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PubMed2004

Lessons learned from the hip and knee musculoskeletal outcomes data evaluation and management system.

In 1994 the American Academy of Orthopaedic Surgeons established an outcomes initiative. The Musculoskeletal Outcomes Data Evaluation and Management System had two goals: (1) to create validated patient-based functional health questionnaires that would become the gold standard for musculoskeletal research, and (2) to collect data from practicing orthopaedists using these instruments. We assessed the adequacy of the hip and knee portion of the Musculoskeletal Outcomes Data Evaluation and Management System data collection process to learn how to improve these processes. Database elements included demographic and clinical information and health and well-being scales. Only 715 records or 578 patients of the initial 2419 records (30%) had complete baseline and followup information for either hip or knee replacement procedure. Only 17% of the patients who had a knee replacement and 20% of the patients who had a hip replacement returned for followup between 7 and 9 months. The Musculoskeletal Outcomes Data Evaluation and Management System achieved its goal regarding the development of validated questionnaires, but the data collection component did not. The project's implementation and management were flawed. This experience offers the field of orthopaedics valuable lessons that can be applied to future large-scale data collection efforts.

Arthroplasty, Replacement, Hip↗

PubMed2005

Imitative learning of stimulus-response and response-outcome associations in pigeons.

A novel automated procedure was used to study imitative learning in pigeons. In Experiments 1 and 2, observer pigeons witnessed a demonstrator pigeon successfully performing an instrumental discrimination in which different discriminative stimuli indicated which of 2 topographically distinct responses (R1 and R2) resulted in the delivery of seed. The observers were then presented with the discriminative stimuli and given access to the response panel. Observer pigeons' behavior during the discriminative stimuli was influenced by how the demonstrator had responded during these stimuli. In Experiment 3, observers witnessed demonstrator pigeons performing R1 for Outcome 1 and R2 for Outcome 2. Observers then received a procedure designed to devalue Outcome 1 relative to Outcome 2 and were subsequently less likely to perform R1 than R2. These results suggest that pigeons can learn both stimulus response and response-outcome associations by observation.

Animals↗

PubMed2001

Outcome measurement of problem-based learning.

OBJECTIVE: To determine if there is a significant difference in the national certification examination scores, and in comments received from clinical faculty, between PBL and pre-PBL groups. DESIGN: Retrospective analyses of national certification examination scores and clinical faculty evaluation files. PARTICIPANTS: Medical technology students at the University of Hawaii. MAIN OUTCOME MEASURES: Means of a national certification examination scores of PBL and pre-PBL groups are statistically compared. Types of clinical faculty comments are rank-ordered and compared between the two groups. RESULTS: PBL group did significantly better in the Urinalysis section of the national certification examination. Pre-PBL group received more "Quiet but got better" comments from clinical faculty. CONCLUSION: PBL can affect student outcomes in both national certification exams and perception by clinical faculty.

Humans↗

PubMed1990

Research on teaching methods.

