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PubMed2003

Physician leadership: influence on practice-based learning and improvement.

In response to the technology and information explosion, practice-based learning and improvement is emerging within the medical field to deliver systematic practice-linked improvements. However, its emergence has been inhibited by the slow acceptance of evidence-based medicine among physicians, who are reluctant to embrace proven high-performance leadership principles long established in other high-risk fields. This reluctance may be attributable to traditional medical training, which encourages controlling leadership styles that magnify the resistance common to all change efforts. To overcome this resistance, physicians must develop the same leadership skills that have proven to be critical to success in other service and high-performance industries. Skills such as self-awareness, shared authority, conflict resolution, and nonpunitive critique can emerge in practice only if they are taught. A dramatic shift away from control and blame has become a requirement for achieving success in other industries based on complex group process. This approach is so mainstream that the burden of proof that cooperative leadership is not a requirement for medical improvement falls to those institutions perpetuating the outmoded paradigm of the past. Cooperative leadership skills that have proven central to implementing change in the information era are suggested as a core cultural support for practice-based learning and improvement. Complex adaptive systems theory, long used as a way to understand evolutionary biology, and more recently computer science and economics, predicts that behavior emerging among some groups of providers will be selected for duplication by the competitive environment. A curriculum framework needed to teach leadership skills to expand the influence of practice-based learning and improvement is offered as a guide to accelerate change.

Delivery of Health Care↗
PubMed2005

The management of cognitive load during complex cognitive skill acquisition by means of computer-simulated problem solving.

This study compared the effects of two information presentation formats on learning to solve problems in electrical circuits. In one condition, the split-source format, information relating to procedural aspects of the functioning of an electrical circuit was not integrated in a circuit diagram, while information in the integrated format condition was integrated in the circuit diagram. It was hypothesized that learners in the integrated format would achieve better test results than the learners in the split-source format. Equivalent-test problem and transfer-test problem performance were studied. Transfertest scores confirmed the hypothesis, though no differences were found on the equivalent-test scores.

Adolescent↗
PubMed1996

Effects of discrete kainic acid-induced hippocampal lesions on spatial and contextual learning and memory in rats.

Substantial information is available concerning the influence of global hippocampal lesions on spatial learning and memory, however the contributions of discrete subregions within the hippocampus to these functions is less well understood. The present investigation utilized kainic acid to bilaterally lesion specific areas of the rat hippocampus. These animals were subsequently tested on a spatial orientation task using a circular water maze, and on an associative/contextual task using passive avoidance conditioning. The results indicate that both the dorsal CA1 and the ventral CA3 subregions play important roles in learning. Specifically, CA1 lesions produced a deficit in the acquisition of the water maze task and a significant memory impairment on the passive avoidance task. CA3 lesions also caused learning deficits in the acquisition of the water maze task, and produced even greater impairments in performance on the passive avoidance task. We conclude that CA1 and CA3 hippocampal subregions each play significant roles in the overall integration of information concerning spatial and associative learning.

Animals↗
PubMed1996

Topographically distinct cortical activation in episodic long-term memory: the retrieval of spatial versus verbal information.

Two experiments are reported to study slow potentials in the EEG during reactivation of spatial and verbal information. Subjects had to learn associations between drawings and one, two, or three mediators (locations in Experiment 1, nouns in Experiment 2). During recall, subjects had to decide whether or not two drawings were linked to each other by a common mediator. EEG was recorded during learning and recall. Both experiments were completely equivalent. Irrespective of the quality of the mediators, response time proved to be a linear function of the numbers of mediators to be recalled. Negative slow potentials that accompanied the reactivation of information during anticipation learning and cued recall had a material-specific topography: The maximum was found over the parietal cortex for spatial information and over the left frontal cortex for verbal information. Moreover, the amplitude at these scalp locations varied with the amount of the to-be-retrieved information. The results support the claim of topographically distinct cell assemblies specialized for storage and retrieval of distinct kinds of information.

Adult↗
PubMed1990

Molecular analysis of two group B streptococcal virulence factors.

