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PubMed1991

Preparing doctors for tomorrow: information management as a theme in undergraduate medical education.

The evolving nature of medical knowledge and technology requires that the practitioners of tomorrow be able to develop practice management and computer skills in order to enhance quality patient care, ongoing education, and research. The paper describes how the discipline of medical informatics can be integrated into an undergraduate medical curriculum, not as a course or series of courses but as a repeated theme throughout the 3-year system-based curriculum. Recommendations specific to integrating medical informatics into an undergraduate curriculum are outlined with respect to: (1) content; (2) content organization; (3) management; and (4) evaluation. Six areas of information and computer management applications are discussed. These are computer-assisted learning, retrieving and organizing information from computerised databases, the application of medical informatics tools to the critical appraisal of literature and associated statistical software packages, hospital- and office-based information systems, and electronic communications. Medical education has a history of resistance to change. Reference to guidelines and experiences of others who have negotiated information management and medical informatics changes into medical school environments can therefore be helpful. It is in this context that this paper is presented.

Alberta↗

PubMed1996

School-aged children with spina bifida in Western Australia--parental perspectives on functional outcome.

A questionnaire mailed to the parent(s) of all 86 school-aged children with spina bifida resident in Western Australia in 1992 who were attending a spinal dysfunction clinic or were members of the Spina Bifida Association was returned by 72 parents. All 72 of these children (55 with myelomeningocele, 17 with meningocele) lived at home with their parent(s). All but two children with meningocele were mobile without aids, whereas only 42% of the children with myelomeningocele were. Twenty one per cent of the children were naturally continent of urine day and night, and 36% were naturally continent of faeces. 76% attended a mainstream school although performance at school was rated below average for 40%. Nine children with meningocele (56%) and 42 with myelomeningocele (76%) were reported to have learning difficulties. This information will be useful in counselling parents of unborn and newborn children with spina bifida, and in allocating resources for children and young adults with spina bifida and their families.

Adolescent↗

PubMed2001

A representational approach to patient education.

PURPOSE: To describe the theoretical basis for a representational approach to patient education and the application of this approach to the development, implementation, and preliminary evaluation of a representational intervention for pain management. ORGANIZING CONSTRUCT: Leventhal's common sense model (CSM) was a guide for this approach to patient education. The CSM is based on the idea that people have common sense beliefs, or representations, that guide how they cope with health problems. Theoretically based interventions derived from the CSM have not been reported. METHODS: Steps included: (a) designing a general approach to educational interventions, centered on illness representations; (b) specifying an intervention (RIDPAIN) to facilitate coping with cancer pain; (c) pilot-testing and revising the intervention; and (d) testing feasibility and acceptability of the intervention with 61 patients in a Midwestern American city. FINDINGS: The RIDPAIN intervention was useful in eliciting misconceptions of pain and pain management from patients experiencing cancer pain. Many patients found RIDPAIN to be meaningful and useful, and they perceived it to have an effect on pain-related beliefs and behaviors. CONCLUSIONS: This theory-driven approach should be effective and widely applicable because it includes patients as active participants in all phases of the learning continuum, from information acquisition to behavior change.

Adaptation, Psychological↗

PubMedDate not supplied

Development of alterations in learning: situational learning disabilities.

Until now the nursing diagnosis knowledge deficit has served as a label for all teaching/learning situations. This is inadequate and does not effectively give direction to correct intervention(s). The purpose of this article is to present the diagnostic concept, situational learning disability (SLD), a component of Alterations in Learning, which has been identified as an area to be developed in the Knowing pattern of the NANDA taxonomy. A thorough review of the literature and empirical support involving 20 cardiology patients on a 27-bed telemetry step-down unit is provided. The data support the development of two nursing diagnoses: (1) situational learning disability: impaired ability to learn; and (2) situational learning disability: lack of motivation to learn. The proper identification of these diagnoses can assist nurses in discriminating between patients who can learn, those who cannot learn, and those who need adjustments made in order to facilitate their learning. With this information nurses will be able to make decisions concerning the timing and type of intervention that is most appropriate.

Adult↗

PubMed1983

Management of the obese child in the school.

Improving the nation's health depends on changing lifestyles that are detrimental to health. The school nurse can bring about significant changes in the lifestyles of obese children through the formation of a Health Club. Through participation in the club, children learn to make informed decisions about health. The club aides in health promotion through behavior modification techniques that offer incentives to adopt healthy lifestyles, with the goals of improved health status, quality of life and life expectancy.

Adolescent↗

PubMed2001

Frequent substitution polymorphisms in African green monkey CCR5 cluster at critical sites for infections by simian immunodeficiency virus SIVagm, implying ancient virus-host coevolution.

