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PubMed2003

Different roles for orbitofrontal cortex and basolateral amygdala in a reinforcer devaluation task.

The orbitofrontal cortex (OFC) and basolateral amygdala (BLA) are critical for using learned representations of outcomes to guide behavior. Neurophysiological findings suggest complementary roles in which the BLA acquires associations between cues and outcomes and the OFC subsequently uses them to guide behavior. Here, we have used a reinforcer devaluation paradigm to test this hypothesis. In this paradigm, rats are first trained to associate a light conditioned stimulus (CS) with a food outcome, and then the food is devalued by pairing it with illness. After this devaluation procedure, responding to the CS is assessed in a single probe session. Previously, we have shown that BLA and OFC lesions made before training do not affect the acquisition of conditioned responding but do impair the sensitivity of that responding to reinforcer devaluation. Rats with such lesions fail to exhibit the spontaneous decrease in conditioned responding to the light cue observed in controls in the probe test. Here, we have extended those findings by showing that performance in the probe test is impaired by OFC lesions made after light-food conditioning but not by BLA lesions made after that training. These findings indicate that the OFC and BLA play different roles in mediating normal goal-directed performance in this, and likely other, settings. The BLA seems critical to forming representations linking cues to the incentive properties of outcomes but not for maintaining these representations in memory, updating them with new information, or for expressing them in behavior. In contrast, the OFC seems essential for one or more of these latter processes.

Amygdala↗
PubMed2004

The "every child deserves a medical home" training program: more than a traditional continuing medical education course.

OBJECTIVES: 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels. METHODS: Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child's care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs. CONCLUSION: A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives.

Child↗
PubMedDate not supplied

Comparison of laparoscopic pyeloplasty with and without robotic assistance.

OBJECTIVES: The benefits of laparoscopic surgery with robotic assistance (da Vinci Robotic Surgical System, Intuitive Surgical, Sunnyvale, CA) includes elimination of tremor, motion scaling, 3D laparoscopic vision, and instruments with 7 degrees of freedom. The benefit of robotic assistance could be most pronounced with reconstructive procedures, such as pyeloplasty. We aimed to compare laparoscopic pyeloplasty, with and without robotic assistance, during a surgeon's initial experience to determine whether robotic assistance has distinct advantages over the pure laparoscopic technique. METHODS: We retrospectively compared the first 7 laparoscopic pyeloplasties with the first 7 robotic pyeloplasties performed by a single surgeon. All patients were preoperatively evaluated with computed tomographic angiography with 3D reconstruction to image crossing vessels at the ureteropelvic junction. All patients were followed up by lasix renograms and routine clinic visits. RESULTS: Patients were similar with respect to mean age (34 in laparoscopic pyeloplasty group vs 32 in the robotic pyeloplasty group), operative time (5.2 hours vs 5.4 hours), estimated blood loss (40 mL vs 60 mL), and hospital stay (3 days vs 2.5 days). Two patients in the laparoscopic pyeloplasty group had small anastomotic leaks managed conservatively, and one patient in the robotic pyeloplasty group had a febrile urinary tract infection necessitating treatment with intravenous antibiotics. Another patient in the robotic pyeloplasty group was readmitted with hematuria that was treated conservatively without transfusion. No recurrences were detected in either group. CONCLUSIONS: Operating times and outcomes during the learning curve for laparoscopic pyeloplasty were similar to those for robotic pyeloplasty. Long-term data with greater experience is needed to make definitive conclusions about the superiority of either technique and to justify the expense of robotic pyeloplasty.

Adult↗
PubMed2005

Cooperative learning effects on teamwork attitudes in clinical laboratory science students.

OBJECTIVE: To evaluate clinical laboratory science (CLS) student attitudes toward teamwork when using cooperative learning (CL) as compared to individual learning (IL) in a course and to determine if learning method affects student attitudes toward the course itself. DESIGN/SETTING/PARTICIPANTS: This was a multi-institutional study involving eight classrooms in seven states. The effects of CL and IL on student attitudes were compared for 216 student participants. INTERVENTION: One group of students learned the course material through a CL approach while a second group of students learned via a traditional IL approach. For each course, the instructor, class material, and examination content was identical for the CL and IL students; the only variable was learning method. MAIN OUTCOME MEASURE: Student attitudes toward teamwork and toward the course were evaluated with a 35-item Attitude Questionnaire administered as a posttest. Mean scores for the CL and IL groups were compared using the Student t-test for independent samples. RESULTS: No significant difference was seen between the CL and IL students when assessing the first 30 questions on student attitudes toward teamwork (means = 98.42 and 98.22, respectively) when all institutions were combined. Comparable results were seen for each of the eight institutions. For the five questions comparing attitudes toward the course itself, there usually was no significant difference in attitude between CL and IL students. The only classrooms where CL students had more positive attitudes were those with instructors who had more than 10 years experience with CL. CONCLUSION: Results suggest that CL produces similar student attitudes toward teamwork and toward a CLS course as does IL.

