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PubMedDate not supplied

Applications of telemedicine and telecommunications to disaster medicine: historical and future perspectives.

Disaster management utilizes diverse technologies to accomplish a complex set of tasks. Despite a decade of experience, few published reports have reviewed application of telemedicine (clinical care at a distance enabled by telecommunication) in disaster situations. Appropriate new telemedicine applications can improve future disaster medicine outcomes, based on lessons learned from a decade of civilian and military disaster (wide-area) telemedicine deployments. This manuscript reviews the history of telemedicine activities in actual disasters and similar scenarios as well as ongoing telemedicine innovations that may be applicable to disaster situations. Emergency care providers must begin to plan effectively to utilize disaster-specific telemedicine applications to improve future outcomes.

Disasters↗

PubMed1997

Outcomes and informatics.

OBJECTIVE: To provide an overview of the potential contribution that informatics can make for pathologists who become involved in outcomes assessment and management. DATA SOURCES: Contemporary scientific articles centered on pathologists and the assessment of outcomes, the definitions of outcomes assessment and management, and related methodologic issues, especially those pertaining to information technology and outcomes, and a summary of eight independent group process sessions involving volunteer pathologists and a group facilitator discussing issues related to informatics and outcomes as structured by a clinical scenario with focusing questions. STUDY SELECTION: Articles reviewed were drawn primarily from the literature published since 1985 and found through Medline key word searches of titles and abstracts; likely articles were then selected for subsequent detailed review on the basis of the abstract's contents. Group process data were drawn from summaries of each of the eight groups as prepared by the facilitator from notes taken during the session by a designated scribe. CONCLUSIONS: It is crucial for pathologists to participate in clinical outcomes studies. Informatics can serve as a tool kit for performing outcomes studies relevant to pathology (eg, collect data or analyze data), or it can be seen as a malleable component of health care processes that can be modified to achieve improved outcomes. Pathologists see many potential avenues for using informatics to leverage the impact that the pathologist and laboratory can have on clinical outcomes. Focusing on some specific informatics learning objectives can help the pathologist become a leader in outcomes studies.

Databases, Factual↗

PubMed2006

Food Stamp Program participation is associated with better academic learning among school children.

Household food insecurity is associated with multiple adverse outcomes in children and adolescents, including poor school performance. U.S. federal food assistance programs such as the Food Stamp Program (FSP) aim to help prevent household food insecurity and its outcomes. Program participation may act as a resource either to counteract the effects of constraints such as food insecurity or to modify the effects of food insecurity on outcomes. This study aimed to determine whether FSP participation was associated with child reading and mathematics learning, weight gain, and social skills and whether these associations depended on degree of estimated need for the program. Data used were from the Early Childhood Longitudinal Study-Kindergarten cohort, a large nationally representative sample. A difference (i.e., fixed-effects) model was used to minimize bias in the estimation of association resulting from unmeasured covariates. Starting FSP participation during the 4 years from K to third grade was associated with about a 3-point greater improvement in reading and mathematics score as compared with stopping FSP participation during that period. But it was for female students only that this association was large and significant. Children in households starting FSP participation had slightly but not significantly less weight gain compared with children in households stopping FSP participation. This study provides the strongest evidence to date that FSP participation plausibly has beneficial effects for children on nonnutritional outcomes, specifically academic learning. The mechanisms for this relationship are not well understood and may be through both dietary intake and stress.

Child↗

PubMed2026

A machine learning-derived and functionally validated circadian rhythm signature predicts clinical outcomes and in silico drug sensitivity in colorectal cancer.

BACKGROUND: Colorectal cancer (CRC) displays considerable heterogeneity in clinical outcomes, highlighting the need for reliable prognostic biomarkers. While the aberrant expression of circadian rhythm-related genes has been implicated in cancer pathogenesis, its comprehensive role in CRC progression and predicted therapeutic vulnerabilities remains inadequately characterized. METHODS: Bulk and single-cell RNA-sequencing data were integrated from multiple CRC cohorts. A circadian rhythm signature (CRS) was developed through machine learning algorithms and validated for prognostic value. Comprehensive analyses of tumor microenvironment, genomic alterations, and drug sensitivity were performed. Furthermore, the biological function of the core gene, BHLHE40, was validated in CRC cell lines through CCK-8, EdU, and wound healing assays. RESULTS: Single-cell analysis demonstrated an elevated expression signature of circadian rhythm-related genes in dendritic cells. The optimized CRS, comprising 14 circadian rhythm-related genes, successfully categorized patients into high- and low-risk groups. Patients with a high CRS showed markedly poorer overall survival and computationally inferred immunosuppressive features, including reduced CD8+ T cell infiltration and increased M2 macrophage polarization. Genomic analysis revealed enhanced mutation burden in TP53 and alterations in RTK-RAS/WNT pathways. Notably, in vitro assays confirmed that BHLHE40 is significantly overexpressed in CRC cells. Knockdown of BHLHE40 markedly inhibited tumor cell proliferation and migration. Drug sensitivity profiling identified bexarotene and SMER-3 as potential therapeutic options for high-CRS patients. A nomogram integrating CRS with clinical parameters demonstrated superior predictive accuracy for 1-, 3-, and 5-year survival. CONCLUSIONS: The CRS represents a promising prognostic biomarker that reflects tumor immune status and genomic features, providing valuable insights for personalized treatment strategies in CRC.