In contrast to humans, several primate species are believed to have harbored simian immunodeficiency viruses (SIVs) since ancient times. In particular, the geographically dispersed species of African green monkeys (AGMs) are all infected with highly diversified SIVagm viruses at high prevalences (greater than 50% of sexually mature individuals) without evident diseases, implying that the progenitor monkeys were infected prior to their dispersal. If this is correct, AGMs would be expected to have accumulated frequent resistance-conferring polymorphisms in host genes that are important for SIV replication. Accordingly, we analyzed the coding sequences of the CCR5 coreceptors from 26 AGMs (52 alleles) in distinct populations of the four species. These samples contained 29 nonsynonymous coding changes and only 15 synonymous nucleotide substitutions, implying intense functional selection. Moreover, 24 of the resulting amino acid substitutions were tightly clustered in the CCR5 amino terminus (D13N in the vervets and Y14N in the tantalus species) or in the first extracellular loop (Q93R and Q93K in all species). The Y14N substitution was extremely frequent in the 12 wild-born African tantalus, with 7 monkeys being homozygous for this substitution and 4 being heterozygous. Although two of these heterozygotes and the only wild-type homozygote were naturally infected with SIVagm, none of the Y14N homozygotes were naturally infected. A focal infectivity assay for SIVagm indicated that all five tested SIVagms efficiently use CCR5 as a coreceptor and that they also use CXCR6 (STRL33/Bonzo) and GPR15 (BOB) with lower efficiencies but not CXCR4. Interestingly, the D13N, Y14N, Q93R, and Q93K substitutions in AGM CCR5 all strongly inhibited infections by the SIVagm isolates in vitro. The Y14N substitution eliminates a tyrosine sulfation site that is important for infections and results in partial N-linked glycosylation (i.e., 60% efficiency) at this position. Nevertheless, the CCR5(Y14N) component that lacks an N-linked oligosaccharide binds the chemokine MIP-lbeta with a normal affinity and is fully active in signal transduction. Similarly, D13N and Q93R substitutions did not interfere with signal transduction. Thus, the common substitution polymorphisms in AGM CCR5 strongly inhibit SIVagm infections while substantially preserving chemokine signaling. In contrast, polymorphisms of human CCR5 are relatively infrequent, and the amino acid substitutions are randomly situated and generally without effects on coreceptor function. These results support an ancient coevolution of AGMs and SIVagm viruses and establish AGMs as a highly informative model for learning about host proteins that play critical roles in immunodeficiency virus infections.

Amino Acid Sequence↗

PubMed2006

A case of dextrocardiac ventricular fibrillation arrest.

Successful defibrillation of a patient with dextrocardia using conventional anterolateral paddle positions raises doubts about the necessity to place paddles in the exact recommended positions. Evidence found relates either to volunteers in a laboratory setting or to defibrillation of atrial arrhythmias. The conclusion is that there is no published difference either in transthoracic impedance or in success of defibrillation between anteroposterior and anterolateral paddle positions. In the absence of any evidence for an ideal apical paddle position in the standard anterolateral defibrillation of ventricular arrhythmias, the emphasis in ALS and resuscitation guidelines on "correct" positioning seems misplaced, and, by adding unnecessary information, may hinder learning the skill of defibrillation. Early defibrillation is crucial to successful recovery from cardiac arrest and anything that delays cardioversion should be avoided. The limited evidence suggests that the exact position of the paddles does not matter. The time taken to find the "correct" position is time wasted and it may instead be preferable to teach people merely to place the apical paddle to the left of the nipple in the midaxillary line.

Dextrocardia↗

PubMed1997

Organizational behavior in the new organizational era.

Changes in contemporary firms and their competitive environments translate into a new focus in organizational research. This chapter reviews organizational behavior research reflecting the shift from corporatist organizations to organizing. Key research themes include emerging employment relations, managing the performance paradox, goal setting and self-management, discontinuous information processing, organization learning, organizational change and individual transitions, and the implications of change for work-nonwork relations. Research into organizing is building upon and extending many of the field's traditional concepts. This chapter suggests that some assumptions of organizational behavior research are being superseded by those more responsive to the new organizational era.

Journal Article↗

PubMed1985

The management of patients in a phobia clinic.

Management of people in this phobia clinic is based on a theory that phobias result from misinterpretations of the effects of a natural process that generates fear in responses to imagined dangers as in a nightmare. With support, guidance, exposure, and information, phobic people learn in individual and group settings to confront, control, and understand their phobic experience.

Adaptation, Psychological↗

PubMed1988

Effects of a patient education program in the treatment of schizophrenia.

