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At least 1,099 records · Page 61Linked to original sources

PubMed2004

Donepezil improved memory in multiple sclerosis in a randomized clinical trial.

OBJECTIVE: To determine the effect of donepezil in treating memory and cognitive dysfunction in multiple sclerosis (MS). METHODS: This single-center double-blind placebo-controlled clinical trial evaluated 69 MS patients with cognitive impairment who were randomly assigned to receive a 24-week treatment course of either donepezil (10 mg daily) or placebo. Patients underwent neuropsychological assessment at baseline and after 24 weeks of treatment. The primary outcome was change in verbal learning and memory on the Selective Reminding Test (SRT). Secondary outcomes included other tests of cognitive function, patient-reported change in memory, and clinician-reported impression of cognitive change. RESULTS: Donepezil-treated patients showed significant improvement in memory performance on the SRT compared to placebo (p = 0.043). The benefit of donepezil remained significant after controlling for various covariates including age, Expanded Disability Status Scale, baseline SRT score, reading ability, MS subtype, and sex. Donepezil-treated patients did not show significant improvements on other cognitive tests, but were more than twice as likely to report memory improvement than those in the placebo group (p = 0.006). The clinician also reported cognitive improvement in almost twice as many donepezil vs placebo patients (p = 0.036). No serious adverse events related to study medication occurred, although more donepezil (34.3%) than placebo (8.8%) subjects reported unusual/abnormal dreams (p = 0.010). CONCLUSIONS: Donepezil improved memory in MS patients with initial cognitive impairment in a single center clinical trial. A larger multicenter investigation of donepezil in MS is warranted in order to more definitively assess the efficacy of this intervention.

Adolescent↗

PubMedDate not supplied

International partnerships to promote quality care: faculty groundwork, student projects, and outcomes.

Global health care is now considered a component of core knowledge for 21st century professional nursing practice. The authors describe laying the groundwork for an international experience and projects resulting from a partnership with a nursing program in the developing country of Guyana. In addition, the outcomes from undergraduate nursing international learning experiences for students and practicing nurses are reported. These outcomes provide support for the integration of study abroad as a strategy for enhancing the undergraduate nursing curriculum and ultimately professional nursing practice during the early years of practice.

Attitude of Health Personnel↗

PubMed1997

A naturalistic study of the use of vigabatrin, lamotrigine and gabapentin in adults with learning disabilities.

Epilepsy is a common condition in people with learning disabilities with many patients continuing to suffer from seizures despite antiepileptic drug (AED) treatment. Although the advent of newer AEDs offers hope for better treatment, there is a need to compare the efficacy of each new AED in adults with both drug-resistant epilepsy and learning disabilities. This retrospective casenote study involves the analysis of the outcome for those adults with learning disabilities treated with either vigabatrin, lamotrigine or gabapentin. The information obtained from the casenote analysis was used to both compare the efficacies of the three drugs and also the side-effects and drop-out rates, including reasons for drop-out. The total number of patients involved was 51 who underwent 71 treatment episodes. All three AEDs had similar efficacies. Although vigabatrin was found to be associated with a higher incidence of behaviour problems, behaviour problems occurred with the other drugs as well. Lamotrigine caused increased seizures in 24% of patients, especially when prescribed at a higher dose. Gabapentin appeared to be associated with fewer serious side-effects.

Acetates↗

PubMedDate not supplied

What follow-up studies say about postschool life for young men and women with learning disabilities: a critical look at the literature.

Follow-up studies examining the outcomes for children and youth with learning disabilities who attended special education have appeared in the literature for decades. As American society becomes more technologically advanced and competitive, postsecondary school opportunities and subsequent employment choices that are meaningful and provide a livable wage teeter out of the reach of young people with learning disabilities. Follow-up study investigators seek to understand how to better prepare youth to meet these challenges by studying their long-term outcomes. The authors review data from 13 frequently referenced follow-up studies regarding postschool outcomes, postsecondary education, and employment, with attention to gender differences, for youth with learning disabilities who were served by and graduated from special education programs nationwide. They take a critical look at contradictions in the findings and discuss five methodological issues that seem to influence the conduct and interpretation of follow-up studies: aggregating data across disability categories; combining data on graduates who have been out of school for unequal periods of time; ignoring the issues of missing data, participant attrition, and incomplete data sets; combining data from different informants; and using nonequivalent databases to make comparisons to a population with no disabilities. The authors provide recommendations for conducting follow-up research on the long-term quality of life of children and youth with disabilities and their families.

