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PubMed2000

Listening to the quiet voices of Hispanic migrant children about health.

There is a paucity of literature related to school-aged migrant children's perceptions of their own health. To best provide culturally competent care, more information is needed about migrant children's experiences. Focus-group methodology allowed the voices of migrant children to be heard by primary health care providers at a summer school program for children of migrant farm workers in south Georgia. Seventy-three children participated in 14 focus-group sessions. Six themes emerged from the data that were analyzed by using a qualitative software system. They are healthy behaviors, acculturation issues, environmental influences, health care actions, health behavior outcomes, and learning needs. Emerging patterns within each theme render insight about these migrant children. The findings suggest implications for pediatric nurses related to culturally competent care.

Acculturation↗
PubMed2003

Problem-solving by traumatically brain injured and neurologically intact subjects on an adaptation of the twenty questions test.

PRIMARY OBJECTIVE: RAPS (Rapid Assessment of Problem-Solving) is a clinical measure for assessing verbal problem-solving in hard-to-test patients or those that may not be able to tolerate a longer, more detailed assessment. The design of the test is based on Mosher and Hornsby's Twenty Question test, but RAPS contains several modifications to facilitate its use with brain-injured individuals. This study used RAPS to compare the verbal problem-solving ability of subjects that were neurologically intact and subjects that had chronic traumatic brain injuries. METHODS AND PROCEDURES: Twenty-one adults that were neurologically intact (NI) and 21 adults that had incurred a traumatic brain injury (TBI) matched for age, gender and education took part in the study. Before being tested with RAPS, participants signed an IRB-approved consent form and completed a battery of neurocognitive measures. RAPS entailed the solving of three verbal problems. Each problem involved an array of 32 pictures of common objects (e.g. football) arranged in a 4x 8 grid. The subjects were instructed to ask yes/no questions to determine which picture the examiner was 'thinking of '. Three scores were computed for each problem solved: number of questions asked, percentage of constraint-seeking questions, and question-asking efficiency scores for the first four questions. OUTCOMES: No learning effects across the problems were found for any of the RAPS measures. Scores were averaged across the three problems to determine group effects. Groups of TBI and NI subjects did not differ significantly in the number of questions asked in solving RAPS problems. Members of the NI group asked significantly more constraint-seeking questions (e.g. Is it an animal?) than those in the TBI group, and the subjects that had incurred brain injuries did more guessing than the NI group. Over 70% of the time, guessing took place after the semantic category containing the target picture was known to the subject. Guesses took the form of pseudo-constraint questions (e.g. Is it the animal with a long neck?) rather than frank guesses (e.g. Is it the giraffe?). These trends were seen for both groups. Question-asking efficiency scores, computed for the first four questions of each problem, reflected the amount of information gained by the subjects' questions. It was anticipated that subjects' questioning strategies would target larger rather than smaller number of pictures and systematically reduce the number of total pictures under consideration. Question-asking efficiency scores were significantly higher for the group of NI subjects. Both groups increased question-asking efficiency scores across the first four questions, and there was no significant group x question interaction. Further analysis of the question-asking efficiency scores revealed that questions from the group of NI subjects tended to target multiple categories of pictures and larger single semantic categories of pictures on the 32-item problem-solving board, whereas those from the group of TBI subjects often targeted smaller categories or portions of categories. CONCLUSIONS: Two meta-cognitive functions, planning and strategy shifting, appeared to explain most of the differences in the verbal problem-solving performance between the groups. Both groups, however, demonstrated a range of abilities on RAPS. Until a larger normative database for RAPS is available, it behooves clinicians using the test to analyse results on an individual basis, to consider the subject's pre-morbid problem-solving ability and to weigh those factors associated with brain injury that could affect RAPS performance.

Adult↗
PubMed2001

Referrals and relationships: in-practice referrals meetings in a general practice.

