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PubMed1990

Halo immobilization: discharge planning and patient education.

A recent trend in the treatment of cervical spine injury is the use of halo immobilization to promote healing and afford earlier mobilization. This article focuses on the role of the nurse in discharge planning and education for patients with halo immobilization. The nurse must evaluate patient and family learning needs in order to plan for home management. Use of a patient education record specific for halo immobilization assists in documenting specific learning needs and outcome criteria.

Fracture Fixation↗

PubMed2004

Image is everything: pearls and pitfalls of digital photography and PowerPoint presentations for the cosmetic surgeon.

BACKGROUND: Cosmetic surgery and photography are inseparable. Clinical photographs serve as diagnostic aids, medical records, legal protection, and marketing tools. In the past, taking high-quality, standardized images and maintaining and using them for presentations were tasks of significant proportion when done correctly. Although the cosmetic literature is replete with articles on standardized photography, this has eluded many practitioners in part to the complexity. A paradigm shift has occurred in the past decade, and digital technology has revolutionized clinical photography and presentations. Digital technology has made it easier than ever to take high-quality, standardized images and to use them in a multitude of ways to enhance the practice of cosmetic surgery. PowerPoint presentations have become the standard for academic presentations, but many pitfalls exist, especially when taking a backup disc to play on an alternate computer at a lecture venue. OBJECTIVE: Embracing digital technology has a mild to moderate learning curve but is complicated by old habits and holdovers from the days of slide photography, macro lenses, and specialized flashes. Discussion is presented to circumvent common problems involving computer glitches with PowerPoint presentations. CONCLUSION: In the past, high-quality clinical photography was complex and sometimes beyond the confines of a busy clinical practice. The digital revolution of the past decade has removed many of these associated barriers, and it has never been easier or more affordable to take images and use them in a multitude of ways for learning, judging surgical outcomes, teaching and lecturing, and marketing. Even though this technology has existed for years, many practitioners have failed to embrace it for various reasons or fears. By following a few simple techniques, even the most novice practitioner can be on the forefront of digital imaging technology. By observing a number of modified techniques with digital cameras, any practitioner can take high-quality, standardized clinical photographs and can make and use these images to enhance his or her practice. This article deals with common pitfalls of digital photography and PowerPoint presentations and presents multiple pearls to achieve proficiency quickly with digital photography and imaging as well as avoid malfunction of PowerPoint presentations in an academic lecture venue.

Documentation↗

PubMed2003

Faculty development: how to evaluate the effectiveness of a faculty development program in emergency medicine.

Evaluation of the effectiveness of any faculty development program (FDP) is crucial to provide assessment of existing programs and to yield valid recommendations for designing future programs that better address the needs of individual faculty members and the sponsoring institutions. The author chose the validated Kirkpatrick's model with four levels of program outcomes (satisfaction data, learning data, performing data, and career change) to evaluate the effectiveness of an FDP in emergency medicine. Assessment of the effectiveness of this FDP can be performed by sponsoring organizations or by independent evaluators experienced in the field for better objectivity.

Emergency Medicine↗

PubMed1997

Recommendations from overweight youth regarding school-based weight control programs.

This study aimed to obtain recommendations from overweight youth on the development of school-based weight control programs; to determine their level of interest in participation; and to learn about the outcomes they desired from such a program. Because obesity is prevalent among youth of certain minority groups and low socioeconomic backgrounds, and since few programs address the needs of these youth, the study population was selected from inner city public schools with high percentages of youth from minority groups and low socioeconomic backgrounds. Sixty-one overweight adolescents participated in semi-structured, in-depth individual interviews, which were audiotaped, transcribed, coded, and analyzed. Findings indicated that many overweight adolescents were interested in participating in school-based weight control programs, provided they are conducted in a supportive manner; offer enjoyable activities; are informative; are sensitive to the needs of overweight youth; and do not conflict with other activities. Adolescents stressed the importance of a program leader who understands the difficulties that overweight youth face, and many expressed their preference for a leader who is currently overweight or had been overweight in the past.