Adult↗

PubMed2006

An evaluation of the role of the clinical education facilitator.

AIMS AND OBJECTIVES: The objective of the study was to identify whether clinical education facilitators made a difference to the learning experiences of nurses in a large teaching hospital. BACKGROUND: Strategies for enabling continuous professional development are well established in health care organizations as key components of approaches to lifelong learning. The benefits of continuous professional development include the maintenance of high standards of care, the improvement and development of services, ensuring the competency of all nursing staff and guaranteeing the accountability of nurses for their actions. The role of clinical education facilitator is relatively new and little evaluation of this role has been undertaken. CONCLUSIONS: This study highlights important issues to be considered in developing a 'learning culture' in a hospital organization, through the adoption of such roles as clinical education facilitators. Whilst the roles have had an important function in the active coordination of learning activities in the hospital, there is little evidence of the role directly impacting on the learning culture of clinical settings. Learning mechanisms have been identified. The results of this evaluation can be subjected to further testing through ongoing evaluation of the outcomes arising from the learning mechanisms in place. Given the emphasis on work-based learning and continuing professional development in health care, then this ongoing evaluation can yield important information about future directions for nurse education. RELEVANCE TO CLINICAL PRACTICE: The study highlights the importance of supported learning in the workplace. However, more importantly, it identifies the need for a culture of professional practice to be developed in order to sustain learning in practice. Classroom-based learning alone, cannot create a culture of development in nursing and there is thus a need for models of work-based learning to be integrated into practice environments.

Attitude of Health Personnel↗

PubMed2001

Keeping the curriculum current with research and problem-based learning.

Active learning is more effective than passive learning and the critical activities are discovery, mastery, and application. Only 10% of a typical dentist's career is spent in dental school, so the educational experience must provide the tools used for lifelong learning. Problem-Based Learning is a model used in several dental schools that is grounded in these assumptions. PBL makes use of small groups, patient cases serving as the vehicle for learning, with student directed outcomes.

Curriculum↗

PubMed2003

A comparative study of adults with and without self-reported learning disabilities in six English-speaking populations: what have we learned?

The purpose of this study was to compare adults with and without self-reported learning disabilities (SRLD and NSRLD) from six English-speaking populations including: English-speaking Canada, Great Britain, The Republic of Ireland, New Zealand, Northern Ireland, and the United States. These six populations were selected because they were all English-speaking populations, participated in the first administration of the International Adult Literacy Survey (IALS), and included the optional questions regarding the presence of a disability. In this study, we compared the groups on prevalence by population, percentage of each group by age and gender, awareness of learning disabilities and problems in school, document and quantitative literacy proficiency, educational attainment, reasons for dropping out of school, and employment, occupational and financial status. Findings were reported among these six populations within an historical perspective including differences in awareness and definition of learning disabilities, public policy, special education services, reading pedagogy, and teacher preparation. Recommendations are made for improving literacy and long-term outcomes for those with learning disabilities in all nations as well as future research directions.

Adolescent↗

PubMed1996

The impact of prenatal cocaine exposure: studies of the developing infant.

This article traces several major phases of research evaluating the development of infants exposed to cocaine. Although initial studies focused on the medical neurobehavioral status of the neonate, these studies often lacked appropriate comparison groups, attention to polydrug use, and follow-up after hospital discharge. As studies began to include longer follow-up periods and the types of comparison groups necessary to evaluate the unique effects of cocaine versus factors such as poverty and polydrug use, the deleterious effects of cocaine exposure were not as apparent. Although most early studies focused only on mental and motor outcomes, recent studies evaluating learning processes, emotional development, and the effects of cocaine-exposed infants' unique caretaking environments may provide more detailed descriptions of the outcomes of this growing population. This article discusses numerous methodological issues that continue to challenge this complex research area and recent research efforts that may prove beneficial in guiding future studies.

Cocaine↗

PubMed2005

Recruitment and retention of minority students: diversity in nursing education.

