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PubMed2005

[Impairment of social cognition in Parkinson's disease].

The characteristic four symptoms of motor deficits, bradykinesia, rigidity, resting tremor and impairment of postural reflex with Parkinson's disease (PD) are accompanied by specific cognitive deficits. Deficits of executive functions, skill learning, and visuospatial cognition are well known. The results of our recent studies show the deficit of social cognition which include facial expression recognition, sensation of gaze direction, "theory of mind" in comprehension, and decision making. These symptoms can be explained by the damage of the amygdala and/or its connection, which are known to play a crucial role in social cognition, it is attributed to the involvement of amygdala and it's connection to the frontal lobe in PD. The impairment of social cognition is an important mental change associated with PD.

Cognition Disorders↗
PubMedDate not supplied

Infant oral health education for pediatric and family practice residents.

PURPOSE: The purpose of this study was to investigate whether an infant oral health curriculum implemented in pediatric and family medicine residency programs could improve physicians' oral health knowledge and practice behaviors and promote the age 1 dental visit. METHODS: Residents and faculty members completed a baseline current practices survey and knowledge test before receiving a 1- or 2-hour training session followed by a knowledge post-test. Existing well child care forms were updated with oral health prompts to reinforce newly learned skills. At 1-year follow-up (1 YFU), participants completed a current practices survey and knowledge test. In addition to the residency programs, medical students and advanced practice registered nurses participated in baseline data collection, training, and immediate posttest data collection. RESULTS: A total of 245 people participated, with 78% trained in person and 22% trained via the Web. Of these, 120 were the targeted residents and faculty-of whom 82% completed the 1 YFU. Practice behaviors improved from baseline to 1 YFU, with only 28% of practitioners at baseline referring children to the dentist at age 1, compared to 73% at 1 YFU (P<.05). Knowledge scores were greater at 1 YFU than at baseline (P<.05), and the mode of training showed no difference in knowledge outcomes. Knowledge and prescribing practices regarding fluoride were poor at baseline and showed limited improvement at 1 YFU. CONCLUSIONS: An infant oral health education program can improve physicians' oral health knowledge and behaviors, particularly regarding promoting the age 1 dental visit. Behavior changes regarding fluoride prescribing, however, appear harder to achieve. Web-based training had similar success to in-person training.

Chi-Square Distribution↗
PubMed2005

Early intervention surveillance strategies (EISS) in dental student clinical performance: a mathematical approach.

Graduating dental practitioners requires the mastery of a number of skills and a significant body of basic information. Dental education is a complex combination of didactic and physical skill learning processes. It is necessary to develop appropriate tools to measure student clinical performance to allow the provision of interventional strategies at the right time targeted at the right individuals. In this study, an approach to early intervention surveillance strategies was developed that is cost-effective, transparent, and robust based on mathematical predictions of student clinical achievements. Using a cohort of students' clinical activity profile, a polynomial pair was developed that represents the predictive function of low and high achieving students. This polynomial pair can then be applied to students to predict their final achievement based on their current status. The polynomial methodology is adaptable to local variation such as access to clinical facilities. The early intervention surveillance strategy developed in this study provides a simple, cost-effective, predictive risk assessment system that relies on data sets already collected in most dental schools and can be completed without the need for significant human intervention. The mathematical approach allows the focusing of educational support towards students that require the assistance, thus augmenting the better use of resources.

Achievement↗
PubMed2005

A systems view of health promotion.

This article presents a systems view of health promotion and education. We offer an overview of systems theory, including the hierarchy of systems, the relationship between a system and its environment, and agent-host interactions. A host is any system that may face disruption from an environmental agent or perturbation from an adjacent system. A system is healthy to the extent it can prevent, parry, or dissipate the effects of disruptions and perturbations. Systems can collaborate and cooperate to enhance their capacity to respond adaptively to potential threats from agents. This offers new insights into the three levels of prevention, and into health promotion practice. Health promotion is any effort to influence host systems in ways that will enhance their capacity to prevent, resist, dissipate or respond adaptively to potential threats from their environment. We also offer an account of the balance between stability (or lack of) in the environment and the importance of flexibility enabling systems to adapt to change. We examine high-level wellness, a function of knowledge, learning, skills and stored-up resources that enhance adaptability, flexibility and timeliness in a system's response to anticipated and unanticipated potentially disruptive environmental agents. Finally we draw implications for health promotion and education practice. The health promoter / educator is a helpful agent seeking to influence systems at various levels in the hierarchy of systems in ways that will enhance their capacity to prevent, resist, dissipate or respond adaptively to potential disruptive agents in their environments.

