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PubMed1992

[Better listening, better information, better teaching. Lessons of our incompetence].

Short excerpts of conversations held during medical consultations permit analysis of a whole range of poorly adapted attitudes and thus demonstrate the possibility for improvement of affective contact, confidence and efficacy. It is recommended to: listen more attentively, avoid interruptions, excuses, simplifications, interpretations and premature information and to learn to repeat the flow of thoughts of the patient; inform more adequately without usage of medical terminology, abstain from confused explications, frequent change of subject, imprecision and attitudes forcing the patient into an inferior role; improve teaching of the patient by proposing distinct goals and by inviting him to find solutions to his problems by learning from errors, this without patronising and under consideration of the attitude of the patient towards his disease.

Attention↗
PubMed2001

A randomized trial comparing the effectiveness and preference of a touch-screen computer system with a leaflet for providing women with information on urinary symptoms suggestive of detrusor instability.

OBJECTIVES: To evaluate how well women learned and retained information given to them by either a leaflet or a computer-generated information system, and which system they preferred to use for obtaining information about urinary symptoms. SUBJECTS AND METHODS: Forty women answered 11 questions on the aetiology, investigation and treatment of lower urinary tract symptoms. They were then randomized to use one of the information systems for 20 min, after which they answered the same urological questions. The women then crossed over to use the other information system for 20 min and afterwards completed a preference questionnaire. RESULTS: The mean baseline scores from a possible total of 11 were 3.9 and 4.3 for the computer and leaflet groups, respectively. The mean improvements in scores were 3.6 (P < 0.001) and 2.8 (P < 0.001) for the computer and leaflet groups, respectively. Both information systems were well liked by all of the women and 26 (65%) said they would prefer to use a computer-generated system in the future if given a choice. CONCLUSIONS: Women significantly increased their knowledge of urinary problems after using a computer-generated information system or a leaflet. Although there were few subjects, there appeared to be a trend for the computer system to be both better liked and slightly more effective.

Adult↗
PubMed1998

Observational learning and the use of retrieval information during the second and third years.

The authors report 2 cross-sectional studies dealing with observationally derived acquisition of serial and sequentially coordinated activities in children between 12 and 30 months. In Study 1, greater improvements in activity occurred at every age beyond 12 months for modeling than for control groups, demonstrating age-related advances in ability to use modeling in connection with these action classes. However, significant gains did not imply complete reconstruction from memory, which resulted most typically for fewer than 50% of children. Moreover, when sequential tasks were subdivided on the basis of task demands, somewhat greater observationally derived change was found for the class of constrained tasks than for free-standing tasks. Study 2 concentrated on serial task performance and the use of massive retrieval cues in the form of assembled stationary displays, to test the efficacy of such cues in helping children reproduce the serial activities they had observed. Again, children who witnessed modeling were better at reproducing serial assemblies than control-group children. The use of retrieval information, however, was noticeably lacking as late as 22 months, whereas substantial gains were made over the next 6 months. The outcome was supported by exploratory processing results for the 2 ages. Increased use of the cues by 28 months appears to reflect important developments in awareness of the uses to be made of retrieval information, as well as success in its utilization.

Attention↗
PubMedDate not supplied

Trends in undergraduate medical education: clinical clerkship learning objectives.

OBJECTIVE: To assist and inform the process of revising learning objectives for the psychiatry clerkship, a comprehensive review of the current state of learning objectives endorsed by national specialty organizations for core clinical clerkships was undertaken. METHODS: National specialty organizations that have developed and endorsed clerkship learning objectives were identified and learning objectives and support materials were reviewed. RESULTS: All core clinical clerkships have learning objectives developed and endorsed by national specialty organizations. The format for organizing these learning objectives varies widely among specialties from lists of topics of interest to exhaustive curriculum resource guides. Most specialty clerkship learning objectives have undergone extensive revision since 2000 or are currently in the revision process. Comparisons and trends in specialty clerkship learning objectives and curriculum resources are discussed. CONCLUSIONS: Revision of psychiatry clerkship learning objectives will benefit from adoption of features utilized by other specialties, including: prioritizing objectives; emphasizing contextual learning and skills mastery; linking learning objectives to support resources such as clinical cases, recommendations for instructional methodology, assessment strategies, and performance expectations; and shifting the focus of undergraduate psychiatry education beyond the clerkship to the entire four-year curriculum.