A culturally diverse nursing workforce is essential to meet the health needs of an increasingly diverse Canadian population. The recruitment and retention of nursing students representing diverse backgrounds are vital to the building of this diversified work force. Studies have shown that diversity within the student body benefits everyone. For example, students who study and work within a diverse environment are better able to understand and consider multiple perspectives and to appreciate the benefits inherent in diversity. This paper describes one school of nursing's project on the Recruitment and Retention of Black students into their Bachelor of Science Nursing (BScN) Program. The project goals are to increase diversity, foster student learning, and ultimately improve health care for the Black community. Presented in this paper are the project background, implementation process, challenges and outcomes. This may provide learned lessons and future directions for similar initiatives in other institutions.

Black or African American↗

PubMed2026

Proteomic and machine learning analysis predicts treatment response signatures in Myasthenia Gravis.

BACKGROUND: Myasthenia gravis (MG) is a prototypical antibody-mediated autoimmune disease with variable treatment responses with a need for biomarkers to guide therapeutic decision making. Proteomic profiling, coupled with machine learning, offers a hypothesis-free approach to identify multi-protein signatures associated with treatment response. METHODS: We analyzed sera collected at entry (baseline) from participants in a phase 3 trial randomized trial comparing thymectomy plus prednisone versus prednisone alone, along with matched controls using liquid chromatography-mass spectrometry. We derived disease-specific proteomic signatures and evaluated associations between baseline proteins and 6-month clinical outcomes using multiple machine-learning approaches with internal validation. RESULTS: Baseline serum proteomes distinguished MG from controls, with pathway enrichment implicating complement activation, immunoglobulin production, and T-cell receptor signaling. Distinct protein panels predicted 6-month clinical improvement within each treatment arm. In the thymectomy-plus-prednisone group, models captured non-linear relationships of predictive proteins in contrast with the predominant additive patterns observed in the prednisone-alone group. Predictive proteins were enriched for T-cell signaling and leukocyte trafficking functions, providing insight into treatment-specific biology. CONCLUSIONS: Baseline serum proteomics captures core disease characteristics of MG and predicts short-term clinical response in a treatment-specific manner. While our results require validation in independent cohorts, these findings could enable biomarker-guided selection of thymectomy, refine risk stratification, and furnish mechanistic readouts for future MG trials and clinical care. We aim to conduct future studies using -omic approaches to validate these baseline predictive biomarkers and pathways of treatment response in patients with MG.

Adult↗

PubMed2003

Selected outcomes of community-oriented, problem-based nursing programmes in South Africa.

UNLABELLED: Whilst there is a significant body of research on the outcomes of problem-based learning (PBL) programmes (Albanese and Mitchell, 1993; Vernon and Blake, 1993), there is little information regarding the outcomes of community-oriented programmes (COL) for nursing students. Between 1994 and 1997, four university schools of nursing implemented problem-based, community-oriented learning (COL) programmes. This research sought to describe, evaluate and compare the outcomes of graduates from these four universities with graduates who had followed conventional programmes. RESEARCH OBJECTIVES: These were to describe and explore the incorporation of illness prevention and health promotion of graduates from PBL/COL programmes and non-PBL/COL programmes in South Africa, as described by the graduates and their supervisors. Secondly, to describe whether and how the graduates from PBL/COL and non-PBL/COL programmes engaged themselves in continued learning. RESEARCH METHODOLOGY: This was a qualitative evaluation study, which is descriptive and comparative in nature. In-depth interviews were held with the graduates and their supervisors about six months after completion of their training. Use was made of Miller and Crabtree's (1994) Template Analysis Style and of Benner's (1984) interpretative approach to analyze data. Analysis was done using the NVIVO computer programme. This programme was used to manage the categories which were developed with regard to each concept as the analysis proceeded. FINDINGS: Both the graduates and the supervisors appeared to have difficulty describing activities relating to health promotion and illness prevention. Only three types of health promotion were described--mass education, increasing personal skills and creating a supportive environment. The most commonly mentioned means of illness prevention were health education and medical-surgical asepsis. A few graduates described activities which indicated that they had taken context into consideration during patient care.

Attitude of Health Personnel↗

PubMed2003

Pretreatment task persistence predicts smoking cessation outcome.

R. Eisenberger's (1992) learned industriousness theory states that individuals display differing degrees of persistence depending on their history of reinforcement for effortful behavior. These differences may influence the development, maintenance, and cessation of addictive behaviors. In cross-sectional studies, E. P. Quinn, T. H. Brandon, and A. L. Copeland (1996) found that cigarette smokers were less persistent than nonsmokers, and R. A. Brown, C. W. Lejuez, C. W. Kahler, and D. R. Strong (2002) found that smokers who had previously abstained for 3 months were more persistent than those who had never quit. The present study extended these findings by using a prospective design. A pretreatment measure of task persistence (mirror tracing) completed by 144 smokers predicted sustained abstinence throughout 12 months of follow-up. Moreover, persistence predicted outcome independent of other significant predictors: gender, nicotine dependence, negative affect, and self-efficacy.

