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PubMed1986

Associative factors in the effects of morphine on self-stimulation.

These experiments tested the hypothesis that the suppressing and facilitating effects of morphine on intracranial self-stimulation (ICS) (measured 1 h and 3 h post-injection, respectively) are influenced by associative, non-pharmacological factors. Experiment 1 confirmed previous demonstrations that the facilitation of ICS by morphine (10 mg/kg) develops with repeated drug exposures. Once ICS facilitation had developed, the effect was mimicked by saline injection in most subjects. In a separate group of animals, previous exposure to morphine in the home cage prevented drug-induced facilitation of ICS. Tolerance to ICS suppression developed after repeated pairings of the drug and the ICS chambers, but not when the drug had previously been received in the home cage. Experiment 2 examined the effect of low (0.3, 1, 3 mg/kg) doses of chronic morphine on ICS. Facilitation was observed with 1 and 3 mg/kg, but only after repeated testing. Naloxone (0.1 and 1 mg/kg) failed to reverse facilitation in a number of these subjects. In Experiment 3, animals receiving their daily injections of morphine were allowed to self-stimulate only at 3 h post-injection (when ICS facilitation is usually maximal), rather than at 1 h and 3 h post-injection. ICS facilitation was not observed, even with repeated testing. These data indicate that the facilitation of ICS by morphine is the outcome of a learned association between drug administration and the ICS procedure, rather than the invariable result of opiate receptor activation. Repeated exposure to morphine is required for the initial establishment of ICS enhancement, but the subsequent expression of this behavior is not directly related to opiate receptor activity.

Animals↗

PubMed2005

Introducing ethics across the curriculum at South Dakota School of Mines and Technology.

This paper describes how the Electrical and Computer Engineering Department at South Dakota School of Mines and Technology has chosen to integrate ethics into their curriculum. All university freshmen engineering students are introduced to ethics through the presentation of ethical dilemmas. During this exercise, students are forced to argue both sides ('for' and 'against') of a hypothetical ethical engineering dilemma. It provides a setting for great discussion with the desired outcome that they learn to carefully analyze a situation before they draw conclusions. In the sophomore year, students are introduced to methods to use the fundamental principles, the fundamental canons, and the suggested guidelines for use with the fundamental canons of ethics when analyzing appropriate action to be taken when confronted with ethical dilemmas. We currently use the 'sophomore' method for seniors because the sequencing is just beginning. Next year the seniors will do more in-depth analysis of ethical case studies.

Curriculum↗

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↗

PubMedDate not supplied

Women's health care issues for medical students: an education proposal.

This outline of objectives in women's health care education is intended to provide a model for reviewing medical school curricula by interdisciplinary educators on a national basis to identify core knowledge, skill, and attitudes for medical student education. Review of the core objectives identified for internal medicine, pediatrics, family medicine, and surgery allows us to identify those that are essential to good patient care so they can be reinforced and evaluated at various outcome points. Developing learning objectives that are complementary rather than additive, that clarify important objectives for students, that bring course directors into collaborative communication, and that ultimately improve communication will require an atmosphere of cooperation among disciplines.

Adolescent↗

PubMed2005

Formal training in advanced surgical technologies enhances the surgical residency.

INTRODUCTION: Surgeons have been consistently instructed to use better tools by which to improve upon a patient's medical care. Since the first laparoscopic cholecystectomy, the desire for advanced surgical technologies has continued. This surgical breakthrough has been one of many changes in modern surgical and medical therapy that now represents the standard of care. The aim of this article is to examine the changes in surgical technologies that occurred in the past 15 years, evaluate the possible solutions that have been discussed and formally present the results of a formal training rotation in advanced surgical technologies at the University of Louisville, Department of Surgery. METHODS: Questionnaires were sent to 36 former residents who had completed the residency and the advanced surgical technologies rotation to evaluate the success of their training. RESULTS: From its inception in 1998 to 2004, the residents have performed a total of 1097 procedures, or an average of 35 cases per month. Much of the exposure was gained in advanced laparoscopy, including laparoscopic nissen fundoplication, gastric band, gastric bypass, splenectomy, colon resection, small-bowl resection donor nephrectomy, and hepatic ablation. Similarly, an evaluation of the 2 procedures that in the late 1990s were considered advanced surgical procedures--sentinal node biopsy and endovascular procedures--shows that the number of these procedures performed on this rotation has fallen over the past 2 years. The overall impression of the rotation from these former residents was either integral or essential in 70% and was helpful in 20%. CONCLUSION: The number of demands impacting medical education have never been this numerous or complex. The rapid advances in science, systems, and information technology provide numerous advances in surgical training that continue to be the requirement and responsibility of general surgical training. The cultural changes in surgery include the team approach to provide services in surgical technologies, focus on the aging population, and outcomes assessment. The learning curve, for any and all of these procedures, is inevitably steep, and traditional resident training too often focuses on the more conventional procedures done in routine rotations. The need for formal training in advanced surgical technologies continues to be of utmost importance in these rapidly evolving times.

