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PubMed2002

Applying research to practice. Practical guidelines for occupational health nurses.

Much has been written about the research practice gap--and there is no doubt this gap exists in occupational health nursing. It is an irony that the professionals who would benefit most from occupational health and safety research may be the ones who do not participate in or contribute to research. Closing the gap requires a commitment on the part of both practitioners and researchers. It behooves occupational health nurses to constantly seek ways to make the connection--to forge relationships that can continue to advance the specialty. Researchers must increase their efforts to conduct research in "real world" conditions, because this research is most likely to improve practice. Practitioners must be willing to familiarize themselves with research so they can become active participants in the ongoing effort to find answers to troubling occupational health and safety problems. Rosenheck (2001) presents an interesting perspective on the barriers to eliminating the research practice gap. He purports that, although professionals often are highly respectful of scientific endeavors, in reality, "daily decision making is shaped more by power structures, ingrained routines, and established resource configuration than by current scientific findings." In most organizations, standard operating procedures and behavioral norms are the major influences on workplace practices; scientific evidence plays a minor role (Rosenheck, 2001). Several reasons can be found for this lack of reliance on research as a basis for practice. Studies may demonstrate effectiveness among large groups. However, practitioners may not see the relevance or applicability of such studies to individuals or small groups of clients. Also, practitioners may fear that the implementation of new strategies will require more oversight than they are able to provide. Another logistical barrier is the application of the research may require the collaboration of multiple individuals--dynamic environments with extensive turnover may result in constant personnel changes and diminished commitments on the part of the team. Applying research to practice requires thoughtful and careful strategizing. Success depends on the commitment of key people within the organization to see the activities through from planning to implementation to evaluation. The involvement and support of management is crucial to a successful outcome. In many cases, the benefits of the research many not be readily apparent. However, if management perceives the potential value and the eventual "pay offs," they are more likely to allocate funds and other resources needed to assure the research is supported to its completion. Finding the time and resources to read and apply research in the occupational setting is a formidable task. However, the importance of a scientific base to occupational nursing practice is becoming increasingly evident. Occupational health nurses must become effective observers who recognize the value of research findings contributing to more effective practice. They must develop strategies for sharing information and for learning from others' experiences, and through this process, demystify the research process and become better research consumers. If occupational health nurses are to maximize their abilities to achieve their most important health and safety goals and to provide cost effective, quality services, they must develop strategies to enable them to use findings from relevant, well designed, practice oriented research studies.

Diffusion of Innovation↗
PubMed1991

What do medical students know about childhood asthma?

A questionnaire designed to measure knowledge about childhood asthma was completed by 216 of the 311 (69%) undergraduate medical students at the University of Newcastle. First year students had a mean score of 16.2 (maximum possible score was 31) which was similar to the background community score of 13.0 obtained in a group of parents with no close contact with asthma. Knowledge about asthma increased over each of the 5 years of the medical course. Final-year students had a mean score of 28.7 (range: 25-31) which was similar to a group of parents thought by their paediatricians to have a high level of knowledge about asthma (mean: 25.3, range: 18-31). The progression of knowledge over the 5 years of the course provided interesting information about the learning process. Although second year students completed the questionnaire after a term devoted to coursework in respiratory medicine, only 26% were able to name two preventive agents and 21% named three agents useful during acute attacks of asthma. Third year students gave correct responses in 39 and 45% of cases, respectively, and the correct response rates rose to 78 and 97% in the fifth year. This was probably because the theoretical knowledge needed to be acquired and tested against a clinical scenario before it could be used. The study demonstrated an increase in knowledge about asthma throughout the problem-based medical course. In addition to providing information about the educational process, it provided information about the questionnaire which was able to measure a range of knowledge and not just extremes of asthma knowledge.

Asthma↗
PubMed2006

Brains Rule!: a model program for developing professional stewardship among neuroscientists.

Brains Rule! Neuroscience Expositions, funded through a National Institute on Drug Abuse Science Education Drug Abuse Partnership Award, has developed a successful model for informal neuroscience education. Each Exposition is a "reverse science fair" in which neuroscientists present short neuroscience teaching modules to students. This study focuses on results of assessments conducted with neuroscientist presenters during Expositions at two sites, Atlanta, Georgia and Corpus Christi, Texas. The effects of participating in the Expositions on presenters' perceptions of their own presentation and communication skills were evaluated, as was the potential for increased active participation by neuroscientists in future outreach programs. In four of the five Expositions studied, pre- versus post-event surveys demonstrated significant changes in presenters' perceptions of their own abilities to explain neuroscience concepts to children. Over the course of an Exposition, presenters learned to fit their approaches to conveying neuroscience concepts to fifth through eighth graders and learned to link information they presented about the brain and nervous system to children's past experiences to improve comprehension. The present data suggest that Brains Rule! Neuroscience Expositions are effective in improving communication and teaching skills among neuroscience professionals and contribute to professional stewardship by increasing motivation to participate in future informal education programs.