Adolescent↗

PubMedDate not supplied

The conceptual framework of the National Diabetes Education Outcomes System (NDEOS).

PURPOSE: This article describes the systems-based conceptual framework for the definition of diabetes education outcomes and the development of the National Diabetes Education Outcomes System (NDEOS). METHODS: Development of the NDEOS was based on integrating diabetes education into the diabetes care system; identifying and tracking standardized learning, behavioral, and clinical outcomes measurements; and gathering data at the individual, program, and national levels. Each component was formulated based on available literature and through consensus with the American Association of Diabetes Educators (AADE) Outcomes Task Force and other multidisciplinary healthcare professionals. RESULTS: Behavior change is the key outcome measurement for diabetes self-management education (DSME). In addition, diabetes educators should collect other immediate, intermediate, and long-term outcomes for monitoring the impact of DSME. The NDEOS system includes standardized data collection tools for the participant, the educator, and the program manager, and provides reports at the individual, program, and national levels. CONCLUSIONS: By capturing outcomes data using valid, reliable, and evidence-based tools, the NDEOS strives to support diabetes educators and provide a uniform data set that can be used to influence public policy, support reimbursement negotiations, and assist researchers.

Behavior Therapy↗

PubMed1979

Discrimination learning without short-term memory: dissociation of memory processes in pigeons.

Pigeons were trained to perform delayed matching to samples of food and no food when each sample concurrently served as the outcome of a discrimination learning trial which immediately preceded each matching trial. Ambient light presented during the delays after the samples of food or no food severely disrupted matching but had no effect on the rate of discrimination learning.

Animals↗

PubMed2002

Worksite "lunch and learn": a collaborative teaching project.

Overall, the collaborative teaching project in community health nursing was successful in meeting the needs of students, faculty, the HMO, the employer, and the community. Health education program outcomes and the lessons learned from the processes indicated the collaboration should continue and be expanded. In subsequent academic years, faculty and HMO staff worked to identify additional employer groups and to make this type of learning experience available to a larger number of nursing students. As career paths diverged, this specific collaboration dissolved. However, the opportunities and challenges observed in this collaborative teaching project have been carried forward into new collaborations.

Cooperative Behavior↗

PubMed2004

On becoming a surgeon.

A dentist who has just completed eight years of oral and maxillofacial residency training reflects on what drew him to the specialty and how it changed him. He notes three characteristics of his training that differed from predoctoral education and help define a surgeon: patient-based learning, learning from constant discussions with colleagues, and the habit of facing unexpected outcomes as a source of learning.

Career Choice↗

PubMed1997

Spinal cord injury rehabilitation. 3. Functional outcomes.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on spinal cord injury rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article contains information about mobility, ambulation, upper extremity function, bowel management, and technology to enhance function in the community. New advances covered in this section include functional electrical stimulation for enhancing mobility and upper extremity function.

Activities of Daily Living↗

PubMed2006

Instrumental learning within the spinal cord: underlying mechanisms and implications for recovery after injury.

Using spinally transected rats, research has shown that neurons within the L4-S2 spinal cord are sensitive to response-outcome (instrumental) relations. This learning depends on a form of N-methyl-D-aspartate (NMDA)-mediated plasticity. Instrumental training enables subsequent learning, and this effect has been linked to the expression of brain-derived neurotrophic factor. Rats given uncontrollable stimulation later exhibit impaired instrumental learning, and this deficit lasts up to 48 hr. The induction of the deficit can be blocked by prior training with controllable shock, the concurrent presentation of a tonic stimulus that induces antinociception, or pretreatment with an NMDA or gamma-aminobutyric acid-A antagonist. The expression of the deficit depends on a kappa opioid. Uncontrollable stimulation enhances mechanical reactivity (allodynia), and treatments that induce allodynia (e.g., inflammation) inhibit learning. In intact animals, descending serotonergic neurons exert a protective effect that blocks the adverse consequences of uncontrollable stimulation. Uncontrollable, but not controllable, stimulation impairs the recovery of function after a contusion injury.

Animals↗