Molecular biology has provided new technology for evaluating the traits of bacterial pathogens that are important in the pathogenesis of infections. The ability to derive isogenic strains that differ by a single trait provides a powerful tool for investigating the interaction of a putative virulence factor with the host at any of the various steps in pathogenesis. Recombinant DNA techniques afford the opportunity to clone the genes involved in the biosynthesis of a particular virulence factor. Once the gene(s) are cloned, a vast amount of information can be learned about their composition, structure, and regulation, and similarity with genes in other organisms. Understanding the molecular biology of a virulence factor also provides information about potential targets for future therapies and preventive modalities. The molecular analysis of two virulence factors from the type III group B streptococcus has been reviewed to provide specific examples of how these techniques can be used. The data has shown that the capsular polysaccharide is an essential factor in GBS virulence. The structural influence of sialic acid on the capsule plays a major role in its virulence properties. The importance of the capsule has been tested in several assays to identify its role in pathogenesis. Its primary role appears to be evading host phagocytic mechanisms, but it does not appear to be essential in the vascular response observed during GBS sepsis. Using the isogenic strains, we have also learned that the capsule does not mask a fibronectin receptor on GBS. In contrast to the capsule, the beta-hemolysin of GBS does not appear to be essential for systemic disease once the organism has invaded. Its role in the initial invasive steps in GBS pathogenesis has not been tested, but the availability of isogenic mutants in beta-hemolysin production will allow this question to be answered once the model systems are available.(ABSTRACT TRUNCATED AT 250 WORDS)

Amino Acid Sequence↗
PubMed2006

Working off the record: physicians' and nurses' transformations of electronic patient record-based patient information.

BACKGROUND: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training. METHOD: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted. Data were analyzed using constructivist grounded theory and visual rhetoric. RESULTS: Three main features of participant interactions with EPR-based information were identified: (1) EPR-based information was routinely transformed into paper documents; (2) these transformations were organized by profession-specific guiding principles; and (3) transformation strategies were learned through an informal curriculum. CONCLUSIONS: This study describes how and why health care professionals work around EPR-based patient information, and suggests that an EPR's visual organization may be incompatible with professional activities. The study addresses the socializing implications of these activities, and highlights their educational potential.

Canada↗
PubMed2003

Learned dynamics of reaching movements generalize from dominant to nondominant arm.

Accurate performance of reaching movements depends on adaptable neural circuitry that learns to predict forces and compensate for limb dynamics. In earlier experiments, we quantified generalization from training at one arm position to another position. The generalization patterns suggested that neural elements learning to predict forces coded a limb's state in an intrinsic, muscle-like coordinate system. Here, we test the sensitivity of these elements to the other arm by quantifying inter-arm generalization. We considered two possible coordinate systems: an intrinsic (joint) representation should generalize with mirror symmetry reflecting the joint's symmetry and an extrinsic representation should preserve the task's structure in extrinsic coordinates. Both coordinate systems of generalization were compared with a naïve control group. We tested transfer in right-handed subjects both from dominant to nondominant arm (D-->ND) and vice versa (ND-->D). This led to a 2 x 3 experimental design matrix: transfer direction (D-->ND/ND-->D) by coordinate system (extrinsic, intrinsic, control). Generalization occurred only from dominant to nondominant arm and only in extrinsic coordinates. To assess the dependence of generalization on callosal inter-hemispheric communication, we tested commissurotomy patient JW. JW showed generalization from dominant to nondominant arm in extrinsic coordinates. The results suggest that when the dominant right arm is used in learning dynamics, the information could be represented in the left hemisphere with neural elements tuned to both the right arm and the left arm. In contrast, learning with the nondominant arm seems to rely on the elements in the nondominant hemisphere tuned only to movements of that arm.

Adolescent↗
PubMedDate not supplied

Stroke rehabilitation: benefits of educational initiatives.

The supportive education of stroke survivors and their carers has been identified as a key area of interest to rehabilitation nurses. The Audit Commission recommends the widespread use of stroke units within the NHS (Audit Commission, 2000). The aim of this review is to determine the authority of available evidence and to discuss how such evidence might influence practice. The literature tended to assume that education had a positive effect on the outcome of rehabilitation. Various education interventions were attempted, including information-giving through the use of written material as well as more supportive and facilitative approaches. Factors that may affect the ability to learn or absorb information were identified and attempts have been made to evaluate the effect of educational interventions.