Brain↗
PubMed2005

One month of human memory consolidation enhances retrieval-related hippocampal activity.

We studied the role of the hippocampus in memory retrieval at 1 day and 1 month following associative learning of word pairs. Retrieval-related brain activity was recorded using functional magnetic resonance imaging in 20 healthy students, of which 12 were good learners and eight were poor learners. At the day lag, the poor learners exhibited enhanced neural recruitment in the hippocampus and neocortex to reach a retrieval performance comparable to that of the good learners. Over the 20 subjects, there was a positive correlation between retrieval-related hippocampal activity at the day lag and forgetting over the month retention interval (the greater the activity, the more forgetting). Although the poor learners' retrieval performance declined dramatically from the day to the month lag, the good learners maintained a high retrieval performance, which distinguishes them as good memory consolidators. Their retrieval-related hippocampal and neocortical activity increased from the day to the month lag. This increase was observed both when retrieval performance was matched between the day and the month lag and when the learning procedure for information retrieved at the day and the month lag was matched. This activity increase in the task-specialized neural network from the day lag to the month lag may reflect an increase in task demands or the proliferation of hippocampal-neocortical memory traces during memory consolidation as suggested by the multiple trace theory.

Adult↗
PubMed1994

Cue reactivity as a predictor of drinking among male alcoholics.

Social learning theories suggest that conditioned responses may increase the risk for relapse. Responses to alcohol use cues (cue reactivity) are associated with variables suggestive of risk but little research exists on the relationship of cue reactivity to treatment outcome. Alcoholic men admitted for detoxification to a treatment program (n = 45) underwent a cue reactivity assessment protocol, and 91% received 3-month follow-up interviews. Greater salivary reactivity predicted greater frequency of drinking during follow-up. Attentional factors added independent variance to the prediction of drinking outcome, with greater attention to stimulus or to response predicting less drinking. Cue reactivity did not predict length of hospital stay or latency to first drink. Results are discussed in the context of information processing, social learning theories, and clinical implications for relapse prevention.

Adult↗
PubMed2004

When sporadic disease is not sporadic: the potential for genetic etiology.

BACKGROUND: Approximately 2% of Alzheimer disease cases and 10% to 15% of prion disease cases are due to mutations in autosomal dominant genes. Mutations have been found in patients without family histories of neurological disease. OBJECTIVES: To emphasize the need for consideration of a genetic etiology of prion disease and early-onset Alzheimer disease, regardless of the absence of a significant family history, as well as the need for pretest genetic counseling of all patients or their families. DESIGN: Three case reports. PATIENTS AND RESULTS: Patient 1, a 53-year-old man with possible Creutzfeldt-Jakob disease, was enrolled in a research study that included sequencing of the prion protein gene. Although there was no family history of neurological disease, an E200K mutation was found. This unexpected result caused the family significant distress. Patient 2, a 55-year-old woman with biopsy-proven Creutzfeldt-Jakob disease, participated in a prion disease research study. Her family was counseled about the possibility of hereditary Creutzfeldt-Jakob disease, despite the lack of family history. After assessing the ramifications, the family decided not to learn about the patient's genetic test results. Patient 3 was a 54-year-old man with a 6-year history of memory loss. A diagnosis of probable Alzheimer disease was given, and the patient and his family were counseled on the availability of presenilin 1 testing, although there was no known family history of dementia. The family agreed to testing, and a presenilin 1 mutation was identified. CONCLUSIONS: Certain neurodegenerative diseases may have a genetic etiology, despite the lack of a positive family history. Revealing a newly discovered hereditary cause of Creutzfeldt-Jakob disease or Alzheimer disease can have a profound effect on families. Pretest counseling on genetic issues is essential to better prepare families and to allow them to make an informed choice about learning genetic test results.

Alzheimer Disease↗
PubMed2006

How clinical instructors can enhance the learning experience of physical therapy students in an introductory clinical placement.

