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A quantitative assessment of a medicinal chemistry problem-based learning sequence.

OBJECTIVES: To establish an aggressive problem-based learning (PBL) format for the medicinal chemistry course and assess the outcomes of student learning. METHODS: To assess learning in the new format, precourse and postcourse examinations were given to students enrolled before and after problem-based learning was implemented, and appropriate statistical analyses were conducted. RESULTS: The PBL cohort did not learn the same amount of factual content yet performed the same on higher-order thought questions as the non-PBL cohort. CONCLUSIONS: Problem-based learning may not be the ideal method for teaching medicinal chemistry. This may be due to several factors including: student learning type, the lack of a cognitive framework for learning in the basic sciences, and time constraints.

Chemistry, Pharmaceutical↗

The role of nutrition in pregnancy course and outcome.

Much has been learned during the past several decades about the role of nutrition in the course and outcome of pregnancy. While the bulk of the data is derived from animal models, human observations are gradually accumulating. It is generally appreciated at the present time that the fetus is not a "perfect parasite"; maternal stores can be drawn upon for support but a limit exists as to the ability of the fetus to drain maternal supplies. The consequences of poor maternal nutrition range from prevention of pregnancy (through the development of amenorrhea) to the stimulation of spontaneous abortion, stillbirth and congenital malformations. Limited maternal weight gain and subsequent low birth weight is the most common result of suboptimal maternal nutrition. The impact of excessive nutrient intake during pregnancy is poorly understood at the present time. Additional work is also required to clarify the impact of toxic agents consumed by women through water, foods, or nutritional supplements.

Animals↗

The problem of bias in training data in regression problems in medical decision support.

This paper describes a bias problem encountered in a machine learning approach to outcome prediction in anticoagulant drug therapy. The outcome to be predicted is a measure of the clotting time for the patient; this measure is continuous and so the prediction task is a regression problem. Artificial neural networks (ANNs) are a powerful mechanism for learning to predict such outcomes from training data. However, experiments have shown that an ANN is biased towards values more commonly occurring in the training data and is thus, less likely to be correct in predicting extreme values. This issue of bias in training data in regression problems is similar to the associated problem with minority classes in classification. However, this bias issue in classification is well documented and is an on-going area of research. In this paper, we consider stratified sampling and boosting as solutions to this bias problem and evaluate them on this outcome prediction problem and on two other datasets. Both approaches produce some improvements with boosting showing the most promise.

Bias↗

The introduction of large class problem-based learning into an undergraduate medical curriculum: an evaluation.

When considering implementing integrated curriculum models, such as problem-based learning (PBL), concerns may be expressed about the need for increased staff resources required to deliver tutor-led small group PBL. Less staff intensive ways of supporting PBL need to be explored. We compared the outcomes of a PBL module conducted in a large class format within a lecture theatre with a module having the same defined learning outcomes delivered in small group PBL format, both supported by e-learning resources. The pre-existing 27 small groups within the whole class (n = 246) of first year students undertaking a cardiovascular basic science module at Sheffield undergraduate medical school, UK, were randomized to 22 groups undertaking the large class Integrated Learning Activity (ILA) and 5 groups to traditional small group facilitated PBL sessions. Outcome measures were: a pre-post knowledge based test, a student educational effectiveness questionnaire, and assessment of student group work and presentations. There seemed to be no significant differences in learning outcomes between the methods although it is recognized that students would prefer the small group teaching format. Within institutions where resources to support small group PBL are limited, the large group ILA format supported with e-learning techniques may be a useful alternative approach.

Education, Medical, Undergraduate↗

The surgical learning curve in aural atresia surgery.

OBJECTIVE: The objective of this retrospective case review is to examine the effect of surgical learning on hearing outcomes and complications in congenital aural atresia surgery. PATIENTS: Sixty-four consecutive ears (in 60 patients) operated on during the period of 1994 to 2004 at a tertiary referral center were studied. INTERVENTION(S): Intervention consisted of aural atresiaplasty through an anterior approach by the same surgeon (C.S.). MAIN OUTCOME MEASURE(S): Hearing outcomes and complication rates were compared between four temporally sequential groups of 16 ears. Acceptable hearing and complication rate outcomes were defined as results comparable to larger series in the literature. RESULTS: Hearing results, in the short term, comparable to larger series were achieved during the first group of ears (nos. 1-16). A plateau in the learning curve for short-term hearing outcomes was achieved after the first two groups, that is, after 32 ears. Hearing outcomes, in the long term (>1 year) comparable to larger series, were achieved in the second group of ears (nos. 16-32). The learning curve for long-term hearing demonstrated a significant improvement in outcomes in the final group of 16 ears compared with the first 48 ears. Long-term hearing results for the final group show closure of the postoperative air-bone gap to less than 30 dB in 94% of cases. Postoperative complication rates were equivalent to larger series in the first group of 16 ears and showed no statistically significant difference between the four groups. There was one patient with sensorineural hearing loss after surgery; there were no anacoustic ears and no facial palsies in the study group. CONCLUSIONS: A learning curve of at least 32 ears was required to achieve stable short-term hearing results. To achieve stable long-term hearing results required a learning curve of at least 48 patients in our series. Complication rates remained stable throughout the study period.

