Factors affecting the learning environments and school-related outcomes of Australian adolescents.

In this follow-up study of an earlier investigation (Marjoribanks, 1991), discriminant analysis was used to examine relationships between social categories, defined by ethnicity, gender, and social status, and measures of adolescents' family and school-learning environments and their school-related outcomes. There were 470 16-year-old Australian adolescents and their parents from Anglo-Australian, Greek, and Southern Italian families in the sample. The results of this study and of the earlier investigation suggest that differences in the profiles of students' learning environments and school outcomes are related particularly strongly to ethnicity, but that within ethnic groups there are significant gender and social-status variations in such profiles.

Acculturation↗

PubMed1989

The predictive relationship between beliefs, attitudes, intentions and secondary school mathematics learning: a theory of reasoned action approach.

This study investigated how attitudes and intentions about learning mathematics might be related to subsequent mathematics learning and achievement using the Ajzen and Fishbein theory of reasoned action. The sample consisted of 142 boys and girls between 12 and 14 years old in a large inner city comprehensive school who were assessed in a follow-up design over a nine-month period. Beliefs about the outcomes of learning, attitudes to learning, perceptions of significant others' prescriptions about learning, intentions to engage in learning behaviours, self and teacher reported learning behaviour and mathematics achievement were assessed at both stages. Regression analysis suggested that while the expectancy-value components of attitude did relate to learning behaviour intentions, perceived prescriptions did not relate to intentions. There was a weak relationship between the two measures of learning behaviour, but with neither measure did intention independently predict future behaviour once prior behaviour was taken into account. The best predictor of subsequent mathematics achievement was prior achievement, though teacher-reported learning behaviour did have an independent relationship with subsequent achievement. The findings are discussed in terms of the assessment of learning behaviours, the relevance of the behaviour intention construct for repeated multiple behaviours and future work on how affective variables might be related to cognitive achievements.

Achievement↗

PubMed1996

A questionnaire examining learning in general practice.

Vocational training is a key element of professional development in general practice. Learner-centred approaches to teaching bring a need for greater understanding of the individual learning styles and preferences of trainees. This paper reports the findings of a pilot study undertaken to determine factors that may influence learning among general practice trainees. A questionnaire survey of 261 trainees in six regions in the UK was carried out to explore attitudes to a series of themes identified in semi-structured interviews with trainees at the end of their training. Six distinct subscales were identified using principal components analysis. These are named 'Learning from Patients', 'Openness to Criticism', 'Negative Attitudes', 'Desire for Clear Guidelines', 'Peer Support', and 'Academic Approach'. Males scored significantly higher on 'Academic Approach' (P < 0.05). Each of the subscales reflects themes that permeate the atmosphere of general practice training. Further work is required to establish relationships between the subscales and the outcomes of learning and to explore the implications for continuing professional development. The questionnaire is an instrument that may prove useful in the future investigation of learning in general practice.

Family Practice↗

PubMed2005

Social-ecological resilience and social conflict: institutions and strategic adaptation in Swedish water management.

Dealing with uncertainty and complexity in social-ecological systems is profoundly dependent on the ability of natural resource users to learn and adapt from ecological surprises and crises. This paper analyzes why and how learning processes are affected by strategic behavior among natural resource users and how social conflict is affected by social and ecological uncertainty. The claim is that social conflict among natural resource users seriously inhibits the possibilities of learning and adaptation in social-ecological systems. This is done combining insights from political science, experimental economics, and social-psychology and an analytical case study elaborating social conflict and institutional change in Swedish water management institutions. This paper also discusses the crucial role the institutional context plays in defining the outcome of learning processes in Swedish water management institutions and hence highlights previously poorly elaborated political aspects of learning processes and institutional change in social-ecological systems.

Community Participation↗

PubMed2005

Social and structural housing conditions influence the development of a depressive-like phenotype in the learned helplessness paradigm in male mice.

Structural and social factors are known to play a crucial role in the pathogenesis of depression. Since animal models of depression are a major tool to gain insights into the mechanisms involved in the pathophysiology of this disease it is important not only to exploit but also to be aware of factors that may affect these models. As housing represents a fundamental external factor, which is controversially debated to affect the animals' emotionality, this study aimed to investigate the impact of different social and structural housing conditions on the development of a depressive-like syndrome in the learned helplessness paradigm. Group housing in an impoverished environment led to an increased vulnerability in the learned helplessness paradigm. Groups that were housed enriched, however, were less helpless. Furthermore impoverished conditions did not increase the vulnerability in single housed animals. Regarding emotionality in the animals, basal anxiety was reduced and the exploration was enhanced by group housing and enriched environment. These results suggest that housing conditions significantly influence the outcome of learned helplessness studies.