PURPOSE: There is little understanding of how physical therapy students are influenced by clinical instructors (CIs) particularly at the outset of their clinical learning. The purpose of this study was to evaluate physical therapy students' perceptions of their learning experiences during an introductory clinical placement. METHODS: Subjects were 51 physical therapy students participating in an introductory clinical placement following the first unit (semester) of a 2-year, entry-level Master's program. Each day of their placement, students completed a questionnaire based on Brookfield's Critical Incident Questionnaire. Students were asked when they felt most engaged or distanced, what actions of others were most affirming or puzzling, and what surprised them about the placement that day. Two evaluators independently read and coded the entries in all questionnaires, and then collaborated to establish themes related to the behaviors of the CI. RESULTS: The CI could enrich the students' experiences in the following ways: (1) prepare them by introducing, explaining, demonstrating, or allowing them time to obtain information. (2) Confirm learning by providing feedback and recapping. (3) Provide "hands on" experiences appropriate to students' knowledge, skills and comfort. (4) Challenge students by questioning, discussing possibilities, or providing time for reflection. (5) Respect students, value their input and allow them an appropriate level of independence. (6) Demonstrate professional behavior related to communication, evidence-based practice and continuing education. CONCLUSIONS: Physical therapy students value CIs who involve them in patient care; confirm, challenge and prepare them for learning; respect their input and model professional behavior.

Adult↗
PubMed2002

Community learning disability teams: the need for objective methods of prioritization and discharge planning.

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Case Management↗
PubMed2000

Strategic planning in medical education: enhancing the learning environment for students in clinical settings.

BACKGROUND: The 1999 Cambridge Conference was held in Northern Queensland, Australia, on the theme of clinical teaching and learning. It provided an opportunity for groups of academic medical educators to consider some of the challenges posed by recent changes to health care delivery and medical education across a number of countries. PURPOSE: This paper describes the issues raised by the practical challenges posed by the current environment and how they might be addressed in ways that could promote more effective learning in clinical settings. METHOD: A SWOT analysis is a tool that can help in forward planning by identifying the strengths, weaknesses, opportunities and threats presented by any situation. Our SWOT analysis was used to generate a list of items, from which we chose those most feasible and most likely to promote positive change. RESULTS: Twenty different issues were identified, with four of them chosen by consensus for further elaboration. The discussion gave rise to four main recommended strategies: ensuring that clinical teachers thoroughly understand the purpose and process of learning in clinical settings; equipping learners with 'survival skills'; making the best use of learning resources within different clinical environments and making judicious use of information technology to enhance learning efficiency. CONCLUSIONS: The four strategies were selected not only because of their inherent importance, but also because of their feasibility. Modest changes can motivate students to feel part of a clinical team and a 'community of practice' and enhance their capacity for self-regulated practice.

Clinical Clerkship↗
PubMed2002

A potent weapon in the battle against HIV: your own immune system.

The goal of HIV vaccines is to teach the immune system new and hopefully better ways to win the battle against the virus. There are different types of immune responses, those we were born with (innate immunity) and those we "learn" (acquired immunity). HIV vaccines exploit the side of the immune system that is learned (acquired) by providing information to cells in new ways in hopes of enhancing their learning and making them more effective fighters.

AIDS Vaccines↗
PubMed1997

Preparing our future physicians: integrating medical informatics into the undergraduate medical education curriculum.

This paper describes how two medical schools have integrated "medical informatics" into their undergraduate medical education programs with the aim of preparing their students for future practice. It describes the components or elements of the informatics programs, how learning opportunities have been integrated into the curricula, how the informatics programs have evolved, and future directions. The medical schools approached the task of introducing informatics in a parallel way. Following needs identification, similar topic areas, goals, and specific informatics learning objectives were developed. These were used as a basis for implementation and evaluation. In general, the topic areas selected are: computer literacy, communications, information retrieval and management, computer-aided learning, patient management, office practice management, and hospital information systems. Learning opportunities in informatics were integrated for the above goals, in accordance with how the curriculum was organized in each school. These opportunities, and the support activities provided will be described.

Alberta↗
PubMed1994

The role of information in the planning, management and evaluation of community nutrition programmes.

Protein-energy malnutrition has many diverse location-specific causes which make if difficult to solve through uniform interventions implemented through vertical programmes. This paper investigates the role of information in the planning, management and evaluation of several community nutrition programmes judged to be successful. The programmes come from Tanzania (Iringa), India (Tamil Nadu), Dominican Republic and Colombia. The review finds that the initial conceptualization and design of these programmes benefited from the results of earlier surveys and experience with similar programmes in the same or other countries. Strong capacity for operations research is important to assist with a myriad of small but important programme design details and larger mid-term re-orientations. The impact of this information depends upon the flexibility of the programme and receptivity of its management towards a learning-by-doing approach. Information for on-going programme management differs widely and conforms to the overall character of the individual programme. Thus, Iringa employs a simple system based on community growth monitoring, primarily to catalyze intervention planning and action at household and community levels. Tamil Nadu's system is far more complex and is primarily intended to assist in the delivery of centrally planned interventions. Programme evaluation benefited from information generated within the programme, but more rigorous impact evaluation requires stronger designs and more in-depth analysis than is usually provided. Overall, the review suggests that characteristics like community participation, empowerment and growth monitoring are less important in the short/medium term than strong management, a learning-by-doing approach, and the existence of some method for informing programme design and management about community needs and responses to the programme. The former characteristics may well be important for the longer-term sustainability of programmes.