Adolescent↗

PubMed2006

Improving child protection: a systematic review of training and procedural interventions.

AIM: To synthesise published evidence regarding the effectiveness of training and procedural interventions aimed at improving the identification and management of child abuse and neglect by health professionals. METHODS: Systematic review for the period 1994 to 2005 of studies that evaluated child protection training and procedural interventions. Main outcome measures were learning achievement, attitudinal change, and clinical behaviour. RESULTS: Seven papers that examined the effectiveness of procedural interventions and 15 papers that evaluated training programmes met the inclusion criteria. Critical appraisal showed that evaluation of interventions was on the whole poor. It was found that certain procedural interventions (such as the use of checklists and structured forms) can result in improved recording of important clinical information and may also alert clinical staff to the possibility of abuse. While a variety of innovative training programmes were identified, there was an absence of rigorous evaluation of their impact. However a small number of one-group pre- and post-studies suggest improvements in a range of attitudes necessary for successful engagement in the child protection process. CONCLUSION: Current evidence supports the use of procedural changes that improve the documentation of suspected child maltreatment and that enhance professional awareness. The lack of an evidence based approach to the implementation of child protection training may restrict the ability of all health professionals to fulfil their role in the child protection process. Formal evaluation of a variety of models for the delivery of this training is urgently needed with subsequent dissemination of results that highlight those found to be most effective.

Attitude of Health Personnel↗

PubMed2004

An audit of acupuncture in general practice.

An audit was conducted to determine the effects of acupuncture treatment used in a dedicated clinic in primary care by a GP, starting shortly after first learning acupuncture. The outcome measure was MYMOP2 which was developed into the MYMOP pictorial during the course of the audit to improve patient compliance. Out of 62 patients enrolled in the audit, 55 completed both the initial and follow-up questionnaires: they had a mean age of 56 years, and included 43 women. The overall mean improvement in symptom 1 was 2.0 (standard deviation 1.6) scale points, and the improvement was significant in 30 patients (55%). Twenty-eight patients reported significant improvement in activity (58% of those reporting this section), and 23 patients (48% of those reporting) obtained a significant improvement in wellbeing. Adverse events were minor, though one patient fainted and fell to the floor. Although the conclusions of this audit are limited by its small size, nevertheless the results were generally encouraging, and the authors recommend that acupuncture should be considered for use in primary care for a wide range of complaints.

Acupuncture Therapy↗

PubMed2002

Translating research into action: reducing disparities in mental health care for Mexican Americans.

This article describes a case study in which epidemiologic research findings were translated for multiple stakeholders and applied to reduce disparities in mental health services for Mexican Americans in Fresno County, California. The aims of this evidence-based process were to educate the community and mobilize action, translate research for multiple stakeholders to inform practitioners and policy makers about the need for improved mental health care for minorities, and effect regional policy changes to increase and improve the availability, accessibility, and appropriateness of mental health care for Mexican Americans. Through this process, a community-driven and consumer-oriented model evolved, which resulted in the allocation of resources to expand mental health services in rural areas of Fresno County. The authors discuss the process of translating research into action, key antecedents to an effective outcome, and lessons learned from the process.

California↗

PubMedDate not supplied

A reconceptualization of learning disabilities via a self-organizing systems paradigm.

A dilemma exists regarding the interpretation of learning disabilities. A self-organizing systems (SOS) paradigm suggests widespread, diffuse outcomes, whereas a specific learning disability concept suggests more localized dysfunction. There may be very good reason to doubt the veridicality of the concept of a specific learning disability, not because the construct of learning disabilities itself is a frivolous concept, as some have held, but because the biological or neurological events that underlie a learning disability do not remain focal and constrained only to specific dysfunction. It is important to know whether an identified learning disability remains contained or whether processing disorders might be found in other areas. The assessment profiles of school-age children identified with nonverbal learning disabilities (NLD), assumed to have primarily right-hemispheric brain dysfunctions, and children with language-based learning disabilities (LLD), assumed to have primarily left-hemispheric brain dysfunctions, were examined to explore learning disabilities using an SOS paradigm. The pilot study reported here is used as an exemplar of how a self-organizing systems paradigm is conceptualized. Although a more comprehensive study is needed to confirm the data, this exemplar suggests that overflow into areas not typically associated with each disability subtype may occur. Concerns regarding ways of determining discrepancy for diagnostic purposes are noted, and remediation strategies designed for specific disabilities are questioned.