Animals↗

PubMed2000

Complex coping patterns and their role in adaptation and neuroimmunomodulation. Theory, methodology, and research.

This paper describes the evolution of a model of adaptative coping, as well as an example of the converse, a maladaptive coping pattern, type C. It was hypothesized that the more closely a coping process resembles the inverted U-shaped function that characterizes homeostasis for most biological systems, the more likely it is to be adaptive, and to be associated with more positive health outcomes. Maladaptive learned coping patterns, such as type C coping, represent deviations from homeostasis in that they fail to recognize, respond appropriately to, and/or resolve stressors, thus keeping the physiological stress response chronically engaged, with subsequent long-term damage to implicated biological systems. This interpretation of how maladaptive coping patterns such as type C can influence health outcomes is consistent with findings from the author's 20-year program of research on the type C pattern, its assessment, and its association with poorer health indicators and outcomes in cancer (malignant melanoma) and HIV/AIDS.

Adaptation, Psychological↗

PubMed1998

Learning disability, school achievement, and grade retention among children with cleft: a two-center study.

OBJECTIVE: This study examined the prevalence of learning disability (LD), level of school achievement; and prevalence of grade retention by type of cleft and gender at two craniofacial centers. SETTING: The setting included two university-based craniofacial centers. DESIGN/PATIENTS: Participants included 84 consecutively evaluated patients from one center who were matched by cleft type, age, and gender with 84 patients evaluated at the second center. OUTCOMES: The outcomes included learning disability, school achievement, and grade retention. RESULTS: The results revealed that 46% of subjects with cleft had LD, 47% had deficient educational progress, and 27% had repeated a grade (excluding kindergarten) in school. Males with cleft palate only (CPO) had a significantly higher rate of LD than any other subject group. Males with CPO and females with cleft lip and palate (CLP) were more likely to repeat a grade in school than were females with CPO and males with CLP. CONCLUSIONS: Children with cleft are at risk for learning disability, low school achievement, and grade retention.

Adolescent↗

PubMedDate not supplied

Parental hopes for therapy outcomes: children with sensory modulation disorders.

OBJECTIVE: Understanding parents' hopes for therapy outcomes is essential to family-centered care. This qualitative study explored parents' points of view regarding their hopes for the outcomes of occupational therapy using a sensory integration treatment approach. METHOD: Data were collected as part of a larger research project on the effectiveness of rehabilitating children who have sensory modulation disorders. Five interviews were randomly selected from 17 parent interviews conducted in the larger study. Data were analyzed using grounded theory methods. FINDINGS: Three themes pertinent to the occupations of children and two themes related to the occupations of parenting and sustaining family life emerged. Child-focused outcomes include social participation, self-regulation, and perceived competence. Parent-focused outcomes include learning strategies to support children and obtaining personal validation. DISCUSSION: Interventions are proposed that relate to children's participation in contexts in which they live, learn, and play, as well as the support of parents in the occupations of parenting.

Adult↗

PubMed1985

Sharply timed and lateralised events at time of establishment of long term memory.

In the chick long term memory is known suddenly to become more resistant to disturbance 25 minutes after training. This was investigated using two bead pecking tasks: training involved either presentation of an ill-tasting bead (causing inhibition of spontaneous pecking) or habituation by prolonged presentation. Retention tests revealed two brief periods of improved recall, centred at 25 and at 30-32 minutes after learning. The first appeared to be associated with systems fed by the left eye and the second with right eye systems. In a final experiment memory formation in right or left hemisphere was directly disturbed by intracranial injection of the amnesic beta-antagonist sotalol. The first (and perhaps also second) period of improved recall was associated with interaction between the hemispheres. Right- and left-eyed birds differed markedly, both in the character of such interaction and in the outcome of learning.

Animals↗

PubMedDate not supplied

Perceived learning needs of patients with coronary artery disease using a questionnaire assessment tool.

