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At least 1,081 records · Page 60Linked to original sources
PubMed2001

Length of stay as a source of bias in comparing performance in VA and private sector facilities: lessons learned from a regional evaluation of intensive care outcomes.

OBJECTIVES: Compare intensive care unit (ICU) mortality and length of stay (LOS) in a VA hospital and private sector hospitals and examine the impact of hospital utilization on mortality comparisons. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Consecutive ICU admissions to a VA hospital (n = 1,142) and 27 private sector hospitals (n = 51,249) serving the same health care market in 1994 to 1995. MEASURES: Mortality and ICU LOS were adjusted for severity of illness using a validated method that considers physiologic data from the first 24 hours of ICU admission. Mortality comparisons were made using two different multivariable techniques. RESULTS: Unadjusted in-hospital mortality was higher in VA patients (14.5% vs. 12.0%; P = 0.01), as was hospital (28.3 vs. 11.3 days; P <0.001) and ICU (4.3 vs. 3.9 days; P <0.001) LOS. Using logistic regression to adjust for severity, the odds of death was similar in VA patients, relative to private sector patients (OR 1.16, 95% CI 0.93-1.44; P = 0.18). However, a higher proportion of VA deaths occurred after 21 hospital days (33% vs. 13%; P <0.001). Using proportional hazards regression and censoring patients at hospital discharge, the risk for death was lower in VA patients (hazard ratio 0.70; 95% CI 0.59-0.82; P <0.001). After adjusting for severity, differences in ICU LOS were no longer significant (P = 0.19). CONCLUSIONS: Severity-adjusted mortality in ICU patients was lower in a VA hospital than in private sector hospitals in the same health care market, based on proportional hazards regression. This finding differed from logistic regression analysis, in which mortality was similar, suggesting that comparisons of hospital mortality between systems with different hospital utilization patterns may be biased if LOS is not considered. If generalizable to other markets, our findings further suggest that ICU outcomes are at least similar in VA hospitals.

APACHE↗
PubMed2004

Successful implementation of a novel internet hybrid surgery curriculum: the early phase outcome of thoracic surgery prerequisite curriculum e-learning project.

BACKGROUND: The internet CD-ROM thoracic surgery (TS) e-learning system was implemented in 2001 as a prospective randomized trial testing resident acceptance and educational impact of a unique web-based curriculum system on prematriculated TS residents. The Prerequisite Curriculum (PRC) contains 75 segments organized with textbook and case-based navigational systems. METHODS: Web-based technology tracked the PRC use for each resident. Of 142 residents, 138 thoracic surgery residents matching in 2001 for 2002 matriculation participated in a prospective randomized trial comparing the PRC system to a control group. Two sets of in-training exams, as well as resident and faculty knowledge/performance surveys, were used from July 2001 through January 2004 for ongoing, blinded multidimensional evaluation. RESULTS: Most residents (55/69) responded to the written prematriculation surveys and indicated they used the PRC (43/55), averaging 1.45 hours weekly. The PRC was rated as easy to use (8.3/10), a valuable study guide (7.7/10), and superior to traditional texts and journals for preresidency preparation (7.9/10). Web-based tracking revealed that 47/69 actually used the PRC. Sessions averaged 23.3 minutes with an average of 148 sessions over the prematriculation year. The in-training exam performance when evaluated at 1 and 9 months into the TS residency revealed a positive correlation between examination performance and PRC use. After TS residency matriculation, the self-evaluated knowledge and performance satisfaction scores were superior among PRC users in all categories. Simultaneous TS faculty evaluations of the same resident groups demonstrated smaller, but significant group differences. CONCLUSION: The implementation of the TS PRC has been exciting and successful. Future multidisciplinary curricular progress will hopefully continue to build upon this e-learning strategy.

CD-ROM↗
PubMed1990

An outcome study of an early intervention for specific learning disabilities.

Subjects at risk for specific learning disabilities were assessed on standardized measures throughout elementary and middle school following an intervention based on task analysis of kindergarten curricula and team teaching. All results were significant for the treatment group in relation to an at-risk cohort and comparable to a current random cohort and national averages.

Achievement↗
PubMed1998

[The learning curve in refractive laser surgery: criteria for outcome evaluation].