BACKGROUND: GP referrals to secondary care are an important factor in the cost of running the NHS. The known variation in referral rates between doctors has the potential to cause tension within primary care which will be exacerbated by the latest reorganization of primary care and the trend towards capitation-based budgets. The importance of postgraduate learning for GPs has been recognized; continuing professional development is moving towards self-directed practice-based learning programmes. Educational interventions have been shown to alter doctors' prescribing behaviour. This, together with the pressure on accounting for referral activity, makes the prospect of improving, and possibly reducing, referral activity through educational interventions very attractive. OBJECTIVES: This study complemented a randomized controlled trial (RCT) which investigated whether an intervention of the type which had reduced prescribing costs would have a similar effect on referral activity. METHODS: The context of the study, description of the characteristics of the practice and the issues seen as important by the doctors and practice manager were identified through preliminary semi-structured interviews. The practice then held a series of educational in-practice meetings to discuss referrals and issues arising from referrals. The audio- and videotaped transcripts were interpreted using content and group dynamic analysis. Participants commented upon our preliminary findings. In addition, we used dimensional analysis to induce a preliminary theory describing the effect of the intervention on this general practice which enabled us to review the findings of the parallel RCT. The educational value of the meetings and the learning needs of the participants were also assessed. RESULTS: Our complementary study showed no alteration of practice referral rates following the educational intervention. The qualitative study, unencumbered by the assumptions inherent in the development of the hypothesis tested in the RCT, highlighted the complexity of decision making in general practice and the likely impact of historical background and a variety of internal and external pressures on this self-directive educational intervention. The practice members described the individual and group learning needs identified as a result of the meetings. CONCLUSION: The findings of this study raise important questions for developing practice-based learning. The outcomes of self-directive interventions in practices will be influenced by internal and external events both past and present. Such outcomes may be qualitative and difficult to measure. They are likely to differ from outcomes seen when interventions are applied to groups of doctors who are not all members of the same practice.

Family Practice↗
PubMed2002

Iliac bone graft for steroid-associated osteonecrosis of the femoral condyle.

The use of steroid medication may predispose to osteonecrosis of the femoral condyle. However, there is a controversy regarding treatment of this disease, especially for lesions in advanced stages. Since 1987, the authors have treated such lesions by autologous osteoperiosteal graft obtained from the iliac bone. When limb alignment was affected by the disease, proximal tibial valgus or varus osteotomy was done concomitantly. The rationale for this method is to replace the necrotic bone and damaged cartilage by autogenous bone and periosteum, anticipating the chondrogenic potential of the latter. In this study, 10 knees in eight patients were reviewed to learn the outcome of this procedure with a mean followup of 79 months (range, 32-158 months). The grafts were incorporated successfully in nine joints, and satisfactory results were achieved in all patients. Therefore autologous iliac bone graft is a promising alternative for treatment of osteonecrosis, especially when patients are young and physically active.

Adolescent↗
PubMed1991

Expert learning system network for diagnosis of breast calcifications.

Breast calcification diagnosis was studied by using clinical findings and computerized image processing of a mammogram in a network of trained expert learning systems (Outcome Advisor [OA]). The system was tested with records not used for training and performance was compared with radiologist. The network was 72% accurate in classifying clusters of calcifications as malignant or benign over a set of test cases radiologists had considered "hard-to-diagnose calcifications," and referred for biopsy. The radiologists had decided to conduct biopsy by selecting an equal number of positive and negative cases for the test group; thus the radiologists' performance with respect to categories of benign versus malignant was constrained to be 50/50. Statistical analysis shows only a 2% probability that the observed accuracy of 72% was a chance performance in recognizing whether a cluster is benign or malignant. The feasibility of developing a network of OAs for diagnosing breast cancer integrating digital image processing of mammograms is promising.

Breast Diseases↗
PubMed1998

A cultural transformation model for nursing.

The rapidity and constancy of change, coupled with a culture of staff entitlement and passive and defensive leadership behaviors, prompted the development of an intensive plan for cultural transformation. The cultural transformation steps of leadership development, nominal group technique, quality improvement teams, and evaluation process are explored in detail. Lessons learned and outcomes obtained within the first 6 months after implementation are identified.