Health Education↗
PubMedDate not supplied

Core competency in laparoendoscopic surgery.

BACKGROUND: Concern about patient safety and physician competence was highlighted by the Institute of Medicine report, revealing the prevalence of fatal medical errors. There is also awareness that technical difficulties specific to laparoendoscopic surgery can cause medical errors. Reported herein is a review of the evidence pertaining to objective assessment of core competency components in laparoendoscopic surgery: cognitive skills, technical skills, surgical performance, and judgment. METHODS: PubMed and MedLine searches were performed to identify articles with combinations of the following key words: core competency, competency, laparoscopy, training, assessment, and curriculum. Further articles were obtained by searching reference lists of identified papers and through personal communication. CONCLUSIONS: The available evidence suggests that it is currently possible to objectively assess core competency components in laparoendoscopic surgery: knowledge and clinical judgment with well-established tests and innate technical abilities with computer-based simulators with embedded metrics. Simulation training is conducted to a proficiency criterion regardless of the number of repetitions or practice hours. Reports indicate that skills learned on a simulator transfer to the operating room. However, to date, objective assessment of surgical performance can be obtained only through review of unedited video tapes of surgical procedures by disinterested experts as recently demonstrated by our Japanese colleagues in urology.

Clinical Competence↗
PubMed2000

Occurrence of gross motor behaviors in integrated and segregated preschool classrooms.

The purpose of this pilot study was to determine incidences per hour of stability, mobility, and transfer behaviors of children with physical disabilities in segregated and integrated preschool classrooms. Ten children performing these behaviors in physical therapy participated in this study. Each child's gross motor and school activities were observed for an entire school day and recorded in 30-second intervals. The incidences per hour of gross motor behaviors did not differ significantly between the two types of preschools; however, incidences per hour differed significantly among the types of motor behaviors and the types of school activities. Stability behaviors consistently occurred at substantially higher rates than mobility and transfer behaviors. Nearly one third of the transfers and mobility behaviors did not involve the child's active participation. Mobility behaviors occurred at highest rates during transition and gross motor activity times. The children's limited active movement is a serious concern. For motor skill learning to occur, children must participate actively. Stability activities occur more often during the preschool routine, whereas mobility and transfers occur significantly less often and likely will require additional practice.

Journal Article↗
PubMed1991

Growing up with a spinal cord injury.

Much of what we need to know to be independent adults is learned in the first five years of life. In the toddler, instead of reteaching learned skills, as we do with older spinal cord injury persons, we are teaching skills for the first time. It is therefore imperative to have a creative therapeutic team who can teach skills which were never acquired and encourage the child's cognitive growth as well as growth towards independence. This paper will include a case report of a 2 year-old C3-4 quadriplegic child rehabilitated through an interdisciplinary family-centered model of care. We will share some of the issues our team has encountered when "rehabilitating" very young children with spinal cord injuries based on the observations of the team members as well as the scant literature available. This will also include a parent's reflections of modification needed in family structure and roles.

Child Development↗
PubMed1990

Dentistry's future at the University of Southern California.

Participation in the National Dental Education Program has been a most important activity. It has had great impact on the future well-being of the USC School of Dentistry. Success in Phases 1 and 2 was, of course, important. However, the involvement in training sessions, where ideas were exchanged and new skills learned, was probably of more importance. Communication with university officials suddenly became easier--we now spoke a common language and could respond more effectively than before. While the outcomes will be important in changing the school's course, the process leading to the outcomes will also produce significant change. Planning took on new meaning at USC. We are now able to respond to opportunities that come knocking at our door. We are able to see relationships previously invisible. We are beginning to recognize that what each does, in whatever activity, matters a great deal. We--faculty, students, staff, and alumni--are interdependent to a larger degree than previously thought. Challenging years are in store for the USC School of Dentistry. Much needs to be done to ensure dentistry's future at USC into the 21st century. The school is located at the right place at the right time. The external environment beckons for increased involvement by the School of Dentistry. If the school can address the challenges posed by the changed internal environment, it is well positioned to become the most important resource in dental education, in dental care, and in dental information in the Southwest.

California↗
PubMed1989

Lesions of the amygdala that spare adjacent cortical regions do not impair memory or exacerbate the impairment following lesions of the hippocampal formation.