Adolescent↗

Internalizing agency of self-action: perception of one's own hand movements depends on an adaptable prediction about the sensory action outcome.

Extensive work on learning in reaching and pointing tasks has demonstrated high degrees of plasticity in our ability to optimize goal-directed motor behavior. However, studies focusing on the perceptual awareness of our own actions during motor adaptation are still rare. Here we present the first simultaneous investigation of sensorimotor adaptation on both levels, i.e., action and action perception. We hypothesized that self-action perception relies on internal predictions about the sensory action outcome that are updated in a way similar to that of motor control. Twenty human subjects performed out-and-back pointing movements that were fed back visually. Feedback was initially presented in spatiotemporal correspondence with respect to the actual finger position, but later rotated by a constant angle. When distorted feedback was applied repetitively, subjects' perceived pointing direction shifted in the direction of the trajectory rotation. A comparable perceptual reinterpretation was observed in control trials without visual feedback, indicating that subjects learned to predict the new visual outcome of their actions based on nonvisual, internal information. The perception of the world, however, remained unchanged. The changes in perception of one's own movements were accompanied by adaptive changes in motor performance of the same amount, i.e., a secondary motor compensation opposite to the direction of the imposed visual rotation. Our results show that the perception of one's own actions depends on adaptable internal predictions about the sensory action outcome, allowing us to attribute new sensory consequences of our actions to our own agency. Furthermore, they indicate that the updated sensory prediction can be used to optimize motor control.

Adult↗

A randomized, double-blind, crossover study of methylphenidate and lithium in adults with attention-deficit/hyperactivity disorder: preliminary findings.

The authors examined the efficacy of methylphenidate (MPH) and lithium to treat attention-deficit/ hyperactivity disorder (ADHD) in adults, using a randomized, double-blind, crossover design. Patients received 8 weeks of MPH treatment (up to 40 mg/day) and 8 weeks of lithium treatment (up to 1,200 mg/day), by random assignment. Independent evaluators blind to group assignment assessed response every 2 weeks and at the end of each phase. The primary outcome measure was the Conners' Adult ADHD Rating Scale sum score for the clusters of hyperactivity, impulsivity, and learning problems. Secondary outcome measures were scores of irritability, overt aggression, antisocial behavior, anxiety, and depression, and scores on tests of verbal learning and sustained attention. In this preliminary study, lithium and MPH produced similar improvements on the primary outcome measure and on measures of irritability, aggressive outbursts, antisocial behavior, anxiety, and depression.

Adolescent↗

Diabetic patient education: determinants of success.

Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions. These factors include targets set, self-management skills, influence of living with diabetes, emotional factors, role of other people, perceived benefits and barriers, feelings of self-efficacy, weight concern and diet barrier. Training in learning processes and factors governing behaviour are essential for all those involved in delivery of patient care. Educational programmes should recognise the wide range of learning strategies used by different people.

Attitude to Health↗

Combining treatment for written and spoken naming.

Individuals with left-hemisphere damage often have concomitant impairment of spoken and written language. Whereas some treatment studies have shown that reading paired with spoken naming can benefit both language modalities, little systematic research has been directed toward the treatment of spelling combined with spoken naming. The purpose of this study was to examine the therapeutic effect of pairing a lexical spelling treatment referred to as Copy and Recall Treatment (CART) with verbal repetition of target words. This approach (CART + Repetition) was compared with treatment using verbal repetition without the inclusion of orthographic training (Repetition Only). Two individuals with moderate aphasia and severe impairment of spelling participated in the study using a multiple baseline design across stimulus sets and treatment conditions. Both participants improved spelling of targeted words as well as spoken naming of those items, but improvement in spoken naming was marked for one individual in the CART + Repetition condition, while the other participant made smaller gains in spoken than written naming irrespective of treatment condition. Consideration of the participant profiles suggested that CART + Repetition provides greater benefit when there is some residual phonological ability and the treatment serves to stimulate links between orthography and phonology.