Caregivers↗
PubMed2004

Implicit strategy affects learning in children with heavy prenatal alcohol exposure.

BACKGROUND: Learning and memory deficits are commonly reported in children with heavy prenatal alcohol exposure. Our recent work suggested that children with heavy prenatal alcohol exposure retained information as well as controls on a verbal learning test but not on a test of nonverbal learning and memory. To better understand the cause of this differential pattern of performance, the current study re-analyzed data from our previous study to determine if the presence of an implicit learning strategy may account, at least in part, for the finding of spared retention. METHODS: The current study examined verbal learning and memory abilities in 35 children with Fetal Alcohol Spectrum Disorders (FASD) and 34 nonexposed controls (CON) matched for age (9-16 years), sex, ethnicity, handedness, and socioeconomic status. Groups were compared on two measures of verbal learning, one with an implicit strategy (California Verbal Learning Test-Children's Version; CVLT-C) and one without (Verbal Learning subtest of the Wide Range Assessment of Memory and Learning; VL-WRAML). RESULTS: Children with FASD learned less information overall than children in the CON group. Both groups learned a greater percentage of information and reached a learning plateau earlier on the CVLT-C compared with the VL-WRAML. Groups also showed comparable rates of retention after a delay on the CVLT-C. In contrast, on the VL-WRAML, children with FASD showed poorer retention rates than children in the CON group. Interestingly, children with FASD did not differ from children in the CON group on CVLT-C semantic clustering scores for learning trials 1 through 3, and greater utilization of semantic clustering was correlated with better learning and memory performance in both groups. This overall pattern of results was not related to overall intellectual level. CONCLUSIONS: The finding of spared retention of verbal information on the CVLT-C in our earlier studies may be related to test characteristics of the CVLT-C rather than a finding of spared verbal retention per se, given that spared retention was not found on a separate test of verbal learning and memory without an implicit learning strategy. These results suggest that the use of an implicit strategy positively affected the ability of alcohol-exposed children to learn and retain new verbal information.

Adolescent↗
PubMed2006

Measuring word learning: dynamic versus static assessment of kindergarten vocabulary.

UNLABELLED: This preliminary study investigated the potential of using a dynamic approach to assessing expressive word mapping. Because measuring word mapping with productive language responses is much more difficult than measuring receptive word mapping, incorporating a dynamic measure allowed us to tap partial mapping and provided useful information on word learning. Participants were 24 typically developing African American children, from high-risk backgrounds and low-risk backgrounds, as determined by school and family demographics. Performance was compared on the PPVT-III and on the dynamic assessment of word mapping. The dynamic assessment of word mapping provided information about complete and partial mapping of words. Additionally, there was an interaction between risk and performance on the vocabulary and word learning measures. These data suggest that the use of the dynamic measure in conjunction with traditional vocabulary measures may have the potential to provide an estimate of word-learning ability. LEARNING OUTCOMES: Readers will (1) be able to identify the need for word-learning measures and (2) become familiar with the combined technique of using dynamic assessment and fast mapping.

Aptitude↗
PubMed2000

Developing clinical practice guidelines for spinal cord medicine. Lessons learned.

This article describes the process used by the Consortium for Spinal Cord Medicine to develop evidence-based clinical practice guidelines for managing and treating individuals with spinal cord injury and provides important information on lessons learned and the potential problems to avoid. Issues to consider during the guideline development process include topic selection and explication, methods for selecting the panel chair and panel members, the writing of recommendations and supporting scientific rationales, peer-reviewing guidelines, and the process for disseminating, implementing, and evaluating guidelines. The applicability, advantages, and disadvantages of available evidence and guideline recommendation grading systems and issues arising from the lack of scientific evidence supporting particular recommendations are also discussed.

Humans↗
PubMed2005

Using operational information and information systems to improve in-patient flow in hospitals.