Circadian rhythm↗

PubMed2000

Machine learning for survival analysis: a case study on recurrence of prostate cancer.

Machine learning techniques have recently received considerable attention, especially when used for the construction of prediction models from data. Despite their potential advantages over standard statistical methods, like their ability to model non-linear relationships and construct symbolic and interpretable models, their applications to survival analysis are at best rare, primarily because of the difficulty to appropriately handle censored data. In this paper we propose a schema that enables the use of classification methods--including machine learning classifiers--for survival analysis. To appropriately consider the follow-up time and censoring, we propose a technique that, for the patients for which the event did not occur and have short follow-up times, estimates their probability of event and assigns them a distribution of outcome accordingly. Since most machine learning techniques do not deal with outcome distributions, the schema is implemented using weighted examples. To show the utility of the proposed technique, we investigate a particular problem of building prognostic models for prostate cancer recurrence, where the sole prediction of the probability of event (and not its probability dependency on time) is of interest. A case study on preoperative and postoperative prostate cancer recurrence prediction shows that by incorporating this weighting technique the machine learning tools stand beside modern statistical methods and may, by inducing symbolic recurrence models, provide further insight to relationships within the modeled data.

Artificial Intelligence↗

PubMed1990

Memory consolidation of weak training experiences by hormonal treatments.

Day-old chicks trained on a single-trial passive discrimination avoidance task using a concentrated chemical aversant, methyl anthranilate (MeA), have been shown to exhibit three stages of memory processing; short-, intermediate- and long-term. A similar learning task with the aversant diluted to 20% in ethanol leads to short-and intermediate-term memory, but no long-term memory. Subcutaneous administration of selected doses of the stress-related hormones, noradrenaline, ACTH and vasopressin in close temporal proximity to the training trial, produced long-term memory in chicks trained on the weakly reinforced task, mimicking the outcome of strongly reinforced learning and of retraining with the weakly reinforced task reported previously. These effects are shown to be associated with the production of a nonenergy-dependent phase of the intermediate memory stage, postulated to be necessary for long-term memory consolidation.

2,4-Dinitrophenol↗

PubMedDate not supplied

The 12 1/2 minute learning session: some examples and analysis of impact.

Staff nurses experience time demands that frequently prevent them from attending inservice offerings. The 12 1/2 minute learning session is an innovative approach designed to meet the learning needs of the psychiatric nursing staff in spite of time constraints. The guiding principles for these sessions are: 1) "We learn what we care about," 2) preparation for sessions conveys commitment, and 3) accountability for learning is the individual's responsibility but opportunities for learning are shared. Identified outcomes of these groups are the "earthquake effect" or the shifting of one's footing; opportunity for effective debunking or uncovering of habitual patterns; and "bushfire effect" or contagiousness of enthusiasm.

Education, Nursing, Continuing↗

PubMed2005

Error-related negativity predicts reinforcement learning and conflict biases.

The error-related negativity (ERN) is an electrophysiological marker thought to reflect changes in dopamine when participants make errors in cognitive tasks. Our computational model further predicts that larger ERNs should be associated with better learning to avoid maladaptive responses. Here we show that participants who avoided negative events had larger ERNs than those who were biased to learn more from positive outcomes. We also tested for effects of response conflict on ERN magnitude. While there was no overall effect of conflict, positive learners had larger ERNs when having to choose among two good options (win/win decisions) compared with two bad options (lose/lose decisions), whereas negative learners exhibited the opposite pattern. These results demonstrate that the ERN predicts the degree to which participants are biased to learn more from their mistakes than their correct choices and clarify the extent to which it indexes decision conflict.

Adaptation, Physiological↗

PubMedDate not supplied

Long-term effectiveness of spaced-retrieval memory training for older adults with probable Alzheimer's disease.