Clinical Clerkship↗
PubMed1986

Absorption, metabolism, and excretion of di(2-ethylhexyl) phthalate by rats and mice.

There is convincing evidence in the literature that most of the adverse biological effects of phthalate diesters are actually effects of metabolites rather than of the parent compounds. If so, the dramatic species differences in endpoint metabolic profiles make it essential that metabolism of phthalates be understood in detail, including the factors that may alter the metabolism. A metabolic pathway for phthalates having saturated alkyl groups has been postulated based on identification of metabolites produced in vivo and excreted in urine. The first few steps in the postulated pathway have been confirmed in vitro using enzymatically active preparations from rats and mice; some details of the nature of these early steps have been learned. Although some information concerning later steps is available, much remains to be learned in this area. Species differences are postulated to involve kinetics of several biochemical and physiological events acting in concert or competition. Among these interacting factors are competition of at least three enzymes for phthalate monoesters as substrate, relative kidney clearance rates for different metabolites, relative Km values of oxidative enzymes for the same precursors in different species, and relative equilibria between glucuronide formation and hydrolysis. Essential information that must be obtained in the future includes which metabolites play a causal role in which biological effects, and what factors (age, diet, state of health, etc.) can modify the metabolism of phthalate esters and in what way.

Animals↗
PubMed2004

Situated learning theory: adding rate and complexity effects via Kauffman's NK model.

For many firms, producing information, knowledge, and enhancing learning capability have become the primary basis of competitive advantage. A review of organizational learning theory identifies two approaches: (1) those that treat symbolic information processing as fundamental to learning, and (2) those that view the situated nature of cognition as fundamental. After noting that the former is inadequate because it focuses primarily on behavioral and cognitive aspects of individual learning, this paper argues the importance of studying learning as interactions among people in the context of their environment. It contributes to organizational learning in three ways. First, it argues that situated learning theory is to be preferred over traditional behavioral and cognitive learning theories, because it treats organizations as complex adaptive systems rather than mere information processors. Second, it adds rate and nonlinear learning effects. Third, following model-centered epistemology, it uses an agent-based computational model, in particular a "humanized" version of Kauffman's NK model, to study the situated nature of learning. Using simulation results, we test eight hypotheses extending situated learning theory in new directions. The paper ends with a discussion of possible extensions of the current study to better address key issues in situated learning.

Humans↗
PubMed2001

Obstacle avoidance during human walking: learning rate and cross-modal transfer.

1. The aim of this study was to investigate the significance of specific afferent information during motor learning. Blindfolded subjects stepped over an obstacle on a treadmill while different stimuli (acoustic (ACU), somatosensory (SOM) and light flash (LED)) signalled the approaching obstacle. The effect of the above stimuli was then evaluated and compared to full vision (VIS) locomotion. In the non-visual conditions feedback information about the performance was provided by an acoustic signal. 2. Using each of the different stimuli for information the level of subject performance was assessed by noting foot clearance and analysing both leg muscle electromyographic activity and movement trajectories during three successive runs. Each of these runs consisted of 100 steps over the obstacle. 3. The best performance at the onset of the first run was achieved during the VIS condition. When the VIS condition (run 1 + 2) was followed by ACU or SOM information or when the ACU condition (run 1 + 2) was followed by LED, little cross-modal transfer (CMT) occurred, i.e. adaptation in run 3 started again at a low level of performance. In contrast, if adaptation started with ACU stimuli followed by SOM stimuli, almost full CMT occurred. The absolute level of performance achieved after the second or third runs was similar in the VIS and non-VIS conditions. 4. In conclusion, the course of motor learning depends on specific afferent information, and feedforward control has a special influence on the performance only at the onset of the experiment but not on the rate of learning. The fact that little CMT occurs from visual to non-visual stimuli and from ACU to LED suggests that visual afferent input is processed in a different way to non-visual stimuli.