OBJECTIVE: To determine the perceived learning needs and their level of importance in patients with angina pectoris or myocardial infarction at hospitalization and follow-up clinic visit and to assess the reliability of a self-administered questionnaire. DESIGN: Longitudinal, exploratory. SETTING: West Coast university-affiliated medical center and clinics that serve primarily a veteran population. PATIENTS: Twenty-eight adults who were admitted with a diagnosis of angina pectoris or myocardial infarction. Age range was 31 to 80 years (mean 61 years). OUTCOME MEASURES: Learning needs, questionnaire. INTERVENTION: Data collection was initiated at hospitalization and continued at the first clinic visit after discharge. A self-administered questionnaire and personal data sheet were completed by the patients. RESULTS: Matched-pair t-tests and Pearson's correlation were used for data analysis. No statistical differences were demonstrated between learning needs at hospitalization and clinic visit. Three content areas including symptom recognition, cardiac anatomy and physiology, and medications were ranked as the most important learning needs of patients at hospitalization and follow-up clinic visit. The least important learning needs at both times were content areas of smoking, work, and sex. No correlation was found between the importance of perceived learning needs and age, occupation, smoking, and marital status. The questionnaire contains 38 items and is self-administered. It was developed on the basis of a previous tool and preliminary study results. Content and validity were supported by clinical experts. The internal consistency reliability alpha coefficients of the questionnaire were 0.96 at hospitalization and 0.93 at the clinic visit. CONCLUSIONS: The findings of this study suggest that the most important perceived learning needs of patients at hospitalization and follow-up clinic visit are those that affect survival. A self-administered questionnaire can be used as a practical and reliable tool to determine the perceived learning needs of patients with coronary artery disease during the recovery phase of illness. Cardiac educational programs for patients with coronary artery disease can focus on the content areas that patients consider most important.

Adult↗

PubMedDate not supplied

Effectiveness of hospital staff mass-casualty incident training methods: a systematic literature review.

INTRODUCTION: Recently, mass-casualty incident (MCI) preparedness and training has received increasing attention at the hospital level. OBJECTIVES: To review the existing evidence on the effectiveness of disaster drills, technology-based interventions and tabletop exercises in training hospital staff to respond to an MCI. METHODS: A systematic, evidence-based process was conducted incorporating expert panel input and a literature review with the key terms: "mass casualty", "disaster", "disaster planning", and "drill". Paired investigators reviewed citation abstracts to identify articles that included evaluation of disaster training for hospital staff. Data were abstracted from the studies (e.g., MCI type, training intervention, staff targeted, objectives, evaluation methods, and results). Study quality was reviewed using standardized criteria. RESULTS: Of 243 potentially relevant citations, 21 met the defined criteria. Studies varied in terms of targeted staff, learning objectives, outcomes, and evaluation methods. Most were characterized by significant limitations in design and evaluation methods. Seventeen addressed the effectiveness of disaster drills in training hospital staff in responding to an MCI, four addressed technology-based interventions, and none addressed tabletop exercises. The existing evidence suggests that hospital disaster drills are effective in allowing hospital employees to become familiar with disaster procedures, identify problems in different components of response (e.g., incident command, communications, triage, patient flow, materials and resources, and security) and provide the opportunity to apply lessons learned to disaster response. The strength of evidence on other training methods is insufficient to draw valid recommendations. CONCLUSIONS: Current evidence on the effectiveness of MCI training for hospital staff is limited. A number of studies suggest that disaster drills can be effective in training hospital staff. However, more attention should be directed to evaluating the effectiveness of disaster training activities in a scientifically rigorous manner.

Disaster Planning↗

PubMed2006

Moving from evidence to practice in the care of patients who have acute coronary syndrome.

Both acute management and secondary prevention for patients presenting with the spectrum of ACS have evolved greatly during the last decade, as evidenced by the multitude of clinical trials and the development of CPGs. The goal of the next decade is to ensure the accurate, equal,and timely application of these therapies and management strategies in clinical practice. In the emergency department, initiation of guideline-based management is especially challenging given the dynamic process of risk stratification that must take place to ensure properly directed care. It is clear, however, that application of such therapies leads to improved outcomes. Lessons learned from previous and ongoing quality improvement initiatives will provide the tools needed to ensure that widespread adoption of guideline-based therapy is complete.

Combined Modality Therapy↗

PubMed1998

The effect of surgeon experience on velopharyngeal functional outcome following palatoplasty: is there a learning curve?