Humans↗
PubMed2005

Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment.

INTRODUCTION: When considering the appropriate and effective use of palliative procedures, a surgeon is often confronted with a full range of multidisciplinary treatment options and technical considerations that could potentially relieve some of the symptoms of an advanced malignancy. Practitioners must often deliberate over complex choices that can greatly impact a patient's final days. METHODS: Advances in the understanding of surgical palliation are reviewed with emphasis on elements required for sound clinical decision making. RESULTS: Palliation of complications from advanced cancer demands the highest level of surgical judgment. Although consideration of risk in terms of treatment-related toxicity, morbidity and mortality is an important part of the surgical decision making process. Attention to this element should not be the sole factor in making decisions about palliative therapy. Decisions are best made on endpoints such as the probability of symptom resolution, the impact on overall quality of life, pain control, and cost effectiveness. CONCLUSIONS: Regardless of the anatomic site and cause leading to the need for palliative intervention, deliberations over surgical palliation must consider the medical condition and performance status of the patient, the extent and prognosis of the cancer, the availability and success of nonsurgical management, and the individual patient's quality and expectancy of life. Therapy for symptoms must remain flexible and individualized to continually meet the patient's unique and ever changing needs.

Humans↗
PubMed1999

Models of competitive learning: complex dynamics, intermittent conversions, and oscillatory coarsening.

We present two models of competitive learning, which are respectively interfacial (i.e., where the interiors of domains are unaffected by the rules of the model) and cooperative (i.e., where the bulk as well as the interface of an individual domain is governed by the rules of the model) learning. This learning is outcome related, so that spatially and temporally local environments influence the conversion of a given site between one of two different types. We focus here on the behavior of the models at coexistence, which yields critical behavior and the existence of a phase involving a type of coarsening which is oscillatory in nature. In the discussion we speculate on, among other issues, the likely behavior of the models away from coexistence.

Journal Article↗
PubMedDate not supplied

Development of bilingual tools to assess functional health patterns.

TOPIC: The theory and process of developing bilingual assessment tools based on Gordon's 11 functional health patterns. PURPOSE: To facilitate assessing the individual, family, and community in a student clinical practicum in a Spanish-speaking country. SOURCES: Multiple family and community health promotion theories; translation theories, Gordon's Manual of Nursing Diagnosis (1982); translation/back-translation involving Ecuadorian faculty and students; student community assessments; faculty and staff workshops in Ecuador. CONCLUSIONS: Bilingual, culturally sensitive health assessment tools facilitate history taking, establish nursing diagnoses and interventions, and promote mutual learning. These outcomes demonstrate potential application to other systems in the international nursing community.

Boston↗
PubMed2003

Dental education in Kuwait.

For a long time there has been a need to establish a dental school in Kuwait, due to the fact that the majority of dentists working in Kuwait are expatriates from various countries. An Amiri decree in 1996 made it possible, and the first dental students were admitted to the Kuwait University Faculty of Dentistry in 1998. The mission of the Faculty of Dentistry is 'to promote oral health in Kuwait through education, research and cooperation with other professional health care institutions as well as the community at large'. A 6.5-year dental curriculum was completed after 2 years of committee work and was accepted by the University Council in 2001. This curriculum incorporates current trends in medical and dental education, such as the evidence-based and community-based approaches, problem-solving methodology for outcome-based learning, and competency achieved through comprehensive patient care.

Curriculum↗
PubMedDate not supplied

Correlates of postsecondary employment outcomes for young adults with learning disabilities.