Monkeys with stereotaxic lesions of the amygdaloid complex that spared the surrounding cortex (i.e., the periamygdaloid, entorhinal, and perirhinal cortices) performed normally on the delayed nonmatching to sample task, as well as on 3 other memory tasks (object retention, concurrent discrimination, and delayed response) administered during the 1 1/2 years after surgery. These animals also performed normally on pattern discrimination and motor-skill learning, 2 tasks analogous to ones amnesic patients perform well. A second group of monkeys with conjoint lesions that included both the amygdaloid complex, as just described, and the hippocampal formation were impaired on the same 4 memory tasks. However, the severity of impairment in this group was no greater than in monkeys with lesions of the hippocampal formation alone. Thus, circumscribed bilateral lesions of the amygdala did not impair performance on 4 different memory tasks, nor did they exacerbate the memory impairment that followed hippocampal formation lesions alone. These findings suggest that one must look to structures other than the amygdala to account for the severe memory impairment that follows large lesions of the medial temporal region. One possibility is that damage to the cortical regions that surround the amygdala contributes to memory impairment.

Amygdala↗
PubMed1989

[Results of the revision of the 1983 Hamburg-Wechsler Intelligence Test for Children in students with severe reading disorders].

In connection with the current discussion about the use of the HAWIK-R in differential diagnosis, 20 children with severe reading retardation were tested with both the HAWIK and the HAWIK-R and the results compared, and 48 children with this disorder were tested with the HAWIK-R and divided into three groups by the amount of difference between verbal and performance scores. The results on the subtests of the HAWIK-R were grouped by the categories recommended by Titze and Tewes. In the first part of the study, the 20 reading retarded children scored lower on the HAWIK-R than on the HAWIK on the majority of subtests and also had much lower verbal, performance and full scale IQs. In the second part of the study, we found marked differences between the groups on most of the HAWIK-R subtests, especially between the groups where the verbal IQ was lower than the performance IQ and where the verbal IQ was higher than the performance IQ. With regard to the categories of subtests, the children with a lower verbal than performance IQ showed deficits attributable to poor learning skills, milieu and attention relatively frequently. On the other hand, the children with a higher verbal than performance IQ tended to have deficits in perceptuomotor skills and disorders of integrative brain functions. The problems involved in using the HAWIK-R for differential diagnosis are critically evaluated. If the HAWIK-R data are examined in detail and the child involved is observed carefully this test can provide useful information for setting up remediation programs for poor readers.

Achievement↗
PubMed1989

Pathology in the new pathway of medical education at Harvard Medical School.

In 1985 Harvard Medical School initiated an experimental curriculum that incorporated many of the recommendations of the report on the General Professional Education of the Physician (GPEP). Key features are problem-based small group tutorials that emphasize active learning, with increased independent study time and a decreased number of lectures. Tutors serve as guides to their students and are not necessarily experts in the discipline of the cases studied. Learning skills are taught, including information acquisition and criticism and computer literacy. Knowledge is integrated from the beginning by interdisciplinary basic science courses, by earlier introduction of the clinical sciences, and by juxtaposition of the scientific and humanistic aspects of medicine. Preventive medicine, health maintenance, and ambulatory care are given more attention. The students are organized into societies that provide vertical integration and promote cooperation among students and closer contact with faculty. Pathology has proved to be a popular and key bridge in the new curriculum. The success of the early efforts at Harvard and several pioneering medical schools should encourage others to move toward more problem-solving, student-centered, integrative medical education.

Curriculum↗
PubMed1988

Responses of myopes to volitional control training of accommodation.

Twelve young, low myopes were trained to control volitionally their accommodation responses and to achieve clear focus on visual targets moved progressively outward in optical distance. The trainees participated in from 15 to 40 daily training sessions (mean = 28 sessions). All demonstrated volitional control with varying degrees of control authority. Though three of the trainees were unsuccessful, the group achieved a statistically reliable extension of their far points. Post-training optometric examinations were reliably improved over pre-training examinations, but did not appear to be commensurate with the large gains in far-point extension. It was hypothesized that the learned skill may have been 'instrument-specific', i.e. it might not fully generalize to significantly improved post-training binocular performance unless it were accompanied by clinical assistance to transfer the training.

Accommodation, Ocular↗
PubMed1988

The effectiveness of training intellectual functions in adults with acquired brain damage. An evaluation of occupational therapy methods.