BACKGROUND: We wanted to analyse and compare the results of our first 100 cases of refractive surgery using the commonly accepted refractive parameters and using more subjective data. MATERIALS AND METHODS: Retrospective analysis of the first 100 consecutive cases of refractive surgery using objective and subjective criteria. RESULTS: Our objective refractive results are comparable to the results of many other authors. The subjective evaluation reveals a large discrepancy compared to the objective data. CONCLUSIONS: The evaluation of the results in refractive surgery should include more subjective parameters. This will allow to better correlate the quality-parameters of the surgery to the patient's expectations.

Adult↗
PubMed2005

A quantitative and qualitative assessment of verbal short-term memory and phonological processing in 8-year-olds with a history of repetitive otitis media.

UNLABELLED: Language outcome in children experiencing fluctuant hearing loss due to otitis media (OME) remains highly equivocal. In the current study, we assessed performance on highly sensitive verbal short-term memory (STM), new word learning and phonological processing tasks in 8-year-old children who had suffered from recurrent OME before the age of 3. Relative to a control group with no history of OME, we observed strictly normal performance for different STM and new word learning tasks. Performance on these tasks was also normally influenced by phonotactic, lexical and semantic variables. However, at the level of phonological processing, a small but significant decrease of performance was found in a speeded nonword identification task and a rhyme judgment task. The results of this study suggest that outcome of OME is characterized by subtle impairments at the level of perceptual-phonological analysis, but there is no significant impact on verbal STM and new word learning abilities. LEARNING OUTCOMES: As a result of this activity, the participant will be able to (1) explain the outcome of recurrent OME before age 3 on later language and verbal STM development, (2) be aware of the complex relationships that link language development and verbal STM, (3) explain how fluctuant hearing loss during infancy and early childhood could affect verbal STM development and learning capacity for new phonological information, (4) describe different verbal STM measures that distinguish retention capacities for phonological and lexico-semantic information, and (5) explain the influence of phonotactic frequency on nonword processing in language and verbal STM tasks.

Child↗
PubMed2006

Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP).

The Lower Extremity Assessment Project (LEAP) is a multicenter study of severe lower extremity trauma in the US civilian population. At 2- and 7-year follow-ups, the LEAP study found no difference in functional outcome between patients who underwent either limb salvage surgery or amputation. However, outcomes on average were poor for both groups. This study and others provide evidence of wide-ranging variations in outcome following major limb trauma, with a substantial proportion of patients experiencing long-term disability. In addition, outcomes often are more affected by the patient's economic, social, and personal resources than by the initial treatment of the injury--specifically, amputation or reconstruction and level of amputation. A conceptual framework for examining outcomes after injury may be used to identify opportunities for interventions that would improve outcomes. Because of essential differences between the civilian and military populations, the findings of the LEAP study may correlate only roughly with combat casualty outcomes.

Amputation, Surgical↗
PubMed2003

Congenital and acquired brain injury. 5. Outcomes after acquired brain injury.

UNLABELLED: This self-directed learning module highlights several aspects of outcome after acquired brain injury rehabilitation. It is part of the chapter on brain injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. In this article, functional measures commonly used in rehabilitation are described, and their potential uses for various populations are discussed. Key physiologic factors that predict outcome for persons with different acquired brain injuries are identified. Variables that affect return to school and work are described, and the studies evaluating the effectiveness of brain injury rehabilitation programs in general, as well as their subcomponents, are also reviewed. OVERALL ARTICLE OBJECTIVES: (a) To describe variables that affect outcome after acquired brain injury and (b) to identify the outcome tools most appropriate for the patient populations and outcomes to be studied.

Brain Injuries↗
PubMed2002

Problem based learning in continuing medical education: a review of controlled evaluation studies.

Reviews of undergraduate medical education cautiously support the short term and long term outcomes of problem based learning compared with traditional learning. The effectiveness of problem based learning in continuing medical education, however, has not been reviewed. This review of controlled evaluation studies found limited evidence that problem based learning in continuing medical education increased participants' knowledge and performance and patients' health. There was moderate evidence that doctors are more satisfied with problem based learning.

Education, Medical, Continuing↗
PubMedDate not supplied

Learning disability, attention-deficit disorder, and language impairment as outcomes of prematurity: a longitudinal descriptive study.