Aged↗

An outcomes model prototype: integrating continuing education learning into practice.

BACKGROUND: A method for measuring the downstream effects of a continuing education conference on nursing practice was developed and tested. METHOD: In collaboration with conference faculty, the authors developed an assessment of knowledge and nursing experience related to the course content. Knowledge about the conference content was measured before the conference and at its conclusion. Experience was measured before the conference and 3 months after. RESULTS: Increases were found in both knowledge and experience, indicating that knowledge gained at the conference was integrated into nursing practice. CONCLUSION: Based on positive findings from this pilot, the method will be tested further.

Clinical Competence↗

A comparison of older longstay psychiatric and learning disability inpatients using the Health of the Nation Outcome Scales.

OBJECTIVE: With increasing longevity, the number of elderly patients with psychiatric or learning disabilities is likely to increase. The degree of overlap of symptoms and needs of these two groups of patients, which may allow for their care within the same service, was examined. DESIGN: Twenty-six longstay, elderly (> 65 years) psychiatric patients resident in psychogeriatric wards of a psychiatric hospital were compared with 23 longstay, elderly patients and 40 longstay patients aged 50-65 years, both resident in the wards of a specialist hospital for learning disabilities. The instrument used was the Health of the Nation Outcome Scales (HoNOS). RESULT: On the HoNOS, the elderly psychiatric patients scored significantly higher for problems with mood, relationships and occupation/activities. There were no significant differences for any of the scales rated between the 50-65 and > 65 years old patients with learning disabilities. CONCLUSION: The similarities between the three groups of patients would suggest that for some patients the same services may be utilized. This could reduce the cost of the care in the community and entail more economical use of the facilities and staff. The HoNOS proved to be a concise and simple instrument, which could become a useful tool in monitoring the outcome of healthcare in longstay patients.

Aged↗

Future directions for neurobehavioral studies of environmental neurotoxicants.

Three proposals for enriching neurobehavioral toxicology studies are discussed. First, while IQ has proven useful as a primary endpoint, such apical measures are limited: they obscure important individual differences, tend to reflect the product rather than the process of learning, sample a limited range of intelligent behaviors, and are insensitive to critical outcomes such as learning disabilities. In terms of societal disease burden, behavioral and psychiatric morbidities might be even more important than cognitive morbidities. Such endpoints warrant careful attention. Second, the models of child development can be enriched, increasing our ability both to control for confounding bias and to evaluate potential modification of neurotoxicant effects by contextual factors. While the use of the Home Observation for Measurement of the Environment (HOME scale) and other measures of family-level proximal factors was an important advance, recent sociological work demonstrates the importance of broader conceptualizations of the ecology of child development (e.g. neighborhood and community characteristics). Third, much effort has been expended in attempts to identify the behavioral signature associated with exposure to a particular neurotoxicant. Given the limited success in identifying behavioral phenotypes even for well-characterized genetic disorders (e.g. Fragile-X, Williams, Velocardiofacial syndromes), the prospects seem grim for identifying specific and relatively invariant patterns in the expression of neurotoxicant effects across diverse dosing regimens and biological and cultural settings. In part this results from the likely influence of complex, but largely unknown, patterns of effect modification on the expressions of toxicity. Efforts to define the nature of these contingencies might be more productive than continued efforts to identify behavioral phenotypes.

Animals↗

Outcome value and early warning indications as determinants of willingness to learn from experience.

In this study of willingness to learn from experience, it was hypothesized that managers would show a negative outcomes bias, that is, a stronger tendency to initiate "learning-from-experience" processes after negative outcomes than after positive outcomes. Another aim of the study was to explore the impact of the existence of early warning signals about decision outcomes on the magnitude of the negative outcome bias. Eighty-three managers were asked to read vignettes describing a managerial decision and its outcomes. The outcomes were either positive or negative, and in half of the cases early warning signals existed that made it possible to predict potential negative outcomes while in the other half there were no such signals. The managers were asked to evaluate the need for a learning-from-experience process in general and to rate the degree to which several specific learning processes should be instituted in each of the scenarios. As hypothesized, a negative-outcome bias was found. The more negative the outcomes described, the stronger the managers' inclination to recommend a more intensive learning process. Similarly, a need to ensure control and follow-up procedures was reported mostly after negative outcomes. The existence of early warning signals before the decision was taken did not influence the motivation to learn. Theoretical implications regarding the impact of negative outcomes in general and implications for understanding learning from experience processes in particular are discussed.

Affect↗