Two groups of schizophrenic patients were compared to determine the effects of educating patients about schizophrenia and its treatment. One group completed a three-week educational program while the other was involved in the usual ward activities. Comparison of the groups' pretest and posttest scores on three instruments (the Experiential World Inventory, the Scale for the Assessment of Negative Symptoms, and the Knowledge of Illness and Resources Inventory) revealed the experimental group had a significant increase in knowledge of the illness and a significant decrease in the negative symptoms of schizophrenia. No significant difference was found between the groups in change in the positive symptoms of schizophrenia. The results suggest that severely psychiatrically ill patients can learn and retain information and that educating chronic patients about their illness can help improve their functioning.

Adaptation, Psychological↗

PubMed2001

On "Telepathic dreams?": an unpublished paper by Robert J. Stoller.

In 1973 Robert Stoller wrote a paper on a series of dreams-his own and his patients'--that he reluctantly found himself calling "telepathic." He never submitted the paper for publication, though he returned to the topic of unconscious communication and telepathy with increasing fascination in the years before his death. Publication of Stoller's paper seems particularly opportune just now. In it he pleads for open-minded examination of data, however alien to current scientific belief those data seem. In the past, despite numerous published reports of possibly telepathic experiences in analysis, their investigation remained relatively one-sided, since a technical posture of anonymity with patients constrained analysts from revealing that a communication struck them as telepathic. This has limited what analysts have been able to learn about the information actually exchanged, how it was exchanged, and whether the communication was experienced as uncanny by the patient. Recent attention to the intersubjective nature of the analytic situation has led to a deemphasis of anonymity, opening freer dialogue that may facilitate the rigorous investigation Stoller calls for. Such investigation may further analytic understanding of unconscious mental function and communication in the clinical setting, and lend perspective to the growing body of carefully controlled experimental research on anomalous mental phenomena.

Dreams↗

PubMed2002

Receptive and expressive language skills of children with five years of experience using a cochlear implant.

The language of 7 children who had used a cochlear implant for 5 years was evaluated by means of the Clinical Evaluation of Language Fundamentals-3, the Peabody Picture Vocabulary Test-Revised, and the Expressive Vocabulary Subtest of the Test of Word Knowledge. All subjects demonstrated impaired skills relative to normal-hearing children on 1 or more subtests. Variability in performance occurred between subjects and within subjects across subtests. Strengths in semantic skills were evident compared to weaker syntactic and morphological abilities. The nature of the subjects' language impairments is considered with reference to language delay and specific language impairment. The findings support the need for further evaluation of the rate and course of development of language subskills. Investigation of the influences of information processing, and learning styles and strategies, on children's outcomes is also warranted. These findings have implications for implementation of optimal habilitation and education programs for children with cochlear implants.

Child↗

PubMedDate not supplied

Impact of a lead-safe training program on workers conducting renovation, painting, and maintenance activities.

OBJECTIVE: An important source of lead exposure is lead-based paint that is disturbed when unsafe work practices are used during renovation, remodeling, and maintenance activities. This study explores the success of a pilot lead-safe skills training program for home improvement contractors and their employees (including renovators, remodelers, and painters) and small property owners. METHODS: The study evaluates whether attendees at eight-hour lead-safe work practices training courses learned and retained information about lead exposure; developed and retained positive attitudes toward lead-safe work practices; and developed lasting, positive behavioral intentions to use lead-safe work practice skills and techniques. A questionnaire was administered immediately before, immediately following, and several months following the training program. Coded data from the questionnaires were analyzed using SPSS software. RESULTS: Respondents showed statistically significant changes from before to after the training program, and the changes were maintained over time. Knowledge improved, and attitudes and behavioral intentions changed in a favorable direction. CONCLUSION: These results suggest that lead-safe training can be successful and can create lasting changes in lead-safe knowledge, attitudes, and behaviors.

Adult↗

PubMed2002

The cerebellum: it's about time! But timing is not everything--new insights into the role of the cerebellum in timing motor and cognitive tasks.

Converging evidence from different research studies supports a role for the cerebellum in timing neural processes. The cerebellum is part of a distributed system for motor control. The timing hypothesis provides a specific functional role for the unique contribution of the cerebellum. The timing capabilities of the cerebellum appear to extend beyond motor control into tasks focusing on perceptual processing that require the precise representation of temporal information and sensorimotor learning. Behavioral and modeling studies suggest that the cerebellar timing system is best characterized as providing a near-infinite set of interval-type timers rather than as a single clock with pacemaker or oscillatory properties, but this is controversial. In addition to learning precisely timed motor responses, the cerebellum is involved in on-line processing using feed-forward systems for which sensory input is used prior to movement execution to improve movement accuracy. This would be a mechanism for triggering accurate "time." The cerebellum continues to fascinate scientists, and although survival is possible without the cerebellum, the resultant quality of life is significantly compromised with clumsiness, ataxia, hypotonia, dysarthria, slowing of various cognitive perceptual processes, and impaired fine motor and ocular-motor coordination. The last three decades have seen the development of research that has focused on how the cerebellum functions. Further neurophysiologic research in cerebellar cortical neurotransmission is likely to further our understanding of the cerebellar contribution to timing sensorimotor processes.