Attitude↗
PubMed2005

Linking primary care information systems and public health information networks: lessons from the Philippines.

Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems.

Community Health Services↗
PubMed2005

Surviving the enrollment growth funding formula.

Leadership changes in universities usually bring about philosophical and operational shifts within the institution. When these shifts involve resource allocation procedures, nursing programs are often highlighted because their costs appear great in comparison to traditional academic units. This was the exact situation at East Carolina University, a case history of which is presented here. Strategies for dealing constructively with this negative situation are outlined, as are lessons learned. A positive outcome required a thorough knowledge of funding processes, faculty involvement in generating solution alternatives, frequent and effective communication, and patience.

Benchmarking↗
PubMed2006

[Quality of nursing education--a review].

Nursing education in Germany is thoroughly characterised by heterogeneous structures and qualifications. Both compared to national and international standards, the education system appears to be very specific and not designed as a permeable qualification system. Additionally, until now quality assurance of nursing education is rarely developed. Where such efforts have been undertaken so far, they have mostly resulted from single initiatives and are based on quality assurance models originally developed for linear production and service processes. However, taking recent developments in vocational training and higher on European level into account, some new impulses for quality assurance and improvement can be expected with regard to German nursing education. A consistent European Qualifications Framework (EQF) is to be designed, which is determined by permeable education structures, transparent as well as comparable education programms and compatible credit point systems (Bologna Process, Copenhagen Process). This framework should be accompanied by a quality assurance system which primarily focuses on learning programms and outcomes. In the future, these changes forced by the EU Member States will influence the area of nursing education in Germany and will require quality assurance efforts which are accordingly structured and aimed.

Curriculum↗
PubMed2005

Linking primary care information systems and public health vertical programs in the Philippines: an open-source experience.

Community-based primary care information systems are one of the building blocks for national health information systems. In the Philippines, after the devolution of health care to local governments, we observed "health information system islands" connected to national vertical programs being implemented in devolved health units. These structures lead to a huge amount of "information work" in the transformation of health information at the community level. This paper describes work done to develop and implement the open-source Community Based Health Information Tracking System (CHITS) Project, which was implemented to address this information management problem and its outcomes. Several lessons learned from the field as well as software development strategies are highlighted in building community level information systems that link to national level health information systems.

Community Networks↗
PubMed1986

Ethical issues in caring for tiny infants.

In the early years of perinatal medicine and heroic programs of saving premature infants, we have witnessed "halfway" technology practiced in an environment of morally simplistic ethics, law, and policy. These practices have led to troubling outcomes. The lessons learned during this difficult phase of perinatal health care now yield to a period characterized by more advanced research, more appropriately applied technology, more sensitive and sensible public policy, and more responsible ethics.

Congenital Abnormalities↗
PubMed1978

Thoughts on aging.

Aging has not received attention in proportion to its effect on the life of every individual. Much of society's reluctance to deal with old age results from "ageism," a personal and cultural dread that stems from a view of aging that sees only the negative aspects. If we are to understand human development, we must learn about its outcome, old age. One means of doing this to listen to the reminiscences of old people. Psychiatrists can apply their special expertise in working to overcome ageism. Current and future legislative and research efforts can help identify and resolve some of the economic and physical problems of the elderly and thereby improve the quality of their lives.

Adolescent↗
PubMed1997

Evaluation of a programme to train Russian émigré nurses.

This project evaluates a curriculum model designed to specifically help Russian émigré nurses overcome major barriers to employment in the United States of America. Training cycles included: vocational English, basic nursing skills, socialization theory, transcultural care theory, clinical preceptorships, job search workshops and NCLEX-RN preparation. Specific learning objectives and outcome criteria were developed, evaluated and adapted for subsequent training cycles based on pilot programme testing.

Curriculum↗
PubMed1997

Developing curricula to promote preventive medicine skills. The Teaching Immunization for Medical Education (TIME) Project. TIME Development Committee.