The purpose of this study is twofold: (a) to examine the efficiency of a set of selected variables for predicting postsecondary employment success for young adults classified as learning disabled in high school and (b) to provide a portrayal of employment adjustment in the first years after exiting high school. Data on both employment stability and job status were gathered through telephone interviews. Of the 284 students with learning disabilities who exited the four participating high schools between 1986 and 1989, contact was made with 175 (62%). This sample was composed of 75% males, who ranged in age from 18 to 23 years. Statistical tests reveal that students (a) with high math ability, (b) who were employed during high school, and (c) whose parents actively participated in their education were more likely to experience employment success after high school. Overall, 86% of the sample was employed either full- or part-time, with the majority in entry-level, unskilled jobs. In terms of postsecondary education, 26% completed at least one semester of college or technical school, though at the time of follow-up only 13% were enrolled in school.

Adolescent↗
PubMedDate not supplied

Short- and long-term retention of a nursing home education program on metered-dose inhaler technique.

OBJECTIVE: To evaluate an education program on metered-dose inhaler (MDI) technique designed for nurses and trained medication aides (TMAs). DESIGN: The education program included a handout, a lecture incorporating a videotape on correct inhaler and device technique, and hands-on experience with placebo inhalers. The participants' ability to verbalize and demonstrate correct MDI technique was assessed by the same two-person teams before, immediately after, and two months after the program. SETTING: Five nursing homes. PARTICIPANTS: Fifty-six nurses and TMAs practicing in nursing homes. MAIN OUTCOME MEASURES: Learning and retention. RESULTS: The participants' mean (+/- SD) verbal and demonstration scores increased immediately after the program by 68 +/- 18 points for verbalization and 47 +/- 16 points for demonstration. The participants were always better at demonstrating than verbalizing MDI technique. The participants' baseline verbal and demonstration scores correlated with the amount learned. Learning was influenced by the individual nursing home (verbal and demonstration) and personal use (demonstration only), but not by academic degree, previous training, past instruction of a patient, or current care of a patient who was receiving inhaler therapy. After two months, the scores were lower than immediately after the program test by 0-92 points for verbalization and 10-80 points for demonstration; however, the mean scores were still significantly greater (p less than 0.05) than the baseline scores. Retention of knowledge on the correct technique was greater for the demonstration component. Retention was influenced only by the nursing home in which the participant worked, and not any of the other variables. CONCLUSIONS: Our structured education program significantly improved inhaler technique; however, to maintain retention of the material, the program should be frequently repeated.

Clinical Competence↗
PubMed1975

Evaluating the impact of program consultation in health services.

This article describes a methodology developed to be useful to both consultant and consultee in evaluating their mutual efforts to improve agency health service programs. Reporting forms and instruction manuals based upon the concept of mutuality in consultation were used by 19 consultants in 29 consultations. Two-thirds of the respondents reported some increase in problem-solving ability. The implications of evaluating program consultation are discussed, as are certain issues in consultation: definition, implementation, process, utilization, impact delays, interpersonal interactions, hidden agendas, organizational learning, and outcome measurements.

Evaluation Studies as Topic↗
PubMed1998

Efficacy outcome and sex difference in learning of hypermedia programming skills.

86 occupational therapy students participated in a 20-hr, training course in hypermedia programming for selecting functions for development of rehabilitation software. Analyses showed that the training program significantly enhanced their self-efficacy in development of software for clinical practice. The students generally showed a positive attitude towards the feasibility and significance of applying hypermedia programming in occupational therapy, but no significant sex difference in programming self-efficacy was found.

Adolescent↗
PubMed1995

Verbal learning and memory impairment in adult civilians following penetrating missile wounds.

Verbal memory and learning patterns, as measured by the California Verbal Learning Test (CVLT), following penetrating head injury (PHI) from gunshot wound were studied in 10 acutely injured patients (mean age 25.3 years) at a mean of 2.1 months post-injury. Primary impairment was found on measures of free recall of new verbal information which appeared to be related to deficits in organisational and retrieval functions: (1) the group's learning characteristics were marked by disorganization and an underutilization of active learning strategies; (2) rate of acquisition also appeared to be mildly decreased; (3) nevertheless, the PHI group did not show severe disruption in all aspects of learning and memory. In fact, the group showed a relatively intact capacity to store new information in memory.

Adolescent↗