Research on teaching methods in nursing education was categorized into studies on media, CAI, and other nontraditional instructional strategies. While the research differed, some generalizations may be made from the findings. Multimedia, whether it is used for individual or group instruction, is at least as effective as traditional instruction (lecture and lecture-discussion) in promoting cognitive learning, retention of knowledge, and performance. Further study is needed to identify variables that may influence learning and retention. While learner attitudes toward mediated instruction tended to be positive, investigators failed to control for the effect of novelty. Control over intervening variables was lacking in the majority of studies as well. Research indicated that CAI is as effective as other teaching methods in terms of knowledge gain and retention. Attitudes toward CAI tended to be favorable, with similar problems in measurement as those evidenced in studies of media. Chang (1986) also recommends that future research examine the impact of computer-video interactive instruction on students, faculty, and settings. Research is needed on experimental teaching methods, strategies for teaching problem solving and clinical judgment, and ways of improving the traditional lecture and discussion. Limited research in these areas makes generalizations impossible. There is a particular need for research on how to teach students the diagnostic reasoning process and encourage critical thinking, both in terms of appropriate teaching methods and the way in which those strategies should be used. It is interesting that few researchers studied lecture and lecture-discussion except as comparable teaching methods for research on other strategies. Additional research questions may be generated on lecture and discussion in relation to promoting concept learning, an understanding of nursing and other theories, transfer of knowledge, and development of cognitive skills. Few studies attempted to identify variables that may influence learning, particularly characteristics of the learner. Only six investigators addressed learning styles and their interactions with the teaching method and outcomes (Gillies, 1984; Goldsmith, 1984; Kirchhoff & Holzemer, 1979; Kissinger & Munjas, 1981; Norris, 1986; Stein et al., 1972). Research in the future needs to focus on the relationship of different learner characteristics, attributes of the teaching method, and learning outcomes. In addition, initial learning, retention, transfer to practice, and instructional time should be studied. Characteristics of the teacher and setting and relationship to the methodologies used and outcomes of instruction need investigation. Research should attempt to identify optimal conditions for learning and ways in which methods should be used for particular students, subject matter, and points in the nursing curriculum...

Audiovisual Aids↗

PubMed1996

Community care for adults with learning disability and their carers: needs and outcomes from the Leicestershire register.

A cross-sectional study, based on an epidemiological register, was carried out to describe the prevalence of disabilities, felt needs and use of services for adults with learning disability and to compare outcomes of reported morbidity, stress and satisfaction among their informal carers. Subjects included 2117 adults and 982 carers known to specialist services in Leicestershire. Behavioural and psychological problems and epilepsy were the main disabilities in adults. The leading unmet needs reported by residential carers were for daycare and other forms of residence, and those reported by informal carers were for financial help, long-term social support, respite care and housing adaptations. Informal carers reported 40% more limiting health disorders compared to the general population, with depression almost four times more common among female carers. Divisions between health and social care are causing inequality and hardship. Lifelong informal carers need options for independence. The increase over time in the prevalence of adults with severe learning disabilities adds to the evidence that more resources for care are needed. Epidemiological registers and methods should be developed to aid purchasing and provision for this client group.

Activities of Daily Living↗

PubMed1995

The role of health sciences librarians in the teaching and retention of the knowledge, skills, and attitudes of lifelong learning.

For the past decade, the medical education community has recognized lifelong learning as a desirable educational outcome. Problem-based learning (PBL) appears to foster the requisite knowledge acquisition, skills, and attitudes. This paper briefly summarizes research that found no differences in perceptions of lifelong learning between graduates of PBL curricula and traditional curricula. The paper analyzes the assumptions that suggest such differences should exist and asserts that these assumptions are invalid within the global context of the education process. The paper concludes by suggesting a new way of looking at the teaching and retention of knowledge, skills, and attitudes of lifelong learning and the essential role that health sciences librarians must play in the process.

Clinical Competence↗

PubMed2002

Evaluating outcomes of HIV prevention programs: lessons learned from Houston, Texas.

The Centers for Disease Control and Prevention (CDC) fund state and local health departments to contract with community-based organizations for HIV prevention tailored to the needs of populations at risk. In 1999, the CDC began requiring health departments to develop the capacity to evaluate the outcomes of these programs. The CDC requirements create the need for practical, low-cost methods of outcome monitoring that can be applied at the local level. We describe the development of a multisite evaluation of seven city health department funded (via CDC) HIV counseling programs in Houston, Texas. Initial findings indicate that (1) behavioral change information that reflects program objectives can be obtained through a brief survey; (2) community providers were not able, or were unwilling, to follow the evaluation protocol related to surveying their clients; (3) that asking clients to mail back posttest surveys resulted in low response; and (4) a one-contact intervention made establishing rapport, commitment, and/or trust difficult for evaluation purposes. These findings suggest areas for improvement, including providing staff training and/or better motivation to ensure protocol fidelity, considering the use of an external evaluator to conduct pre-post surveys, and developing a different design to evaluate one-shot interventions.