CONTEXT: Vaccines are underused in the United States, resulting in needless morbidity. Many experts have concluded that clinician education is critical to increasing the nation's vaccination rates. OBJECTIVE: To develop and evaluate case-based curricular materials on immunizations that promote preventive medicine skills. DESIGN: Before-and-after trial of an educational intervention. SETTING AND PARTICIPANTS: Medical schools and primary care residency programs from 20 institutions across the United States participated in the Teaching Immunization for Medical Education (TIME) project. INTERVENTION: A multidisciplinary team developed learning objectives, abstracted clinical cases, and created case-based modules that use contextual learning and small-group interaction to solve clinical and public health problems. The case-based methods are multistation clinical teaching scenarios (MCTS) and problem-based learning (PBL). MAIN OUTCOME MEASURES: Knowledge gained by learners from pretest to posttest and the overall ratings of the sessions by learners and facilitators based on evaluation questionnaires. RESULTS: Pretest and posttest results were obtained on a total of 1122 learners for all modules combined. For the MCTS method, mean scores increased from the 10-item pretest to the posttest by 3.1 items for measles, 3.8 for influenza, 1.8 for hepatitis B, 3.9 for pertussis, 1.9 for adult vaccination, 1.9 for childhood vaccination, and 2.6 for Haemophilus influenzae type b (P<.01 for each). For the PBL method, mean scores increased by 3.4 items for measles, 3.3 for influenza, 2.6 for hepatitis B, and 2.5 for pertussis (P<.01 for each). Most learners (MCTS, 98%; PBL, 89%) and most facilitators (MCTS, 97%; PBL, 100%) rated the sessions overall as very good or good. CONCLUSIONS: Use of TIME modules increases knowledge about immunizations, an essential step to improving vaccination practices of future clinicians. Given the realities of decreased faculty time and budgets, educators face major challenges in developing case-based curricula that prepare learners for the 21st century. Nationally tested libraries of cases such as the TIME modules address this dilemma.

Adult↗
PubMed1998

Mental development and learning disorders in children with single suture craniosynostosis.

OBJECTIVE: This study examined the global intellectual development and presence/absence of learning disorders in children with nonsyndromic metopic, sagittal, and unilateral coronal synostosis who had early surgery (under 1 year of age), late surgery (over 1 year of age), or no surgery to correct the synostosis across three time periods. DESIGN: The design was longitudinal. Children were assessed at initial team evaluation, 1 year after surgery or initial evaluation if surgery was not performed, and annually thereafter. PARTICIPANTS: Participants included 84 consecutively evaluated patients. Seventy-two children were evaluated at Time 1 (T1), 8 months; 57 at Time 2 (T2), 21 months; and 39 at Time 3 (T3), 50 months. Data on learning disorders or mental retardation were available on 34 children who were school age. MAIN OUTCOME MEASURES: The Mental Development Index from the Bayley Scales of Infant Development was the main outcome measure for T1 and T2. The General Cognitive Index from the McCarthy Scales of Children's Abilities was the main outcome measure for T3. Learning disorders were determined from school and clinical records. RESULTS: Repeated measures analyses of variance found no statistical differences in the development of children based on diagnosis or surgical status across time. Base rate of mental retardation at T1 was consistent with normative data; however, the incidence of retardation was two to three times the expected rate at T2 and T3. Learning disorders were present in 47% of school-age children who were not retarded. Chi-square analysis showed no significant differences between rates of retardation or learning disorders based on surgical status. CONCLUSIONS: Most children with nonsyndromic craniosynostosis obtain developmental quotients within the normal range in infancy. Rates of retardation may increase relative to normative expectations as children mature. A high rate of learning disorders was identified. Results are preliminary due to sample size.

Age Factors↗
PubMed2006

Use of handheld computers in medical education. A systematic review.

BACKGROUND: Over the past decade, handheld computers (or personal digital assistants [PDAs]) have become a popular tool among medical trainees and physicians. Few comprehensive reviews of PDA use in medicine have been published. OBJECTIVE: We systematically reviewed the literature to (1) describe medical trainees' use of PDAs for education or patient care, (2) catalog popular software applications, and (3) evaluate the impact of PDA use on patient care. DATA SOURCES: MEDLINE (1993 to 2004), medical education-related conference proceedings, and hand search of article bibliographies. REVIEW METHODS: We identified articles and abstracts that described the use of PDAs in medical education by trainees or educators. Reports presenting a qualitative or quantitative evaluation were included. RESULTS: Sixty-seven studies met inclusion criteria. Approximately 60% to 70% of medical students and residents use PDAs for educational purposes or patient care. Satisfaction was generally high and correlated with the level of handheld computer experience. Most of the studies included described PDA use for patient tracking and documentation. By contrast, trainees rated medical textbooks, medication references, and medical calculators as the most useful applications. Only 1 randomized trial with educational outcomes was found, demonstrating improved learning and application of evidence-based medicine with use of PDA-based decision support software. No articles reported the impact of PDA use on patient outcomes. CONCLUSION: Most medical trainees find handhelds useful in their medical education and patient care. Further studies are needed to evaluate how PDAs impact learning and clinical outcomes.

Attitude of Health Personnel↗
PubMed2005

A web-based tutorial to enhance student learning of activity analysis.