Community Health Services↗
PubMedDate not supplied

Simultaneous training on two hippocampus-dependent tasks facilitates acquisition of trace eyeblink conditioning.

A common cellular alteration, reduced post-burst afterhyperpolarization (AHP) in CA1 neurons, is associated with acquisition of the hippocampus-dependent tasks trace eyeblink conditioning and the Morris water maze. As a similar increase in excitability is correlated with these two learning paradigms, we sought to determine the interactive behavioral effects of training animals on both tasks by using either a consecutive or simultaneous training design. In the consecutive design, animals were trained first on either the trace eyeblink conditioning task for six sessions, followed by training on the water maze task for six sessions, or vice versa. The simultaneous design consisted of six or 11 training days; animals received one session/day of both trace eyeblink conditioning and water maze training. Separate groups were used for consecutive and simultaneous training. Animals trained on both tasks simultaneously were significantly facilitated in their ability to acquire the trace eyeblink conditioning task; no effect of simultaneous training was seen on the water maze task. No effect was seen on acquisition for either task when using the consecutive training design. Taken together, these findings provide insight into how the hippocampus processes information when animals learn multiple hippocampus-dependent tasks.

Animals↗
PubMed2002

Risk awareness, exposure to oral health information, oral health related beliefs and behaviours among students attending higher learning institutions in Dar es Salaam, Tanzania.

OBJECTIVE: To assess the level of exposure to information about oral health from local sources, risk awareness, oral health beliefs and behaviours among male and female students attending higher learning institutions in Dar es Salaam. DESIGN: A cross sectional survey. SETTING: Government recognised higher education institutions in Dar es Salaam, Tanzania in 1999. SUBJECTS: The study population comprised of 1123 university students in Dar es Salaam. MAIN OUTCOME MEASURES: Level of risk awareness, exposure to oral health information, oral health beliefs and behaviour among students. RESULTS: Despite apparent misconceptions, the level of risk awareness was generally high and did not differ between male and female students. Univariate analysis of variance revealed that female students were exposed to more oral health information, had stronger oral beliefs and performed preventive behaviours more frequently than did their male counterparts. In multiple linear regression analysis, beliefs about the importance of preventive behaviours were significantly related to the frequency with which such habits occurred (beta = 0.19, p < 0.001) across gender and students status. This relationship was significantly stronger among females (beta = 0.33, p < 0.001) than among males (beta = 0.11 p < 0.05). CONCLUSION: The results indicate that strengthening beliefs in the presence of accurate knowledge might successfully promote students' oral health enhancing behaviour.

Adult↗
PubMed1996

Infusion of (+) -MK-801 and memantine -- contrasting effects on radial maze learning in rats with entorhinal cortex lesion.

(+)-5-Methyl-10,11-dihydro-5H-dibenzocyclohepten-5,10-imine maleate ((+)-MK-801) and 1-amino-3,5-dimethyladamantane (memantine), two uncompetitive antagonists of the NMDA receptor were tested in an allocentric version of the radial maze test (with four out of eight arms reinforced) both in normal rats and after quinolinic acid-induced entorhinal cortex lesions. Both agents were infused s.c. using Alzet osmotic minipumps in order to assure steady state drug levels in the serum and brain during the experiment. In non-lesioned rats, (+)-MK-801 (0.312 mg/kg per day) produced disturbances in learning of spatial information dependent on reference memory but not that involving working memory. In contrast, memantine (20 mg/kg per day) had no effect in normal rats. In rats with entorhinal cortex lesions, (+)-MK-801 enhanced the lesion-induced deficit in reference memory. In contrast, memantine reversed the lesion-induced increase in reference memory errors. The divergent effects of those two uncompetitive NMDA receptor antagonists could, at least partially, be due to the differences reported in their channel blocking kinetics and voltage dependence. The results indicate that under conditions of pathological impairment of brain structures such as entorhinal cortex lesion, memantine might produce beneficial effects on cognitive functions.

Animals↗