The purpose of this study was to evaluate the effectiveness and maintenance of occupational therapy training of intellectual functions. Gain in generalization, by which is meant the transfer of newly-learned skills to novel but appropriate tasks, was also studied. Sixty-seven patients with acquired brain damage underwent 14 weeks of training in one of the following four groups, to which selection was randomized: Intellectual Function Training (IFT) plus a regular rehabilitation programme (R) (n = 15), Intellectual Housework Training (IHT) plus R (n = 19), and IFT + IHT + R (n = 15). The fourth group, which received regular rehabilitation only (R) (n = 18) was the control. A four-group, pretest-posttest, follow-up, controlled experimental test design was adopted. The training result was assessed with the Intellectual Function Assessment (IFA), the Intellectual Housework Assessment (IHA) and 15 psychometric tests. Comparison between the IFT, the IHT and the IFT + IHT groups respectively and the R group indicated some areas of function where individualized intellectual training was more effective than a regular rehabilitation programme of occupational therapy. The development of intellectual functions within each group was obvious in most areas, but less so within the R group than in the others. The maintenance of training effects could not be demonstrated satisfactorily. Generalization gains were demonstrated in 4/5 "theoretical" intellectual functional areas assessed with IFA, and in 3/7 "practical" intellectual functional areas assessed with IHA.

Adult↗
PubMed1986

Adolescent drug abuse. Diagnosis, treatment, and prevention.

There are clear temporal developmental stages in drug use beginning with cigarettes and alcohol, then progressing to marijuana and finally cocaine, hallucinogens, and other drugs. Of considerable interest is the decline in prevalence of marijuana use and the stabilization of alcohol use in the face of a rise in the incidence of cocaine use. This decline occurs in the face of a decrease in the age of first initiation into drug use. Cocaine use is accompanied by serious medical, psychological, and social consequences including seizures, depression, paranoia, and suspension from school. These findings have definite implications for designing treatment and prevention programs. Inpatient and outpatient programs must require abstinence from drug use. Dysfunctional development, poor interpersonal skills, learning deficits, and concurrent psychiatric illness must be addressed. Family involvement in treatment is mandatory. Every chemically dependent person has a significant impact on the lives of several other people. The social pressures model is the most recent approach to drug prevention and the one most likely to succeed. Direct informational appeals to adolescents are unlikely in themselves to produce immediate changes in drug-related behavior but may assist in gradually changing community norms. School prevention programs need to be designed to target adolescents before the onset of drug use. The seventh grade or before is the correct point to begin. Finally, methods to assess the success of such pilot programs can greatly assist future development efforts. More research into the biologic and behavioral consequences of current drug use patterns including marijuana, cocaine, and hallucinogens is greatly needed.

Adolescent↗
PubMed1987

Concepts for the plastic surgeon from art and sculpture.

The concepts gleaned from the world of artists and sculptors can be profitably used by the plastic surgeon in both aesthetic and reconstructive surgery. Judgment and taste are learned skills; talent is important but not primary.

Art↗
PubMedDate not supplied

Teaching hypnosis within a family practice residency program.

As a result of increasing interest in medical hypnosis, a curriculum has been developed for teaching clinical hypnosis to family practice residents within a Canadian two-year training program. History and theories, demonstrations of techniques, practice of inductions, and clinical applications are presented to all second-year residents within a course titled "Behavioral Medicine in Family Practice." Individual supervision is offered within the family practice teaching unit as well as a one-month elective in behavioral medicine. Residents are encouraged to attend workshops offered by the Canadian Society of Clinical Hypnosis and invited to attend an autogenic training group for patients. Evaluation of continuing use of learned skills in practice settings is in process.

British Columbia↗
PubMed1985

Acquiring and maintaining self-care skills after stroke. The predictive value of apraxia.

The degree of self-care in 120 patients who had suffered unilateral cerebrovascular accident (CVA) was assessed at different stages of recovery. The level of ADL (activities of daily living) function was determined on admission and discharge. Patients with right-sided hemiplegia (r. hem.) were given a set of apraxia tests on admission to the hospital. The results of ADL evaluation showed improved ADL function between admission and discharge, but a worsening after returning home. There were some significant relationships between ADL function in hospital and apraxia. All the apraxia variables are significant as predictors of subsequent dependency. The results show the seriousness of problems related to apraxia in rehabilitation of stroke patients with a lesion in the left hemisphere. One conclusion is that the treatment procedure ought to be directed to the various symptoms of apraxia. The effect of apraxia on ADL in the domestic situation has to be given more attention. More treatment should be given in the home, as patients seem to have difficulty in transferring the skills learned in hospital to the home situation and in maintaining them.

Activities of Daily Living↗