Animals↗

PubMed2006

A graph-search framework for associating gene identifiers with documents.

BACKGROUND: One step in the model organism database curation process is to find, for each article, the identifier of every gene discussed in the article. We consider a relaxation of this problem suitable for semi-automated systems, in which each article is associated with a ranked list of possible gene identifiers, and experimentally compare methods for solving this geneId ranking problem. In addition to baseline approaches based on combining named entity recognition (NER) systems with a "soft dictionary" of gene synonyms, we evaluate a graph-based method which combines the outputs of multiple NER systems, as well as other sources of information, and a learning method for reranking the output of the graph-based method. RESULTS: We show that named entity recognition (NER) systems with similar F-measure performance can have significantly different performance when used with a soft dictionary for geneId-ranking. The graph-based approach can outperform any of its component NER systems, even without learning, and learning can further improve the performance of the graph-based ranking approach. CONCLUSION: The utility of a named entity recognition (NER) system for geneId-finding may not be accurately predicted by its entity-level F1 performance, the most common performance measure. GeneId-ranking systems are best implemented by combining several NER systems. With appropriate combination methods, usefully accurate geneId-ranking systems can be constructed based on easily-available resources, without resorting to problem-specific, engineered components.

Animals↗

PubMed2006

Deconstructing anti-harm-reduction metaphors; mortality risk from falls and other traumatic injuries compared to smokeless tobacco use.

Anti-harm-reduction advocates sometimes resort to pseudo-analogies to ridicule harm reduction. Those opposed to the use of smokeless tobacco as an alternative to smoking sometimes suggest that the substitution would be like jumping from a 3 story building rather than 10 story, or like shooting yourself in the foot rather than the head. These metaphors are grossly inappropriate for several reasons, notably including the fact that they are misleading about the actual risk levels. Based on the available literature on mortality from falls, we estimate that smoking presents a mortality risk similar to a fall of about 4 stories, while mortality risk from smokeless tobacco is no worse than that from an almost certainly non-fatal fall from less than 2 stories. Other metaphors are similarly misleading. These metaphors, like other false and misleading anti-harm-reduction statements are inherently unethical attempts to prevent people from learning accurate health information. Moreover, they implicitly provide bad advice about health behavior priorities and are intended to persuade people to stick with a behavior that is more dangerous than an available alternative. Finally, the metaphors exhibit a flippant tone that seems inappropriate for a serious discussion of health science.

Journal Article↗

PubMed2006

The effects of group exercise on fatigue and quality of life during cancer treatment.

PURPOSE/OBJECTIVES: To determine the feasibility of participating in a structured group exercise program (SGEP) for adult patients receiving cancer treatment and to test the impact of an SGEP on reducing cancer-related fatigue (CRF) and improving quality of life (QOL). DESIGN: One-group, prospective, pre- and post-test design. SETTING: Two community outpatient infusion centers. SAMPLE: Convenience sample of 12 adults with varying cancer diagnoses receiving cancer treatment. METHODS: Nine of 12 subjects participated in SGEP twice weekly for six weeks. Exercises focused on strengthening proximal muscle groups and improving functional ability. All subjects completed the Fatigue Symptom Inventory and the Short Form-36 version 2 (SF-36v2) Health Survey at baseline and six weeks. MAIN RESEARCH VARIABLES: Feasibility of the intervention, CRF, and QOL. FINDINGS: No difference in reported fatigue was found. The SF-36v2 subscale score for bodily pain showed a significant decrease in this symptom. Subscale scores for physical role, vitality, and social function increased but did not yield statistical significance. Social interactions resulted in strong group cohesiveness. A postprogram questionnaire identified themes of support, learning from shared information, and the usefulness of having an exercise program that also serves as an informal support group. CONCLUSIONS: SGEP is feasible, safe, and well tolerated by adult patients with cancer and may have positive effects on CRF and QOL. IMPLICATIONS FOR NURSING: The benefits of exercise for patients with cancer receiving treatment are well documented. Using a multidisciplinary approach, oncology nurses, working with an exercise physiologist, can safely create an SGEP, combining the power of group interactions with the appeal of a wellness-promoting behavior, and provide an additional tool to assist in the management of physiologic and psychosocial effects of cancer treatment.

Adult↗

PubMed2004

Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging.

OBJECTIVE: Patient access to their electronic health care record (EHR) and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access. The objective of our study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care record. METHODS: We conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, we also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. We collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR. RESULTS: A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication. CONCLUSION: Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.

Attitude to Computers↗