Ten older adults with probable Alzheimer's disease (AD) were trained to recall everyday objects using the spaced-retrieval technique. Five persons had participated in a prior spaced-retrieval program (Cherry & Simmons-D'Gerolamo, 1999, Clinical Gerontologist, 20, 39-63). The authors retested these original participants to measure the long-term effectiveness of spaced-retrieval training. Five new participants were included for comparison purposes. During training, participants selected a target object from an array of items at increasingly longer retention intervals. To enhance the effectiveness of spaced-retrieval training, two original and two new participants were given a target object orientation task prior to training. Positive effects of prior experience occurred for most of the original participants. The orientation task enhanced memory for the target objects. Implications for memory remediation in late adulthood are considered.

Aged↗

PubMed1999

The importance of self-determination theory for medical education.

While some theories of human motivation focus exclusively on levels of motivation, self-determination theory argues that different types of motivators, even when the resulting motivation is high, will lead to very different outcomes. This theory differentiates between two primary kinds of motivation, controlled and autonomous. Controlled motivation depends either on explicit or implicit rewards or punishment or on people's internalized beliefs about what is expected of them. Learning in controlled situations, in which students act under pressure and anxiety, is likely to be rote, short-lived, and poorly integrated into students' long-term values and skills. In contrast, autonomous motivation, as its name implies, is personally endorsed and reflects what people find interesting and important. While controlled motivation involves compliance with pressures, autonomous motivation involves behaving with a sense of volition, agency, and choice. Autonomously motivated learning leads to better educational outcomes. There is evidence that medical students who learn in autonomy-supportive environments act in more autonomy-supportive ways in their interactions with patients. Because the reliable implementation of practice guidelines and physicians' use of an autonomy-supportive style have been associated with more positive health outcomes (particularly in the behavior-related areas of smoking cessation, weight loss, etc.), more autonomy-supportive medical education may result in more effective health care delivery.

Achievement↗

PubMed1982

Expectancy mediation of concurrent conditional discriminations.

Pigeons learned a pair of two-choice conditional discriminations concurrently. One was red/green identity matching. The other also employed red and green sample stimuli, but the choice alternatives were vertical vs. horizontal lines, with vertical being correct following red samples and horizontal being correct following green. Correct choices produced either food reward or a brief feedback tone. For the "congruent" group, a given sample reliably predicted a particular outcome (e.g., red-food, green-tone), regardless of whether the animal chose between colors or lines. For the "incongruent" group, the outcome that followed a particular sample was one thing on color-choice trials and the other thing on line-choice trials. For example, if a subject in the incongruent group received food for red matches and tone for green matches, then it received tone for correct vertical choices and food for correct horizontal choices. The congruent group reached significantly higher levels of correct performance on both problems than did the incongruent group. Moreover, these relative levels of performance were reversed when birds trained on the congruent procedure were switched to the incongruent procedure and vice versa, even though the stimulus-response requirements of both problems remained unchanged. The experiment provides further evidence that the outcome expectancies acquired in learning situations can be significant sources of stimulus control of instrumental behavior.

Animals↗

PubMed2002

Patient outcomes for segmental colon resection according to surgeon's training, certification, and experience.

Background. We examined patient outcomes for colon resection to determine if they varied according to surgeon-specific factors including: (1) American Board of Surgery (ABS) certification, (2) colorectal surgery subspecialty certification, (3) site of residency training (university-based vs nonuniversity-based), and (4) years of experience since ABS certification. Methods. We performed a retrospective study of 15,427 admissions of northern Illinois residents who underwent segmental colon resection as their primary operation from 1994 to 1997 at 76 nonfederal Illinois hospitals. There were 514 surgeons. Main outcome measures were inpatient mortality, complications, and hospital length of stay. Regression analyses with mixed effects were used to assess the significance of surgeon-specific variables as a predictor of outcomes after risk adjustment for patient age, gender, emergency admission, surgeon volume, hospital site, colon pathology, and comorbid illnesses. Results. ABS-certification was associated with reduced mortality and morbidity. Increasing years of experience was associated with reduced mortality. Colorectal surgery certification and site of residency training did not significantly affect outcomes. Conclusion. We were able to link patient outcomes with surgeon's training. Certification was an important determinant of patient outcomes for colon resection. Increasing surgeon experience also had a favorable effect on outcomes, suggesting a continued learning curve subsequent to residency. (Surgery 2002;132:663-72).

Adult↗

PubMedDate not supplied

Goodness of fit in the home: its relationship to school behavior and achievement in children with learning disabilities.

This study examined whether a "goodness of fit" theoretical model, applied to families with and without children with learning disabilities, would be valuable in understanding the children's performance in school. A home interview was conducted with 63 families with a child with learning disabilities and 53 families with a comparable child without learning disabilities. The mothers were asked to rate how their own child fit into the family's expectations for children. It was found that, for both groups of families, children who were rated as a "poor fit" in the home demonstrated less positive behavior in the classroom and poorer achievement over the elementary school years. There was some evidence that poor fit in the home was even more negatively related to outcomes for children with learning disabilities. Discussion is centered on the importance of this theoretical model for understanding the importance of the home on successful school function.