Adult↗

PubMed2005

Laparoscopic radical prostatectomy--the experience of the German Laparoscopic Working Group.

PURPOSE: To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome. MATERIAL AND METHODS: The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases. RESULTS: Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages. CONCLUSIONS: The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.

Adult↗

PubMed2005

Building postgraduate capacity in medical and public health research in Vietnam: an in-service training model.

In Vietnam, needs to update medical and public health research capacity, but advanced training in research methodology in universities is still very limited. The first university-certified research training course aimed at physicians was conducted in Ho Chi Minh City in 2000. This paper describes the processes, outcomes and lessons learned from the project, to enable the training course to be repeated to increase research capacity among health professionals in Vietnam and other developing countries. Based on needs assessment, the 9-month, part-time course offered advanced training in practical research skills, including epidemiology, biostatistics and qualitative research methods. Thirty-seven trainees (teaching staff, interns and clinicians) completed the course, which included four group research projects. With active support from university management, the course was rigorous and participation was excellent. Trainees's knowledge of research methodologies increased, and their self-evaluation of achievement of the training objectives was high. The total score of the epidemiology and biostatistics test improved from 56% (median) in the pre-course test to 83% in the post-course test. The group research project results were disseminated through a conference and publication in peer-reviewed journals. The course has since been repeated twice as a 1-month intensive course to accommodate trainees from distant regions. This type of rigorous in-service research training at universities and teaching hospitals in developing countries appears to be an effective, sustainable approach. It also holds promise for producing research data that are responsive to a country's own needs and which are likely to be applied in health policy and practice. Further evaluation of the impact and cost of such models is indicated.

Biomedical Research↗

PubMed2006

Studying primate learning in group contexts: Tests of social foraging, response to novelty, and cooperative problem solving.

Learning commonly refers to the modification of behavior through experience, whereby an animal gains information about stimulus-response contingencies from interacting with its physical environment. Social learning, on the other hand, occurs when the same information originates, not from the animal's personal experience, but from the actions of others. Socially biased learning is the 'collective outcome of interacting physical, social, and individual factors' [D. Fragaszy, E. Visalberghi, Learn. Behav. 32 (2004) 24-35.] (see p. 24). Mounting interest in animal social learning has brought with it certain innovations in animal testing procedures. Variants of the observer-demonstrator and cooperation paradigms, for instance, have been used widely in captive settings to examine the transmission or coordination of behavior, respectively, between two animals. Relatively few studies, however, have examined social learning in more complex group settings and even fewer have manipulated the social environment to empirically test the effect of group dynamics on problem solving. The present paper outlines procedures for group testing captive non-human primates, in spacious arenas, to evaluate the social modulation of learning and performance. These methods are illustrated in the context of (1) naturalistic social foraging problems, modeled after traditional visual discrimination paradigms, (2) response to novel objects and novel extractive foraging tasks, and (3) cooperative problem solving. Each example showcases the benefits of experimentally manipulating social context to compare an animal's performance in intact groups (or even pairs) against its performance under different social circumstances. Broader application of group testing procedures and manipulation of group composition promise to provide meaningful insight into socially biased learning.

Animals↗

PubMed2000

[Cost-effectiveness analysis of the treatment of moderate benign prostatic hyperplasia].

OBJECTIVES: To estimate the most cost-effective alternative of treatment of moderate benign prostatic hyperplasia and to learn whether the outcome can be varied by changing the cost or effectiveness of the alternatives. DESIGN: The study is made by a decision tree in order to test the cost-effectiveness (CE) rate of three treatment strategies: a) watchful waiting; if there is no response a drug is administered and if there is no response transurethral resection of the prostate (TURP) is done, b) pharmacological treatment, and if there is no response TURP is done, and c) to apply TURP initially. The treatment is simulated taking 1000 patients with MBPH and testing the outcome of events and probabilities in a two-year treatment and from the point of view of the health system as services supplier. MEASUREMENTS AND RESULTS: Effectiveness is obtained from an american experts' consensus. Only the direct fangible costs are taken into account, in constant 1998 pts. An univariant simple sensitivity analysis is made considering the cost variables of TURP and from the drugs in an acceptable range of +/- 20%, and the effectiveness of the watchful waiting and the pharmacological treatment. The lower cost alternative per improved patient (IP) is the watchful waiting (77,069 pts./IP) followed by the drug treatment (118,656 pts./IP) and lastly the TURP (456,642 pts./IP). Variations in the variable values make no difference in the relative positions of the tested alternatives. CONCLUSIONS: From the pharmacoeconomics point of view the MBPH treatment must be iniciated by watchful waiting, proceeding to drug administration only if there is a positive response and to make use of TURP when the pharmacological procedures have not been effective.