There is little information in the cleft palate literature concerning the relationship between surgeon volume and clinical outcomes. It is unknown whether such a relationship applies specifically to velopharyngeal dysfunction and the need for secondary physical management of the velopharynx. The purpose of this paper was to explore the concept of an operative learning curve for different surgeons with respect to palatoplasty. Impact of case volume and procedure type on the occurrence of secondary palatal management (the main outcome measure) was assessed. The charts of 472 consecutive palatoplasty patients were reviewed by one speech and language pathologist to determine when the palatoplasty was performed, which surgeon (n = 9) performed the palatoplasty, whether velopharyngeal status was documented at a minimum of 6 years of age, and whether secondary palatal management was prescribed. The results were analyzed by year of palatoplasty, by surgeon, and by number of operations per surgeon to determine total and individual surgeon rates of secondary palatal management. There were 401 palatoplasties (85 percent recovery) with adequate documentation of velopharyngeal status by at least 6 years of age. Palatoplasty rates ranged between 1 and 258 palatoplasties per surgeon. Over the 12 years reviewed, secondary palatal management was performed for 92 patients (23 percent) of the study population. Examination of the proportion of palatoplasty patients receiving secondary palatal management by surgeon and by year showed only one surgeon with a pattern suggesting a learning curve. The proportion of patients receiving secondary palatal management was plotted against the total number of surgeries the surgeon performed. There was a strong relationship between experience and success. The number of procedures this surgeon performed per year increased at approximately the same time as the success rate improved. The categories of "total procedures" and "procedure per year" were highly correlated with each other. Success rates were analyzed by number of procedures performed per year, and there was a clear association between the two variables. To separate the effect of the two variables, a multiple regression model was constructed. The category of "total procedures" was statistically significant in the model, whereas procedures per year was not, suggesting that the key to the dominant surgeon's improvement was cumulative experience rather than frequency of performance of the operation. Palatoplasties performed by high-volume surgeons are more likely to result in better postoperative outcomes (i.e., lower rates of secondary palatal management) as compared with palatoplasties performed by low-volume surgeons. The influence of the surgeon's cumulative experience on improvement seems to be more important than the frequency of performance of primary palatoplasty.

Cleft Palate↗

PubMed2006

The effect of education on hypothetical and actual oxygen administration decisions.

AIM: This study examined the effect of an education intervention on emergency nurses' decisions related to oxygen administration. METHOD: A controlled pre-test/post-test quasi-experimental design was used. The intervention was a written self directed learning package. Outcome measures were (i) factual knowledge measured using parallel form multiple choice questions (MCQs) and (ii) clinical decisions measured using parallel form MCQs, parallel form patient scenarios and clinical practice observation. RESULTS: Eighty-eight nurses from 4 Melbourne EDs participated in the study (control group: n=37 and experimental group: n=51). Subgroups of nurses from the experimental group also participated in the patient scenarios (n=20) and clinical practice observation (n=10). Emergency nurses' knowledge increased as a function of education. Both patient scenario data and clinical practice observation showed decreased selection of nasal cannulae, increased selection of air entrainment masks and a trend towards selection of higher oxygen flow rates following education. CONCLUSIONS: Evaluation of educational interventions in nursing should focus on identifying strategies that enhance learning in a clinical environment, are valid in terms of the clinical context and culture in which they are being used and most importantly, produce sustained improvements in actual clinical practice.

Attitude of Health Personnel↗

PubMed2003

Effect of the learning curve on the early outcomes of laparoscopic Roux-en-Y gastric bypass.

Open gastric bypass has been demonstrated to provide durable weight loss in morbidly obese patients. As laparoscopic techniques have evolved surgeons are offering patients such an approach for performance of gastric bypass. The purpose of this study was to evaluate the relationship between increasing experience and outcome for this technically challenging operation. A retrospective analysis was performed on the initial 160 consecutive patients undergoing laparoscopic gastric bypass by a single surgeon over a 24-month period. Patients were divided into quartiles for data analysis. Duration of surgery decreased significantly between quartiles: 324 +/- 124, 225 +/- 70, 190 +/- 47, and 168 +/- 40 minutes, respectively (P < 0.01). However, the conversion rate (3.1%) and mean hospital length of stay (2.1 +/- 2.4 days) were unaffected by surgeon experience. The early and late postoperative complication rates were 9.4 and 3.1 per cent, respectively. Early complications included: leak (1.3%), bleeding (3.8%), obstruction (1.9%), acute gastric distention (0.6%), subphrenic abscess (0.6%), and wound infection (0.6%). Late complications include: obstruction (1.3%), anastomotic stricture (1.3%), and marginal ulcer (0.6%). The complication rates did not change statistically between quartiles. The excess weight loss at one year was 77.4 +/- 16.7 per cent. These data suggest that throughout the learning curve laparoscopic gastric bypass can be accomplished with acceptable complication rates, conversion rates, and hospital length of stay. Duration of surgery improves with experience. Early weight loss results compare favorably with those of open gastric bypass.