Adult↗

PubMed1993

Odor matching and odor memory in the rat.

To assess olfactory matching-to-sample learning, rats were exposed to two odors separated by a 1-s presentation of clean air. If, and only if, the odors were identical, a response produced a water reinforcer. High levels of performance were maintained over a series of 10 novel three-odor matching-to-sample problems on this conditional go/no-go discrimination procedure. In general, performance accuracy improved over problems and errorless or near errorless performance on many stimulus combinations, particularly near the end of training, indicated acquisition of a learning set. There was little decrement in performance when the interstimulus interval was increased gradually from 1 to 10 s and matching-to-sample was not disrupted when a novel odor was presented during the interstimulus interval. These results demonstrate that rats readily learn an olfactory matching-to-sample task, maintain high levels of performance even with delays of 10-s between stimuli, and can acquire a matching-to-sample learning set. The outcomes are in agreement with prior studies demonstrating exceptional learning of instrumental tasks by rats when they are provided with odor cues.

Animals↗

PubMed1997

Learning disability and epilepsy. 2, a review of available outcome measures and position statement on development priorities.

People with epilepsy plus learning disabilities pose a challenge in terms of clinical management and research investigation, and, to date, the measurement of outcomes in this population has been limited. There have been uncertainties concerning both the 'what' and the 'how' of assessment. This paper presents a comprehensive review of available outcome measures across nine domains, i.e. relating to seizures, drugs, cognitive function, behaviour, social functioning, carer functioning, attitudes, motivation and 'quality of life'. This last domain reflects more global measures designed to encompass several assessment strands. The uses and limitations of each scale is discussed and, where data are available, psychometric properties are also presented. The paper concludes with suggestions for the further development of outcome measures in this population.

Epilepsy↗

PubMed2001

Dementia and disability outcomes in large hypertension trials: lessons learned from the systolic hypertension in the elderly program (SHEP) trial.

In the Systolic Hypertension in the Elderly Program (SHEP) trial (1985-1990), active treatment reduced the incidence of cardiovascular events, but not that of dementia and disability, as compared with placebo. This study aims to evaluate if assessment of cognitive and functional outcomes was biased by differential dropout. Characteristics of subjects who did or did not participate in follow-up cognitive and functional evaluations were compared. The relative risks of incident cognitive impairment and disability were assessed in the two treatment groups, with the use of the reported findings and under the assumption that the proportions of cognitive and functional impairment among dropouts increased. Assignment to the placebo group and the occurrence of cardiovascular events independently predicted missed assessments. From the reported findings, the risk of cognitive and functional impairment was similar between the two treatment groups. However, when 20-30% and 40-80% of the subjects who missed the assessment were assumed to be cognitively and, respectively, functionally impaired, assignment to active treatment reduced the risk of these outcomes. In the SHEP, the cognitive and functional evaluations were biased toward the null effect by differential dropout. This might have obscured the appraisal of a protective effect of treatment on the cognitive and functional decline of older hypertensive adults.

Aged↗

PubMed1986

Outcomes of emergency room visits for asthma. II. Relationship to admission criteria.

To learn how the outcomes of emergency room (ER) care relate to the decision-making process, criteria for the disposition of asthma in the ER were incorporated into a formal protocol in the form of an algorithm for use by pediatric resident physicians. We compared the application of those criteria with the consequences of 199 decisions to admit patients to the hospital for asthma and of 293 decisions to discharge patients from the ER. For most patients the chance of relapse was significantly raised if they were discharged from the ER when the protocol had specified admission. This was not true, however, for a group of "frequent visitors" (12.7% of all patients) who accounted for 66.3% of all relapses. This finding offers an explanation for previous difficulties in identifying characteristics of visits destined to be followed by relapse. Patients were placed in jeopardy by inappropriate ER discharges only if they were high-risk patients who had experienced prior episodes of respiratory failure. Nearly all admissions involving severe episodes of asthma were also limited to high-risk patients. A variety of criteria supported such admissions. At the other extreme, "avoidable" admissions, in which obstruction resolved within a few hours of admission, occurred equally among all patient strata, and no particular admission criterion could be held at fault for admission of such rapidly remitting cases. The results support the use of explicit, quantitative criteria for guiding ER disposition of asthma, especially specific arrangements for management of ER visits by high-risk patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2004

The morbidity and mortality conference: a case assessment tool, quality control measure, and teaching method.