Acoustic Stimulation↗
PubMed2004

Electronic Patient Information -- Pioneers and MuchMore. A vision, lessons learned, and challenges.

OBJECTIVES: This paper must fulfill three different tasks: First, to introduce the topic "Electronic Patient Information -- Pioneers and MuchMore", second, to introduce the invited authors of the symposium, and third, to serve as the author's academic farewell lecture as professor emeritus. RESULTS: The electronic patient record, with all its different kinds of patient information, can be structured in many ways. Here, an historical approach is presented with a primary focus on the development of an information system for in- and outpatients in Germany, especially in Frankfurt, but also in comparison with US systems. The "Stone Age" and "Bronze Age" of patient-related computer applications started with expensive and insufficient hardware, but some years later, the first systems for patient documentation, text generation, and data acquisition could be implemented. The "iron age" and "golden age" yielded until the mid-1970s, e.g. in Oakland, Boston, Salt Lake City, and Frankfurt, quite successful Hospital Information Systems with some special emphasis on natural language processing. The following dark years were filled primarily with administrative systems, but beginning in the early 1980s, an era of enlightenment started, e.g. with rather inexpensive and easy to use PC application, broadly distributed MUMPS systems, and improved thesaurus-based text analysis. Especially in modern times, the medical text processing and classifying has been extended and successfully applied. CONCLUSIONS: Somewhat in contrast to other approaches, in the future the use of medical linguistics for the development of a successful electronic patient record should be better supported. Electronic patient information should be available wherever and whenever needed. For this, intelligent and automated reporting and controlled data exchange is necessary. The computer should do all classification, coding, and administrative work, and the physician should get all relevant information necessary for decision making.

Diffusion of Innovation↗
PubMed2004

Types of college student-to-student learning: correlated interactions.

209 college men and 327 college women took a 20-item Likert survey to assess the types of education-related information students may learn from other students during their informal interactions. Students were very likely to ask other students low level questions such as which professors were good and which classes to take. They were less likely to ask other students about concepts discussed in class and how to solve problems generated in class. If students asked about test taking, these students were also likely to ask about study skills and writing skills for the class. Other research suggests these higher level help-seeking behaviors seem to be related to classroom mastery and achievement.

Adolescent↗
PubMed2003

Long-term improvements in cognitive performance through computer-assisted cognitive training: a pilot study in a residential home for older people.

The aim of the present pilot study was to investigate the effects of computer-assisted cognitive training on aging-associated memory deficits, information processing speed, learning, and interference tendency in older people. Residents of a home for older people (15 women, four men; mean age 83.5; range 75-91) participated in a 14-week computer-assisted cognitive training program. The Niirnberg Aging Inventory and the California Verbal Learning Test were administered prior to the program, immediately after the program and after a period of five months to assess the effectiveness of the cognitive training. After the cognitive training program there were significant improvements in primary working memory and also secondary working memory (for verbal and visual stimuli), on parameters of information processing speed, learning and interference tendency. Improvements in the last two cognitive parameters were maintained five months after completion of the training program. The present study indicates that computerized cognitive training programs can be used in older people to achieve long-term improvements in some important aspects of fluid intelligence. It is suggested that computers could be employed more extensively to prevent and treat cognitive deficits in older people.

Aged↗
PubMed1996

Ethical principles and informed consent: an NIMH perspective.