Adolescent↗

PubMedDate not supplied

A study of certified diabetes educators: influences and barriers.

PURPOSE: There were 2 related goals for this study. The first purpose was to describe the structure (type, staffing, and number of educational sessions provided), process (preferred learning approaches), and outcome measures commonly used to provide patient education. The second purpose was to identify the influences, resources, and constraints that affect and alter the attitudes and practices of diabetes educators. METHODS: A 30-item questionnaire that addressed 4 areas--demographics, practice characteristics, education program structure, and educational processes--was mailed to a sample of American Association of Diabetes Educators members. Three hundred sixty-one registered nurse and registered dietician certified diabetes educators completed the questionnaire and were included in the final analysis. RESULTS: This survey indicated that this group of certified diabetes educators has incorporated new research findings and innovative teaching methods into their practices. They experience few barriers and tend to make changes in their attitudes and practices based on scientific and experiential evidence. The 3 most highly rated influences on these changes were related to patient responses to their teaching, followed by continuing education conferences and new research findings. CONCLUSIONS: Based on these findings, providing continuing education that first and foremost incorporates experience-based examples of effective strategies supported by research published in professional journals appears to have the most influence on the practice of educators.

Certification↗

PubMed2004

"New Choices" for women with addictions: perceptions of program participants.

BACKGROUND: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement. METHODS: A qualitative, exploratory design was used to guide data collection and analysis. Four women participated in a focus group interview and seven women agreed to individual interviews over the course of the program evaluation (N = 11). A semi-structured interview guide was used to explore women's experiences in New Choices and their perceptions of the program and its impact. The interview data were analyzed using NVivo software and an inductive approach to data analysis. RESULTS: The emergent themes captured women's motivations for attending New Choices, benefits of participation, and overall quality of the program. Children were the primary motivating factor for program enrollment. Perceived benefits included decreased substance use, improved maternal health, enhanced opportunity for employment, increased access to other resources, enhanced parenting skills, and improved child behaviour and development. Women highly valued the comprehensive and centralized approach to service delivery that provided a range of informal and formal supports. CONCLUSIONS: Interview findings endorse the appropriateness and potential efficacy of a collaborative, centralized approach to service provision for women with substance use issues. Although the findings provide insight into an alternative model of service delivery for women with addictions, future research is needed to evaluate the effectiveness of the intervention. Research also is needed to determine which program components or constellation of components contribute to desired outcomes, and to learn more about processes that underlie changes in behaviour.

Adult↗

PubMed2006

Knowledge transfer & exchange through social networks: building foundations for a community of practice within tobacco control.

BACKGROUND: Health services and population health innovations advance when knowledge transfer and exchange (KTE) occurs among researchers, practitioners, policy-makers and consumers using high-quality evidence. However, few KTE models have been evaluated in practice. Communities of practice (CoP) - voluntary, self-organizing, and focused groups of individuals and organizations - may provide one option. This paper outlines an approach to lay the foundation for a CoP within the area of Web-assisted tobacco interventions (WATI). The objectives of the study were to provide a data-driven foundation to inform decisions about organizing a CoP within the geographically diverse, multi-disciplinary WATI group using evaluation and social network methodologies. METHODS: A single-group design was employed using a survey of expectations, knowledge, and interpersonal WATI-related relationships administered prior to a meeting of the WATI group followed by a 3-week post-meeting Web survey to assess short-term impact on learning and networking outcomes. RESULTS: Twenty-three of 27 WATI attendees (85%) from diverse disciplinary and practice backgrounds completed the baseline survey, with 21 (91%) of those participants completing the three-week follow-up. Participants had modest expectations of the meeting at baseline. A social network map produced from the data illustrated a centralized, yet sparse network comprising of interdisciplinary teams with little trans-sectoral collaboration. Three-week follow-up survey results showed that participants had made new network connections and had actively engaged in KTE activities with WATI members outside their original network. CONCLUSION: Data illustrating both the shape and size of the WATI network as well as member's interests and commitment to KTE, when shared and used to frame action steps, can positively influence the motivation to collaborate and create communities of practice. Guiding KTE planning through blending data and theory can create more informed transdisciplinary and trans-sectoral collaboration environments.