Achievement↗

PubMedDate not supplied

From RN to BSN: seeing familiar situations in different ways.

Registered nurses enrolled in post-RN programs are a special group of students with unique learning needs. One important outcome of a successful post-RN program is the ability of its graduates to see familiar situations in different ways and to demonstrate these changes in new and different approaches to patient care. This shift in the way nurses see themselves and their worlds can be described and explained by Mezirow's Theory of Perspective Transformation. This article discusses perspective transformation related to post-RN students in nursing programs; describes teaching-learning models that assists perspective transformation to take place; identifies conditions that promote perspective transformation; and suggests some strategies to facilitate the process.

Adult↗

PubMed2002

The effect of sample size and disease prevalence on supervised machine learning of narrative data.

This paper examines the independent effects of outcome prevalence and training sample sizes on inductive learning performance. We trained 3 inductive learning algorithms (MC4, IB, and Naïve-Bayes) on 60 simulated datasets of parsed radiology text reports labeled with 6 disease states. Data sets were constructed to define positive outcome states at 4 prevalence rates (1, 5, 10, 25, and 50%) in training set sizes of 200 and 2,000 cases. We found that the effect of outcome prevalence is significant when outcome classes drop below 10% of cases. The effect appeared independent of sample size, induction algorithm used, or class label. Work is needed to identify methods of improving classifier performance when output classes are rare.

Algorithms↗

PubMedDate not supplied

How documentation outcomes guide the way: a patient health education electronic medical record experience in a large health care network.

BACKGROUND: Despite Joint Commission on Accreditation of Healthcare Organizations' standards in patient health education (PHE), the patient education process oftentimes remains underreported in many patients' medical records. The primary focus of this project was to create a usable electronic medical record (EMR)-based method of documentation of PHE within a large Department of Veterans Affairs (VA) health care network using clinical staff involvement, routine monitoring, and consistent feedback. METHODS: A team of clinical staff was formulated to review current literature, seek out best practices, examine existing VA PHE templates, and create and monitor a user-friendly EMR process for documenting the assessment of patient learning needs and the outcomes of teaching and education. Professional team focus groups, pilot testing, usage monitoring, local action planning, and feedback surveys were selected strategies utilized to create and evaluate success and make timely revisions. RESULTS/RESPONSE: Monthly usage reports were provided to the local PHE teams. An EMR monitoring system for clinical reminders provided an appropriate and tested mechanism to collect specific usage data. Since 2003, steady improvement has been reported with use partly due to greater acceptance of the process and growing competition among network sites. The newly created PHE EMR has since been modified to enhance the quality of documentation as staff becomes more adept at using these tools. CONCLUSION: Staff involvement in format design and development combined with consistent feedback and evaluation resulted in improved documentation compliance. Future work is focused on the quality of evaluations of patient learning needs and electronic recording of patient teaching and education.

Hospitals, Veterans↗

PubMed1994

Treatment of a man with a mild learning disability who was sexually assaulted whilst in prison.

The aim of this study is to describe the psychological effects on a man with a mild learning disability who was sexually assaulted whilst in prison, and the treatment which was carried out. J. suffered Post-Traumatic Stress Disorder (PTSD), as defined in DSM-III-R, combined with associated features of depression and anxiety. Treatment involved imaginal exposure to the assault, followed by systematic desensitization to the traumatic experience of imprisonment preceding the assault. Activities were also carried out to develop J.'s self-esteem, coping strategies and anxiety management. The successful outcome of treatment is discussed in relation to models of emotional processing. Some discrepancies between scores on self-evaluation questionnaires and behavioural observations raise issues concerning the best way of assessing treatment outcome for people with learning disabilities.

Adult↗

PubMed2006

Educating students for practice: educational outcomes and community experience.

The education of pharmacists in the United States integrates classroom and experiential learning. Two organizations played a key role in determining the current education of pharmacy students. They are the Accreditation Council for Pharmacy Education and the American Association of Colleges of Pharmacy. The curriculum offered today provides opportunities for students to learn and achieve ability-based outcomes in both didactic and experiential courses. This review of pharmacy education focuses generally on the national leadership of pharmacy education both past and present and specifically on outcomes of practice that students are expected to achieve. Included in the discussion are recommendations for how preceptors in a community practice model can build on the college curriculum by recognizing and incorporating ability-based outcomes into their activities of the introductory and advanced practice courses.

Education, Pharmacy↗