Cost-Benefit Analysis↗

PubMed2005

Laparoscopic nephrectomy: new standard of care?

OBJECTIVE: The pace of implementation of a laparoscopic nephrectomy programme is affected by factors including surgical expertise, case load, learning curves and outcome audits. We report our experience in introducing a laparoscopic nephrectomy programme over a 3-year period. METHODS: From January 2001 to December 2003, 187 nephrectomies were performed (105 by conventional surgery, 82 by laparoscopy). Hand-assisted laparoscopy was used predominantly. The indications for surgery, factors affecting the approach and outcome parameters were studied. A cost comparison was made between patients with similar-sized renal tumours undergoing laparoscopic versus open surgery. RESULTS: Most operations were performed for malignancy in both the open (70%) and laparoscopic (67%) surgery groups. The laparoscopic approach was most commonly used in upper tract transitional cell cancers (TCCs; 70% of 30 patients) and benign pathologies (49% of 35 patients), followed by radical nephrectomies (34% of 99 patients) and donor nephrectomies (44% of 23 patients). There was a rapid rise in laparoscopic surgeries, from 30% in 2001 to 58% in 2002. The median hospital stay was 5.8 days in the laparoscopic group and 8.1 days in the open surgery group. The procedure cost for laparoscopic surgery was 4,943 dollars compared with 4,479 dollars for open surgery. However, due to a shorter hospital stay, the total hospital cost was slightly lower in the laparoscopic group (7,500 dollars versus 7,907 dollars). CONCLUSION: The laparoscopic approach for various renal pathologies was quickly established with a rapid increase in the number of laparoscopic procedures.

Humans↗

PubMed2003

Quality of life pilot intervention for breast cancer patients: use of social cognitive theory.

OBJECTIVE: The purpose of this article is to evaluate an 8-week pilot intervention based on Social Cognitive Theory to improve quality of life for women with breast cancer. METHODS: A total of 32 breast cancer patients were randomized to either the intervention or standard care. Outcome variables included quality of life, mood, self-efficacy, outcome expectations, and self-regulation. RESULTS: Effect sizes were calculated to examine the impact of the intervention, with moderate to large effect sizes found for several subscales of the outcome expectations variable: learning about cancer and treatment (d = 0.85), having a positive attitude (d = 0.54), talking about cancer (d = 1.02), engaging in relaxation (d = 0.62), and setting goals (d = 1.58). SIGNIFICANCE OF RESULTS: A nonparametric sign test was conducted, indicating that women in the intervention condition either improved more or showed less decline than the women in standard care, p = .034, two-tailed. Implications and suggestions for the content and delivery of future psychosocial interventions with cancer patients are reviewed.

Adult↗

PubMed1998

Teaching critical thinking for transfer across domains. Dispositions, skills, structure training, and metacognitive monitoring.

Advances in technology and changes in necessary workplace skills have made the ability to think critically more important than ever before, yet there is ample evidence that many adults consistently engage in flawed thinking. Numerous studies have shown that critical thinking, defined as the deliberate use of skills and strategies that increase the probability of a desirable outcome, can be learned in ways that promote transfer to novel contexts. A 4-part empirically based model is proposed to guide teaching and learning for critical thinking: (a) a dispositional component to prepare learners for effortful cognitive work, (b) instruction in the skills of critical thinking, (c) training in the structural aspects of problems and arguments to promote transcontextual transfer of critical-thinking skills, and (d) a metacognitive component that includes checking for accuracy and monitoring progress toward the goal.

Adult↗

PubMed1997

Selective and nonselective associations between speech segments and faces in human infants.