Journal Article↗

PubMed2004

Lessons learned from the first 100 cases in a new minimally invasive bariatric surgery program.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGBP) is a technically demanding procedure with a steep learning curve. Experienced laparoscopic surgeons and bariatric surgeons can learn from the outcomes and complications of their initial experience in LRYGBP. METHODS: Between August of 2002 and July of 2003, we performed our first 100 LRYGBPs. Our surgical technique involves the ante-colic, ante-gastric placement of the Roux-limb. A 21-mm circular stapler is used to create the gastrojejunostomy. The stapler anvil is placed transgastrically. RESULTS: The mean preoperative BMI was 49.7 kg/m(2) (range 37-70). 12% of patients were male. Early complications (14%) included 3 leaks, 4 bleeding episodes and 2 gastrogastric fistulas. There was 1 peri-operative mortality and 1 conversion to laparotomy. Late complications (17%) included stenosis of the gastrojejunostomy which occurred in 14 patients. Leaks occurred more commonly in males (16% vs 1%, P<0.05). Elevated BMI was also found to be a risk factor for leak (BMI 58.7 leak vs 49.3 no leak, P<0.05). Stenosis was often associated with other complications such as leak or marginal ulcer. Stenosis responded well to endoscopic dilation. Co-morbid medical conditions responded to weight loss in all patients, regardless of initial BMI. Mean excess weight loss was 69% at 1 year, but varied according to preoperative BMI. CONCLUSIONS: Careful recording of patient outcomes and complications is important, particularly in a new minimally invasive bariatric surgery program. Review and analysis of specific complications may help to minimize the occurrence of similar subsequent complications.

Adult↗

PubMed1998

Effects of practice and learner control on short- and long-term gain and efficiency.

This study investigated the effects of practice opportunities and learner control on short- and long-term learning from a computer-based introductory statistics curriculum. In all, 380 participants were assigned to one of five conditions. The first four conditions differed in terms of the number of problems to solve per problem set. The fifth condition allowed learners to choose the amount of practice. A subset (n = 120) of the original participants returned for testing following a six-month interval. Overall, the fixed-practice conditions showed learning gains that varied in relation to the amount of practice (i.e., more was better). The data from the learner-control condition was unexpected, showing learning gains comparable with the most extended practice condition yet the fastest tutor-completion times. We discuss implications of these findings in relation to the design of efficacious instruction. Actual or potential applications of this research include the modification of computer-based instruction that can enhance individuals' learning efficiency and outcome scores.

Adolescent↗

PubMed2003

Evaluating an all-ranks military staff ride.

Outcomes for a staff ride to a Missouri Civil War battlefield by enlisted personnel and officers of the Army Reserve were evaluated. As expected, enlisted personnel and junior officers were much less likely to have participated in a staff ride previously. Nearly all soldiers expressed an interest in going on another all-ranks staff ride, and a statistically significant gain was achieved in expressed interest in American Civil War history. Most personnel agreed or strongly agreed with the concept of an all-ranks staff ride. There were few differences among officers and enlisted personnel in the success of the outcomes evaluated. However, learning seemed to be maximal among those with an intermediate level of previous staff ride experience.

Adult↗

PubMed2003

Using open-source solutions to teach computing skills for student research.

A course that relies on open-source software for teaching introductory computer programming and Web development to psychology graduate and advanced undergraduate students is described. The rationale, content, learning goals and outcomes of the course are described, along with the specific software used. The advantages of relying on open-source solutions rather than commercial software for implementing such a course are discussed.