The morbidity and mortality conference and other traditions in hospital-based training inculcate the habits of understanding evidence and its clinical application and being able to articulate these to one's peers and to learn from unanticipated outcomes. By contrast, predoctoral dental training and the environment of general dental practice do not encourage collegial reflection on the outcomes of practice. Benefits and cautions in applying the habits learned through M&M conferences are discussed for both the oral and maxillofacial and the general practice settings.

Education, Dental↗

PubMedDate not supplied

Positive pregnancy outcomes in Mexican immigrants: what can we learn?

OBJECTIVE: To provide an integrated review of the literature of potential explanations for better than expected pregnancy outcomes in Mexican immigrants, focusing on socioeconomics, social support, desirability of pregnancy, nutrition, substance use, religion, acculturation, and prenatal care. DATA SOURCES: Computerized searches of MEDLINE and CINAHL databases, as well as reference lists from published articles on low birth weight and prematurity in immigrants and acculturation in immigrants from January 1989 to December 2002. Search terms were Mexican immigrant women, childbearing, and pregnancy outcome, and only English-language articles were reviewed. STUDY SELECTION: Literature was selected from refereed publications in the areas of nursing, medicine, public health, family, and sociology. DATA EXTRACTION: Data were extracted using keywords pertinent to pregnancy outcome in Mexican immigrants. DATA SYNTHESIS: Despite having many of the risk factors for poor pregnancy outcomes, Mexican immigrants have superior birth outcomes when compared to U.S.-born women. Social support, familism, healthy diet, limited use of cigarettes and alcohol, and religion may play a role in improved outcomes. The superior outcomes diminish with the process of acculturation as the individual adapts to her new culture. CONCLUSIONS: Low birth weight and prematurity are public health concerns in the United States. Through further study of the factors that lead to superior birth outcomes among Mexican immigrant women, rates of low birth weight and prematurity in the United States may be reduced.

Acculturation↗

PubMed2006

Tracking preschool children with developmental delay: third grade outcomes.

Educational outcomes were evaluated for 2,046 preschool children identified with developmental delay. Results indicated that at third grade, 26% were in regular education and the remaining 74% were receiving special education services. The most common disability classifications at outcome were specific learning disabilities and educable mentally handicaps. Regular education, but not special education, children had higher retention rates than did the general population. The presence of one or more secondary exceptionalities in preschool was more common for special education than regular education children. Regular education and special education children did not differ on other factors studied. This study highlights the importance of developmental delay as an exceptionality category and advances our understanding of the long-term implications of such delay.

Child, Preschool↗

PubMed2006

Associative encoding in anterior piriform cortex versus orbitofrontal cortex during odor discrimination and reversal learning.

Recent proposals have conceptualized piriform cortex as an association cortex, capable of integrating incoming olfactory information with descending input from higher order associative regions such as orbitofrontal cortex (OFC). If true, encoding in piriform cortex should reflect associative features prominent in these areas during associative learning involving olfactory cues. To test this hypothesis, we recorded from neurons in OFC and anatomically related parts of the anterior piriform cortex (APC) in rats, learning and reversing novel odor discriminations. Findings in OFC were similar to what we have reported previously, with nearly all the cue-selective neurons exhibiting substantial plasticity during learning and reversal. Also, many of the cue-selective neurons were originally responsive in anticipation of the outcomes early in learning, thereby providing a single-unit representation of the cue-outcome associations. Some of these features were also evident in firing activity in APC, including some plasticity across learning and reversal. However, APC neurons failed to reverse cue selectivity when the associated outcome was changed, and the cue-selective population did not include neurons that were active prior to outcome delivery. Thus, although representations in APC are substantially more associative than expected in a purely sensory region, they do appear to be somewhat more constrained by the sensory features of the odor cues than representations in downstream areas of OFC.