The role of affective correspondence between signal and outcome in associative learning was studied in 2 experiments with 4-month-olds. In Experiment 1, an infant-directed (ID) speech segment, categorized by adults as having consoling acoustic properties for infants, was either paired or unpaired with smiling or sad face reinforcers. In other groups, a sad adult-directed (AD) speech segment signaled the smiling or sad faces. Later, all speech segments were tested for their ability to increase infants' visual interest in a checkerboard. Positive summation was observed only when the consoling ID speech segment had signaled the sad face. In Experiment 2, an arousing ID speech segment signaled the smiling or sad face. Positive summation was evident in both conditions. These results show that infants sometimes selectively associate speech segments and faces. Discussion centers on the basis for the selective association.

Association Learning↗

PubMed2002

Linguistic ability and early language exposure.

For more than 100 years, the scientific and educational communities have thought that age is critical to the outcome of language learning, but whether the onset and type of language experienced during early life affects the ability to learn language is unknown. Here we show that deaf and hearing individuals exposed to language in infancy perform comparably well in learning a new language later in life, whereas deaf individuals with little language experience in early life perform poorly, regardless of whether the early language was signed or spoken and whether the later language was spoken or signed. These findings show that language-learning ability is determined by the onset of language experience during early brain development, independent of the specific form of the experience.

Acoustic Stimulation↗

PubMed2002

Perceptions of goal-directed activities of optimists and pessimists: a personal projects analysis.

In this research the authors examined the relationship between optimism and personal projects in a community sample. Three hundred twenty-five community volunteers completed the Personal Projects Analysis (PPA; B. R. Little, 1983) and measures of self-reported optimism and sociodemographic information. Participants who reported high levels of optimism rated their idiosyncratic personal goals significantly higher on PPA factors reflecting Positive Identity Fulfillment and Mastery-Control and significantly lower on the factor reflecting Perceived Strain than did participants who reported low levels of optimism. After the impact of age and education on optimism were statistically controlled, the Perceived Strain and Mastery-Control factors made significant contributions to the prediction of self-reported optimism in both initial and cross-validation samples. Findings indicate that highly optimistic individuals can be differentiated from their less optimistic peers on the basis of their perceptions of idiosyncratic goals. From an expectancy valence perspective, such differences have a direct bearing on individuals' behavior and may be associated with outcomes such as learned helplessness and procrastination.

Achievement↗

PubMed2005

Psychological and stress hormone correlates in early life: a key to HPA-axis dysregulation and normalisation.

Substantial recent research has focused on examining hormone indicators of psychosocial stress and on how relationships between stress and hormone changes might be linked to chronic illness. Particular attention has been paid to disease progression in cancer and HIV/AIDS. This focus has generated a plethora of research which has contributed both theoretically and clinically to the understanding of disease experience and the rate of disease progression. Measurement of salivary cortisol levels and diurnal variation has substantially advanced research methodology. Applying the unifying concept of allostasis and accumulated lifetime stress, this review attempts to assess the relevance of psychological and stress hormone correlates to disease resistance and health, through an examination of such correlates on the experience and outcomes of stress during childhood. Focus is on the role and importance of naturalistic social stress experiences such as school transition in healthy children, with emphasis on salivary cortisol as an endocrine marker of HPA-axis activation. It is argued that differing research perspectives offer valuable insight into the often assumed but largely unexplored links between early life experience and subsequent physical health outcomes in adulthood. Longitudinal studies incorporating measures of acute physical health outcome and of learning and memory are clearly needed.

Adult↗

PubMed2003

The Vanderbilt Professional Nursing Practice Program, part 3: managing an advancement process.

Consistency of performance standards across multiple clinical settings is an essential component of a credible advancement system. Our advancement process incorporates a central committee, composed of nurses from all clinical settings within the institution, to ensure consistency of performance in inpatient, outpatient, and procedural settings. An analysis of nurses advanced during the first 18 months of the program indicates that performance standards are applicable to nurses in all clinical settings. The first article (September 2003) in this 3-part series described the foundation for and the philosophical background of the Vanderbilt Professional Nursing Practice Program (VPNPP), the career advancement program underway at Vanderbilt University Medical Center. Part 2 described the development of the evaluation tools used in the VPNPP, the implementation and management of this new system, program evaluation, and improvements since the program's inception. The purpose of this article is to review the advancement process, review the roles of those involved in the process, and to describe outcomes and lessons learned.

Academic Medical Centers↗

PubMedDate not supplied

A statistical method for development of subconcepts in nursing.

Achievement tests, whether cognitive or performance, often are not analyzed with the intent of detecting subtests within the total test. Subtests should represent unitary concepts. A step-by-step process for detecting subconcepts is proposed and exemplified. Concepts arrived at by the proposed methodology can provide insight to learner strategies for learning and can refine outcome measures to detect effects of the independent variable in teaching-learning investigations.

Achievement↗