A longitudinal study of mildly preterm children and full-term comparison children found a higher-than-expected percentage among preterm children of learning disabilities, attention-deficit disorder (ADD), language impairment, mild neurologic impairment, and general school concerns by Grade 5. Seventy-five percent of the preterms fell into the above outcome diagnostic categories. Examination of early developmental patterns reflected differences in attention deployment at ages 13 months and 15 months, manifesting as increased engaged time on the part of the children with ADD, with a greater number of attentional shifts, and as decreased engaged time for the other outcome diagnostic categories. At 20, 24, and 30 months, mothers' perceptions of their children's competence revealed generally strong assessment of competence among children later identified as ADD, and weak competence in the other outcome diagnostic categories. Variability distinguished the identified groups at all ages and is evident in the Stanford-Binet subscale scores at age 3.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

A neostriatal habit learning system in humans.

Amnesic patients and nondemented patients with Parkinson's disease were given a probabilistic classification task in which they learned which of two outcomes would occur on each trial, given the particular combination of cues that appeared. Amnesic patients exhibited normal learning of the task but had severely impaired declarative memory for the training episode. In contrast, patients with Parkinson's disease failed to learn the probabilistic classification task, despite having intact memory for the training episode. This double dissociation shows that the limbic-diencephalic regions damaged in amnesia and the neostriatum damaged in Parkinson's disease support separate and parallel learning systems. In humans, the neostriatum (caudate nucleus and putamen) is essential for the gradual, incremental learning of associations that is characteristic of habit learning. The neostriatum is important not just for motor behavior and motor learning but also for acquiring nonmotor dispositions and tendencies that depend on new associations.

Aged↗
PubMed2006

Child outcome measures in the study of child care quality.

This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review by Vandell and Wolfe (2000) as the starting point. Serious methodological problems were not pervasive for child outcome measures. However, methodological concerns were most prevalent among measures of socioemotional development. Furthermore, psychometric information on outcome measures was often missing from published reports, and health outcomes and approaches to learning were infrequently studied. Future research should address alignment issues between aspects of quality and the specific child outcomes chosen for study.

Child Day Care Centers↗
PubMed1992

Combining cognitive learning theory and computer assisted instruction for deaf learners.

This study investigated the effects of implementing cognitive learning theory principles in computer assisted instruction of educational psychology concepts. A total of 19 preservice deaf teachers participated in the study. We used a pre-post design to measure the learning and attitude changes of the teachers. The results of the analysis of pretests and posttests of cognitive outcomes indicated that significant learning occurred as a result of the computer-based instruction. Also, the majority of the students reacted positively to the quality of the lessons. The results also suggest that applying an appropriate theoretical framework to the design of instruction offers an avenue for meaningfully addressing the appropriate use of technology.

Adult↗
PubMed2006

E-service learning: A pedagogic innovation for healthcare management education.

This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

Curriculum↗
PubMed2005

Long-term treatment outcome of oral premalignant lesions.

The purpose of the present retrospective study was to learn the long-term outcome of oral premalignant lesions, leukoplakia and erythroplakia, with or without surgical intervention and to relate the outcome to factors supposed to be significant for malignant development including clinical type, demarcation, size, site, presence of epithelial dysplasia, smoking and surgery. A total of 269 lesions in 236 patients were included. Ninety-four lesions were surgically removed, 39 lesions (41%) being homogenous and 46 (49%) non-homogenous leukoplakias whereas nine (5%) were erythroplakias. Seventy-three percent of the lesions were associated with tobacco habits. The mean size of the lesions was 486 mm(2), and 71% of the lesions showed a degree of epithelial dysplasia. After excision the defects were closed primarily by transposition of mucosal flaps or they were covered by free mucosal or skin grafts. A few defects were left for secondary healing. After surgical treatment the patients were followed (mean 6.8 yrs, range 1.5-18.6 yrs), and new biopsies taken in case of recurrences. One hundred and seventy five lesions had no surgical intervention, 149 lesions (85%) being homogenous and 20 (11%) non-homogenous leukoplakias, and 6 (3%) erythroplakias. Eighty-one percent of the lesions were associated with smoking. The mean size of the lesions was 503 mm(2) and 21 of the lesions (12%) exhibited epithelial dysplasia. Sixty-five lesions were not biopsied. These patients were also followed (mean 5.5 yrs, range 1.1-20.2 yrs), and biopsies taken in case of changes indicative of malignant development. All patients were encouraged to quit smoking and candidal infections were treated. The possible role of different variables for malignant development was estimated by means of logistic regression analysis. Following surgical treatment 11 lesions (12%) developed carcinoma after a mean follow-up period of 7.5 yrs. Non-homogenous leukoplakia accounted for the highest frequency of malignant development, i.e. 20%, whereas 3% of the homogenous leukoplakias developed carcinomas. Surgically treated lesions with slight, moderate, severe and no epithelial dysplasia developed carcinoma with similar frequencies, i.e. 9-11%. Without surgical intervention 16% of the 175 lesions disappeared whereas seven lesions (4%) developed carcinoma after a mean observation period of 6.6 yrs. The highest frequency of malignant development (15%) was seen for non-homogenous leukoplakias, this figure being 3% for homogenous leukoplakias. Fourteen percent of lesions with slight epithelial dysplasia developed malignancy and 2% of lesions with no dysplasia showed malignant transformation. Logistic regression analysis showed a seven times increased risk (OR = 7.0) of non-homogenous leukoplakia for malignant development as compared with homogenous leukoplakia and a 5.4 times increased risk for malignant development for lesions with a size exceeding 200 mm(2). No other examined variables including presence of any degree of epithelial dysplasia, site, demarcation, smoking and surgical intervention were statistically significant factors for malignant development.