Animals↗

PubMed2000

The effects of a computer skill training programme adopting social comparison and self-efficacy enhancement strategies on self-concept and skill outcome in trainees with physical disabilities.

PURPOSE: The aim of this controlled, quasi-experimental study was to evaluate the effects of both self-efficacy enhancement and social comparison training strategy on computer skills learning and self-concept outcome of trainees with physical disabilities. METHOD: The self-efficacy enhancement group comprised 16 trainees, the tutorial training group comprised 15 trainees, and there were 25 subjects in the control group. Both the self-efficacy enhancement group and the tutorial training group received a 15 week computer skills training course, including generic Chinese computer operation, Chinese word processing and Chinese desktop publishing skills. The self-efficacy enhancement group received training with tutorial instructions that incorporated self-efficacy enhancement strategies and experienced self-enhancing social comparisons. The tutorial training group received behavioural learning-based tutorials only, and the control group did not receive any training. The following measurements were employed to evaluate the outcomes: the Self-Concept Questionnaire for the Physically Disabled Hong Kong Chinese (SCQPD), the computer self-efficacy rating scale and the computer performance rating scale. RESULTS: The self-efficacy enhancement group showed significantly better computer skills learning outcome, total self-concept, and social self-concept than the tutorial training group. The self-efficacy enhancement group did not show significant changes in their computer self-efficacy: however, the tutorial training group showed a significant lowering of their computer self-efficacy. CONCLUSIONS: The training strategy that incorporated self-efficacy enhancement and positive social comparison experiences maintained the computer self-efficacy of trainees with physical disabilities. This strategy was more effective in improving the learning outcome (p = 0.01) and self-concept (p = 0.05) of the trainees than the conventional tutorial-based training strategy.

Adult↗

PubMed2005

The role of the dorsomedial striatum in instrumental conditioning.

Considerable evidence suggests that, in instrumental conditioning, rats learn the relationship between actions and their specific consequences or outcomes. The present study examined the role of the dorsomedial striatum (DMS) in this type of learning after excitotoxic lesions and reversible, muscimol-induced inactivation. In three experiments, rats were first trained to press two levers for distinct outcomes, and then tested after training using a variety of behavioural assays that have been established to detect action-outcome learning. In Experiment 1, pre-training lesions of the posterior DMS abolished the sensitivity of rats' instrumental performance to both outcome devaluation and contingency degradation when tested in extinction, whereas lesions of the anterior DMS had no effect. In Experiment 2, both pre-training and post-training lesions of the posterior DMS were equally effective in reducing the sensitivity of performance both to devaluation and degradation treatments. In Experiment 3, the infusion of muscimol into the posterior DMS selectively abolished sensitivity of performance to devaluation and contingency degradation without impairing the ability of rats to discriminate either the instrumental actions performed or the identity of the earned outcomes. Taken together, these results suggest that the posterior region of the DMS is a crucial neural substrate for the acquisition and expression of action-outcome associations in instrumental conditioning.

Animals↗

PubMed1996

Learning disability in children with postmeningitic cochlear implants.

OBJECTIVE: To determine the effects of learning disability on measures of auditory perception, receptive language development, and sequential organization in children with postmeningitic cochlear implants. DESIGN: Retrospective study. Follow-up ranged from 12 months to 7 years. SETTING: Tertiary care center. PATIENTS: Ten pediatric patients with cochlear implants, 5 with documented learning disability. MAIN OUTCOME MEASURE: Pediatric cochlear implant test battery performance. RESULTS: Children with learning disability showed slower progress, more inconsistencies, and lower test scores than their partners without learning disability. CONCLUSION: Learning disability is not a contraindication to cochlear implantation, but preoperative counseling must be available to families and support personnel about preoperative achievements and expectation for these children.

Child↗