PURPOSE: To consider how information and information systems can be used to support improving patient flow in acute hospitals (a key target for the National Health Service in England), and the potential role of the National Programme for Information Technology currently being developed. DESIGN/METHODOLOGY/APPROACH: The literature plus past and present research, teaching and consulting experience with all levels of the National Health Service is drawn on to consider information provision and requirements. FINDINGS: The National Programme for Information Technology specifies many features designed to support improving patient flows, though timescales for implementation are longer than those for the pledged flow improvements, and operational use of this type of information system has been problematic in the National Health Service. RESEARCH LIMITATIONS/IMPLICATIONS: The work is limited to the National Health Service and information systems in use and planned for it. The National Health Service access targets, flow improvement initiatives and the National Programme for Information Technology apply primarily to England. PRACTICAL IMPLICATIONS: Some bed/flow management information systems currently in use incorporate tools and capabilities in advance of what is outlined in the National Programme for Information Technology, and some rare cases of culture changes in information system use have been achieved. One should learn from these to inform development and implementation of National Programme systems. These existing information systems and approaches may also be useful to hospitals considering systems prior to implementation of the National Programme for Information Technology. ORIGINALITY/VALUE: There has been very little consideration of the use of operational information and information systems for bed/flow management in the literature. Development and implementation of National Programme for Information Technology systems should build from an understanding of the practice and context of bed/flow management.

Acute Disease↗
PubMed2002

Factorial validity and internal reliability of Honey and Mumford's Learning Styles Questionnaire.

Honey and Mumford's Learning Styles Questionnaire was derived from the same conceptual basis as Kolb's Learning Style Inventory and may provide a more reliable and valid measure of Kolb's learning style constructs. The Learning Styles Questionnaire has not been psychometrically evaluated as extensively as the Learning Style Inventory. Since there is no published information on how the Learning Styles Questionnaire scales were derived, an attempt was made to factor analyze the responses to the questionnaire. Confirmatory factor analysis of 284 psychology undergraduates' responses identified a four-factor oblimin solution as the most satisfactory model investigated. Implications for interpretation and use within higher education are discussed.

Adolescent↗
PubMed1998

Spontaneously hypertensive rats: a potential model to identify drugs for treatment of learning disorders.

Spontaneously hypertensive rats (SHR) of 3 to 12 months of age learned and retrieved less information than normotensive Wistar-Kyoto rats (WKY), although no difference was found with animals from 18 and 24 months of age. The combined influence of hypertension and aging had an additive detrimental effect on cognitive functions. Notwithstanding these deficiencies in learning and memory, SHR have seldom been used as a model in the screening of drugs with therapeutic potential for treatment of disorders of cognitive processes. Moreover, the calcium channel blocker nimodipine has beneficial effects on learning in both aged and hypertensive animals and humans. However, no attempt has been made to investigate whether nimodipine can reverse the additive deleterious effects of aging and hypertension in the same subject. We recently reported that deteriorated animals (middle-aged and/or hypertensive) chronically treated with nimodipine (via osmotic minipumps) exhibit higher learning scores. This information indicates that nimodipine can reverse the impairing effects of either aging or hypertension on learning; the presence of the two conditions, however, produces a severe impairment that can be partially reversed by this drug. Therefore, we propose that mature and middle-aged SHR represent a model for the screening of potentially useful drugs in the treatment of learning disorders, probably associated with hypertension and/or aging. Nevertheless, it must be remembered that the SHR is a genetic model and the appearance of neural disturbances could be a parallel genetic phenomenon and not necessarily or exclusively related to hypertension per se.

Aging↗
PubMed1999

Image recognition: visual grouping, recognition, and learning.

Vision extracts useful information from images. Reconstructing the three-dimensional structure of our environment and recognizing the objects that populate it are among the most important functions of our visual system. Computer vision researchers study the computational principles of vision and aim at designing algorithms that reproduce these functions. Vision is difficult: the same scene may give rise to very different images depending on illumination and viewpoint. Typically, an astronomical number of hypotheses exist that in principle have to be analyzed to infer a correct scene description. Moreover, image information might be extracted at different levels of spatial and logical resolution dependent on the image processing task. Knowledge of the world allows the visual system to limit the amount of ambiguity and to greatly simplify visual computations. We discuss how simple properties of the world are captured by the Gestalt rules of grouping, how the visual system may learn and organize models of objects for recognition, and how one may control the complexity of the description that the visual system computes.

Humans↗