Adult↗

PubMed2005

The Brookline Early Education Project: a 25-year follow-up study of a family-centered early health and development intervention.

BACKGROUND: Clinicians, scientists, and policy makers are increasingly taking interest in the long-term outcomes of early intervention programs undertaken during the 1960s and 1970s, which were intended to improve young children's health and educational prospects. The Brookline Early Education Project (BEEP) was an innovative, community-based program that provided health and developmental services for children and their families from 3 months before birth until entry into kindergarten. It was open to all families in the town of Brookline and to families from neighboring Boston, to include a mixture of families from suburban and urban communities. The goal of the project, which was administered by the Brookline Public Schools, was to ensure that children would enter kindergarten healthy and ready to learn. OBJECTIVE: Outcome studies of BEEP and comparison children during kindergarten and second grade demonstrated the program's effectiveness during the early school years. The goal of this follow-up study was to test the hypotheses that BEEP participants, in comparison with their peers, would have higher levels of educational attainment, higher incomes, and more positive health behaviors, mental health, and health efficacy during the young adult period. METHODS: Participants were young adults who were enrolled in the BEEP project from 1973 to 1978. Comparison subjects were young adults in Boston and Brookline who did not participate in BEEP but were matched to the BEEP group with respect to age, ethnicity, mother's educational level, and neighborhood (during youth). A total of 169 children were enrolled originally in BEEP and monitored through second grade. The follow-up sample included a total of 120 young adults who had participated in BEEP as children. The sample differed from the original BEEP sample in having a slightly larger proportion of college-educated mothers and a slightly smaller proportion of urban families but otherwise resembled the original BEEP sample. The demographic features of the BEEP and comparison samples were similar. The young adults were asked to complete a survey that focused on the major domains of educational/functional outcomes and health/well-being. The study used a quasi-experimental causal-comparative design involving quantitative analyses of differences between the BEEP program and comparison groups, stratified according to community. Hypotheses were tested with analysis of variance and multivariate analysis of variance techniques. Analyses of the hypotheses included the main effects of group (BEEP versus comparison sample) and community (suburban versus urban location), as well as their interaction. RESULTS: Young adults from the suburban community had higher levels of educational attainment than did those in the urban group, with little difference between the suburban BEEP and comparison groups. In the urban group, participation in the BEEP program was associated with completing >1 additional year of schooling. Fewer BEEP young adults reported having a low income (less than 20000 dollars); the income differences were accounted for largely by the urban participants. The percentage of subjects with private health insurance was significantly lower in the urban group overall, but the BEEP urban group had higher rates of private insurance than did the comparison group. More than 80% of both suburban samples reported being in very good or excellent health; the 2 urban groups had significantly lower ratings, with 64% of the BEEP group and only 41.67% of the comparison group reaching this standard. Overall, suburban participants reported more positive health behaviors, more perceived competence, and less depression. Among the urban samples, however, participation in BEEP was associated with higher levels of health efficacy, more positive health behaviors, and less depression than their peers. CONCLUSIONS: No previous study has focused as extensively on health-related outcomes of early education programs. BEEP participants living in urban communities had advantages over their peers in educational attainment, income, health, and well-being. The educational advantages found for BEEP participants in the early years of schooling included executive skills such as planning, organizing, and completing school-related tasks. It is likely that these early advantages in executive function extended beyond education-related tasks to other activities as participants became responsible for their own lives. The long-term benefits revealed in this study are consistent with the findings of previous long-term studies that indicated that participants in high-quality intervention programs are less likely to cost taxpayers money for health, educational, and public assistance services. The BEEP program appears to have somewhat blunted differences between the urban and suburban groups. The results of this study add to the growing body of findings that indicate that long-term benefits occur as the result of well-designed, intensive, comprehensive early education. The health benefits add a unique and important extension to the findings of other studies.

Adult↗

PubMed2001

Calcium hydroxide in endodontic retreatment after two nonsurgical and two surgical failures: report of a case.

AIM: To describe the role of calcium hydroxide in infection control during complex endodontic retreatment. SUMMARY: A case is presented in which two conventional endodontic treatments and two surgical interventions failed to bring periapical healing. Despite this history, a further conventional treatment augmented by long-term disinfection with calcium hydroxide finally delivered a successful outcome. KEY LEARNING POINTS: Periapical healing follows proper intracanal infection control. Despite repeated surgical and nonsurgical intervention, careful retreatment can often bring healing. Calcium hydroxide has long-acting antimicrobial and soft-tissue dissolving activity. It is a helpful adjunct in endodontic retreatment.

Calcium Hydroxide↗