BACKGROUND: This paper describes the impact on learning of a web-based tutorial for the application of activity analysis, with occupational therapy students, at McGill University, Montreal, Quebec. This tutorial offers unique, interactive instructional strategies allowing for self-directed higher cognitive and reflective learning, which has not been possible, to date, in current web-based technology. SCOPE: Through repeated practice, students collaboratively (in dyads) apply concepts of activity analysis, and receive immediate feedback by comparing their answers to a standard. METHODS AND RESULTS: Comparisons of performance outcomes on summative exams before and after implementation of the tutorial are made, suggesting a decrease in variance scores indicating fewer students are falling below the class average. These results are attributed to opportunities to practice activity analysis and to receive immediate feedback. PRACTICE IMPLICATIONS: Web-based instruction can impact student learning if the instructional strategies ensure coherence with all other instructional components, match the learning outcomes, facilitate self-directed and collaborative learning, and allow for practice and feedback.

Canada↗
PubMed2026

Teaching Acute Coronary Syndrome High-Risk ECG Interpretation and Clinical Decision-Making Through FOAMed Videos and Podcast Versus Print-Based Materials Among Emergency Care Providers: Randomized Controlled Mixed Methods Trial.

BACKGROUND: Accurate interpretation of high-risk acute coronary syndrome (ACS) electrocardiograms (ECGs) is essential for early diagnosis and timely reperfusion, yet substantial deficits persist across health care professions. Digital self-learning formats such as FOAMed (Free Open Access Medical Education) are widely used, but their effectiveness has rarely been evaluated for complex, high-risk ACS ECG patterns. Existing ECG education studies often focus on students or single professional groups and established ST-segment elevation myocardial infarction (STEMI) criteria, leaving newer guideline-recognized STEMI equivalents, selected emerging occlusion myocardial infarction (OMI)-related patterns, and interprofessional emergency care underrepresented. OBJECTIVE: This study aimed to compare the effectiveness of FOAMed podcast and videos versus traditional print-based materials for teaching high-risk ACS ECG patterns and related clinical decision-making in emergency providers. METHODS: We conducted a prospective, interprofessional, controlled mixed methods trial across 5 training sites in Germany. Paramedics, prehospital emergency physicians, and emergency department clinicians received either a FOAMed multimedia module or print-based materials through concealed allocation; deviations from the intended 1:1 ratio resulted from participant no-shows. The intervention consisted of a 30-minute supervised self-learning session. In total, 103 participants were allocated to FOAMed (n=45) or print-based materials (n=58). Two coprimary outcomes were assessed: ECG interpretation accuracy and text-based ACS clinical decision-making. Secondary outcomes included subjective confidence, learning experience, and exploratory qualitative free-text responses. Outcome assessment was automated and blinded; mixed ANOVA was the primary analysis. The study was not prospectively registered because it assessed educational outcomes in health care professionals rather than patient health outcomes. RESULTS: All 103 participants completed the study. Both groups improved, with greater gains in the FOAMed group: ECG interpretation increased from 55% to 65.5% and text-based ACS clinical decision-making from 45% to 68%, versus 57% to 60% and from 47% to 63%, respectively, in the print-based group. Effect sizes were &#x3b7;&#xb2;=0.055 for ECG interpretation and &#x3b7;&#xb2;=0.044 for clinical decision-making. Exploratory subgroup analyses provided no evidence of differential effects across age, gender, or professional background and were likely underpowered. Qualitative responses (46 and 37 entries) provided contextual insights into perceived clarity, engagement, and practical relevance supporting the quantitative findings. CONCLUSIONS: This study is innovative in directly comparing a curated FOAMed multimedia module with selected print-based materials in an interprofessional emergency care population. It differs from existing research by focusing on subtle, emerging ischemic patterns and evaluating realistic, time-limited self-learning formats. The findings provide evidence that curated FOAMed resources can produce greater short-term improvements in ECG interpretation and text-based ACS clinical decision-making than traditional print-based materials in this setting. Although implications for clinical performance remain hypothetical, concise, high-quality digital modules may represent a practical supplement to structured continuing education in emergency care.

Humans↗
PubMed2000

Quality in undergraduate nursing programmes: the role of Nursing Council.

This paper looks broadly at issues to do with quality monitoring in higher education and considers the role and focus of the Nursing Council of New Zealand in the approval of and ongoing monitoring of undergraduate nursing degree programmes. It is suggested that the approach taken by the Nursing Council is accountability-led where minimal attention is given to teaching and learning and actual graduate outcomes. This may lead to a mistaken belief that Nursing Council's monitoring focuses on quality or that the outcomes of their monitoring might contribute to programme enhancement. A shift to emphasise learning processes, students and continual improvement in order to enhance programme quality is proposed.

Certification↗