In conclusion, several points are worth emphasizing at this juncture: 1. Clinical researchers must attend to a set of ongoing concerns in new ways and reconsider how best to explain research protocols to potential subjects. Consent procedures and documents 5 or 10 years old may not be considered adequate by current standards. It is clearly important to ensure that consent documents, and the process by which informed consent is obtained and maintained, are state-of-the-art. 2. Many valuable sources of information are available to help researchers, family members, and potential participants learn about proper informed consent. NIMH is taking steps to improve this educational process. Members of IRBs are educated through conferences, newsletters, case books, etc. OPRR (May 1994) has also provided considerable information relevant to informed consent in clinical research. OPRR and NIMH staff may be useful sources of information concerning informed consent. 3. Research on competency and the consent process itself is needed so we can compare what was explained with what was understood and learn what research subjects want to know, what they believe has occurred, and why. 4. Progress in discovering the underlying causes of schizophrenia and other severe mental disorders, and improving their treatment, will require scientifically rigorous studies involving people affected by these disorders. Attempts to prohibit competent people with mental disorders from making decisions about participating in research protocols seem misguided, paternalistic, and stigmatizing. If we are to improve the treatment of severe mental disorders, clinical research is essential, including research that is not likely to directly benefit each individual participating. 5. This is a time of great opportunity for clinical research. New medications being tested have the potential to revolutionize the treatment of severe mental disorders. During recent years, a number of large scale projects have been focusing on underlying genetic vulnerability factors that may shed light on the etiology of these disorders, with profound implications for diagnosis, treatment, and eventually even prevention. Unfortunately, clinical research is also under attack on several fronts, including concerns about consent and the protection of human subjects with mental disorders. If we do not take steps now to ensure that the process by which we protect and inform research participants is state-of-the-art, the very progress we seek will be at risk.

Animals↗
PubMed1998

Information frames: a new multimedia approach to Web-based learning of biology and medicine.

Presentation of content in hyperlinked multimedia formats for teaching has failed using the computer's power of navigation through rich visual and auditory information. We have developed "Information Frames", an authoring tool in hypertext markup language (html) format, that allows easy utilization by technology-challenged teachers and professors, and attracts students because of interactive, design-based learning. An Information Frame contains a definition, explanation and illustration of a single concept. Topics are provided with hyperlinks to other Information Frames having related concepts that may provide prerequisite knowledge, or may raise the concept to a more integrative level. A graphical view of the linked-Information Frames presents a Concept Map of the overall topic.

Computer Communication Networks↗
PubMed2005

Self-organizing learning array.

A new machine learning concept--self-organizing learning array (SOLAR)--is presented. It is a sparsely connected, information theory-based learning machine, with a multilayer structure. It has reconfigurable processing units (neurons) and an evolvable system structure, which makes it an adaptive classification system for a variety of machine learning problems. Its multilayer structure can handle complex problems. Based on the entropy estimation, information theory-based learning is performed locally at each neuron. Neural parameters and connections that correspond to minimum entropy are adaptively set for each neuron. By choosing connections for each neuron, the system sets up its wiring and completes its self-organization. SOLAR classifies input data based on the weighted statistical information from all the neurons. The system classification ability has been simulated and experiments were conducted using test-bench data. Results show a very good performance compared to other classification methods. An important advantage of this structure is its scalability to a large system and ease of hardware implementation on regular arrays of cells.

Learning↗
PubMed1991

Knowledge acquisition and information searching strategies in diagnostic decision making.

The effect of three learning procedures on diagnostic information searching strategies was investigated. Undergraduate students acquired an artificial knowledge domain through either a Taxonomic-, Inductive-, or Case-oriented knowledge acquisition procedure. The use of the competing-hypotheses heuristic as a practical strategy to guide decision making in the face of uncertainty, was compared among the three learning conditions and between each condition and a non-learning control group using the method developed by Kern and Doherty (1982) and Wolf et al. (1985). The small instruction intervention had an effect on the diagnostic nature of subjects' information-searching strategies. Subjects in the Inductive-learning condition exhibited a stronger tendency to seek diagnostically worthless information than the other learning conditions. The outcomes are considered relevant to the nature of expertise in decision making, and to the effect of instruction methodologies on the knowledge representations available to diagnostic classification and decision-making processes.

Diagnosis↗
PubMed2006

The learning processes of international students through the eyes of foreign supervisors.

Semi-structured interviews were conducted with external supervisors of international electives undertaken by Dutch undergraduate students, in order to gain insight into student learning processes during these electives. The interviews served to triangulate information on these learning processes that was obtained from students' self-reports. The results of the case study reported in this paper were largely consistent with findings from prior studies of international electives in which learning processes and sociocultural differences were examined: experiential learning processes appeared to dominate and sociocultural differences occasionally seemed to blur productive learning, especially when the differences between the national cultures of host country and student home country were substantial. It is recommended that students' experiential learning from international electives should be supplemented with 'guided' and 'self-directed' learning with a focus on the sociocultural dimension.

Australia↗