Computer-Assisted Instruction↗

PubMed2000

The reported quality of condom use by young adult Zimbabwean males at higher learning centres in Harare.

OBJECTIVE: To examine the level of reported quality of condom use by young adult Zimbabwean males at higher learning institutions. DESIGN: A cross sectional descriptive survey. SETTING: Two technical colleges in Harare, Zimbabwe. SUBJECTS: A sample of 400 subjects (200 from each of the higher learning centres). MAIN OUTCOME MEASURES: Reported quality of condom use. RESULTS: All participants were males who had at least completed 'O' levels, or the equivalent of high school. The majority of the participants were single (78.2%), while a fifth (20.2%) were married and the remaining few were separated or living with a partner. Among those who were married about one fifth had children. The majority 136 (36.8%) were Roman Catholic. The mean age of students surveyed was 24 (SD 3.5) years. The reported quality of condom use in the last 12 months in this sample was measured by four items: 24.6% reported using condoms every time; 27.7% put the condom on every time before the penis entered the vagina for the first time; 29.3% still had an erection every time they withdrew from the vagina and 26.9% held onto the condom every time they withdrew. In this study the results indicated that behaviour specific influences i.e. attitudes towards condom use, use of marijuana, the situational influences of bars, and condom self-efficacy were independently predictive of the reported quality of condom use. CONCLUSION: Using the health promotion model the results indicated that marital status, having been shown how to use condoms, attitudes towards condom use and use of marijuana were all independently predictive of the reported quality of condom use.

Adult↗

PubMed1992

School functioning of US children with asthma.

Data from the 1988 US National Health Interview Survey on Child Health, a nationally representative cross-sectional survey, were used to determine national estimates of school outcomes (grade failure, learning disabilities, and suspension/expulsion) and mean number of absences for children with asthma (CWA) compared to well children without current health conditions. Families indicated that 536 (4.9%) of the 10,362 survey children in grades 1 through 12 had had asthma in the previous 12 months. Families reported 18% of CWA vs 15% of well children had grade failure, 9% of CWA vs 5% of well children had learning disabilities, and 5% of CWA vs 6% of well children had been expelled or suspended. Children with asthma averaged 7.6 school days absent compared with 2.5 days for the well group. Multiple logistic regression was used to compare the odds of grade failure, learning disabilities, and suspension/expulsion among CWA and well children, overall and stratified by income. Similar methods were used to assess the role of health status among asthmatic children. After adjustment for demographic factors, CWA had similar risks of grade failure and suspension/expulsion, but 1.7 times the risk of learning disability compared with well children. Also, among families with incomes below $20,000, CWA had twice the odds of grade failure compared with well children. For asthmatic children, reported health status was an important predictor of learning disability. Ten percent of CWA were reported to be in fair-poor health. After adjustment for demographic factors, those in fair-poor health were twice as likely to have a reported learning disability compared with those in good-excellent health.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗

PubMed2003

Evaluation of educational software.

Evaluation is an important component of developing educational software. Ideally, such evaluation quantifies and qualifies the effects of a new educational intervention on the learning process and outcomes. Conducting meaningful and rigorous educational evaluation is difficult, however. Challenges include defining and measuring educational outcomes, accounting for media effects, coping with practical problems in designing studies, and asking the right research questions. Practical considerations that make the design of evaluation studies difficult include confounding, potentially small effect sizes, contamination effects, and ethics. Two distinct approaches to evaluation are objectivist and subjectivist. These two complement each other in describing the whole range of effects a new educational program can have. Objectivist demonstration studies should be preceded by measurement studies that assess the reliability and validity of the evaluation instrument(s) used. Many evaluation studies compare the performance of learners who are exposed to either the new program or a more traditional approach. However, this method is problematic because test or exam performance is often a weak indicator of competence and may fail to capture important nuances in outcomes. Subjectivist studies are more qualitative in nature and may provide insights complementary to those gained with objectivist studies. Several published examples are used in this article to illustrate different evaluation methods. Readers are encouraged to contemplate a wide range of evaluation study designs and explore increasingly complex questions when evaluating educational software.

Computer Simulation↗