Adult↗
PubMed2004

People with learning disabilities in a low secure in-patient unit: comparison of offenders and non-offenders.

BACKGROUND: People with learning disability who exhibit challenging behaviour are frequently segregated from services and local teams are often reluctant to receive them back into their care. This situation is worse in those whose challenging behaviour includes a forensic history, but the difference between those labelled as challenging and those treated as offenders is not clear, and there is a lack of evidence about treatment effectiveness. AIMS: To test between-group differences in aggression and treatment outcome in people with learning disability and challenging behaviour, with and without a forensic history. METHOD: Clinical records of 86 former in-patients (45 offenders and 41 non-offenders) of a specialist unit were compared on measures of behavioural disturbance and placement outcome. RESULTS: People in the offenders group were significantly less likely to be aggressive to others and to use weapons, but significantly more likely to harm themselves compared with the non-offenders group. Both groups had a significant reduction in their challenging behaviour during admission, and there was no significant difference in treatment outcome. CONCLUSIONS: The negative reputation of people with learning disabilities who offend needs to be reconsidered.

Adolescent↗
PubMed1989

Comparison of two methods of service delivery for students with learning disabilities.

Both the process and outcome of providing occupational and physical therapy services in the public school system to students with learning disabilities were examined. A therapist-directed group received a combination of large and small group therapy while a consultation group received large group therapy and teacher-led follow-up sessions. Group progress on three standardized tests was compared by analysis of covariance. The result indicated that the consultation group made a greater change in mean standard score on the Bruininks-Oseretsky Test of Motor Proficiency (p <.01). The therapist-directed group made a mean change in standard score of 19.4 on the Test of Visual-Perceptual Skills compared to 7.5 for the consultation group, a difference that was clinically but not statistically significant (p=.07). Both groups made comparable progress on the Test of Visual-Motor Skills. Progress within each group was examined by the proportional change index score for each test subscale and the results were favorable for both groups. Based on student progress, the therapy needs of each group, teacher satisfaction, and utilization of available resources, each method of service delivery was effective for the particular group of students served.

Journal Article↗
PubMed2004

Involving people with learning disabilities in research: issues and possibilities.

Advances in the social position of people with learning disabilities have led to a situation where research and evaluation studies are increasingly required to include the views and opinions of people with learning disabilities. One key outcome of this shift is that some of the major funding bodies now insist on the inclusion of people with learning disabilities as a condition of research funding. This has produced new possibilities and new challenges for researchers, and it has real consequences for people working in health and social care. The present paper sets out to explore some of the developments and challenges in research with people with learning disabilities. The author provides a selective overview of developments with the aim of demonstrating the richness, ingenuity and potential of research involving people with learning disabilities. The paper is divided into three broad sections that focus on: (1) the ethics and philosophy of participatory research; (2) the methodologies employed at particular points in the research process that are designed to ensure the involvement of participants in research; and (3) building capacity in participatory research as a precondition to the further development of this approach. An investment in capacity would enable this approach to move into the mainstream of research activity involving people with learning disabilities.

Ethics, Research↗