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PubMed2005

A strategic approach to developing e-learning capability for healthcare.

OBJECTIVES: This article examines a strategic approach to developing e-learning capability to enhance learning opportunities for the workforce of a healthcare organization. Emphasis is given to the procurement of a bespoke Managed Learning Environment (MLE). Strategic organizational issues impacting on future e-learning developments are considered. METHODS: The 2-year implementation plan was evaluated through a two phase external research project. The first phase focused on the effectiveness of a training programme designed to build capacity for e-learning within the Northern area and also included a virtual learning environment usability study which informed the MLE specification. The second phase evaluation is ongoing during 2005 and interim findings are presented. RESULTS: The MLE has been piloted and on-line learning packages have been acquired. There has been a phased take-up of e-learning opportunities and e-tutor training. Some virtual Communities of Practice have been established. Key organizational issues have been identified and ongoing findings are informing strategic planning. CONCLUSIONS: The healthcare MLE is offering enhanced learning opportunities and assisting area healthcare providers in training their dispersed workforces. Blended learning strategies are most successful. The need for protected time for e-learning is a key issue, financial savings are available. Progress has been slowed by identified organizational constraints-the MLE's benefits are widely recognized.

Community Networks↗

PubMed2006

Evaluation of a pharmacotherapy context-learning programme for preclinical medical students.

AIM: To evaluate a context-learning pharmacotherapy programme for approximately 750 2nd, 3rd and 4th year preclinical medical students with respect to mastering cognitive pharmacotherapeutic skills, i.e. choosing a (drug) treatment and determining patient information. METHODS: The context-learning pharmacotherapy programme consists of weekly organized role play sessions in the form of consulting hours. Fourth year students sit for a therapeutic Objective Structured Clinical Examination (OSCE) in the form of consulting hours at the outpatient clinic. Sixty-one 2nd, 74 3rd and 49 4th year medical students who attended the role play sessions and the OSCE were randomly selected. Their performances were assessed by clinical examiners and clinical experts and compared with a reference group of 6th year graduated students. Additionally, the scores of a questionnaire on study load and appreciation were collected. RESULTS: The level of the pharmacotherapeutic skills of the 4th year students who followed the pharmacotherapy context-learning programme was not far below that of 6th year graduates who had finished their clinical clerkships, but had not followed the pharmacotherapy programme. The time spent on the programme was about 1% of the total study load per year. The students appreciated the role play sessions and OSCE by around 80% and 99% of the maximum possible scores. CONCLUSIONS: Preclinical pharmacotherapy context learning has a modest but positive effect on learning cognitive pharmacotherapeutic skills, i.e. choosing a drug treatment and determining patient information. This effect has been obtained with role play sessions, a suboptimal form of context learning, with a minimal study load and a high appreciation by students.

Adult↗

PubMed2005

NMDA-receptor blockade by CPP impairs post-training consolidation of a rapidly acquired spatial representation in rat hippocampus.

Recent evidence suggests that N-methyl-D-aspartate (NMDA)-receptor mediated plasticity in hippocampus has a more subtle role in memory-based behaviours than originally thought. One idea is that NMDA-based plasticity is essential for the consolidation of post-training memory but not for the initial encoding or for short-term memory. To further test this idea we used a three-phase variant of the hidden goal water maze task. In the first phase, rats were pre-trained to an initial location. Next, intense, massed training was done in a 2-h interval to teach the rats to go to a new location after either an injection of the NMDA receptor antagonist (6)-3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid (CPP) or of vehicle. Finally, under drug-free conditions 24 h after new location training, a competition test was done between the original and new locations. We find that N-methyl-D-aspartate (NMDA)-receptor blockade has little or no effect on new location training. In contrast, when tested 24 h later, the strength of the trace for the new location learned during NMDA-receptor blockade was much weaker compared with the trace for the new location learned after saline injection. Further experiments showed similar effects when NMDA-receptors were blocked immediately after the new location training, suggesting that this is a memory consolidation effect. Our results therefore reinforce the notion that hippocampal NMDA-receptors participate in post-training memory consolidation but are not essential for the processes necessary to learn or retain navigational information in the short term.

Animals↗

PubMedDate not supplied

Web sites for postpartum depression: convenient, frustrating, incomplete, and misleading.

PURPOSE: To evaluate the content and the technology of Web sites providing information on postpartum depression. STUDY DESIGN AND METHODS: Eleven search engines were queried using the words "Postpartum Depression." The top 10 sites in each search engine were evaluated for correct content and technology using the Web Depression Tool, based on the Technology Assessment Model. RESULTS: Of the 36 unique Web sites located, 34 were available to review. Only five Web sites provided >75% correct responses to questions that summarized the current state of the science for postpartum depression. Eleven of the Web sites contained little or no useful information about postpartum depression, despite being among the first 10 Web sites listed by the search engine. Some Web sites contained possibly harmful suggestions for treatment of postpartum depression. In addition, there are many problems with the technology of Web sites providing information on postpartum depression. CLINICAL IMPLICATIONS: A better Web site for postpartum depression is necessary if we are to meet the needs of consumers for accurate and current information using technology that enhances learning. Since patient education is a core competency for nurses, it is essential that nurses understand how their patients are using the World Wide Web for learning and how we can assist our patients to find appropriate sites containing correct information.

Databases, Bibliographic↗

PubMed2005

Promoting organ donation and transplantation among South Asians in the United Kingdom: the role of social networks in the South Asian community.

The percentage of South Asians on the kidney transplant waiting list in the United Kingdom is 3 times their percentage in the general population. Obviously, organ donation and transplantation among South Asians in the United Kingdom needs improvement. In recent years, ethnically targeted campaigns in the mass media have specifically attempted to attract donors from the South Asian communities. A number of pilot studies have been done to evaluate the effectiveness of these initiatives in providing information about organ donation to South Asians. Results indicate that detailed information related to transplantation was learned mainly by people within the community receiving transplants and was transmitted through various informal community networks rather than through the resources provided by the Department of Health. This article provides an overview of who South Asians are and how these community networks were established. Transplant professionals must devise effective strategies to access these community networks, thereby raising the consciousness of transplantation among South Asians in the United Kingdom.

Attitude to Health↗

PubMed1981

Sickle cell trait counseling-evaluation of counselors and counselees.

In this study, information about both counselee and counselor performance was obtained from taped recordings of 193 structured counseling sessions with persons diagnosed as having sickle cell trait. The data provide evidence that: (1) lay persons can understand essential sickle cell information; (2) trained lay persons using a structured format can transmit successfully sickle cell information; (3) only education and age, among counselee characteristics studies, were related to successful learning; (4) the evaluation of information transfer in counseling programs cannot be limited to counselees' comprehension but must also consider other variables such as counselor performance and curriculum content; (5) a reduction in negative feelings associated with a diagnosis of sickle cell trait is an immediate effect of counseling; and (6) audio-taping of counseling sessions is client acceptable and useful for evaluation, quality control, and counselor training.

Adolescent↗

PubMed1993

Emotional memory systems in the brain.

The neural mechanisms of emotion and memory have long been thought to reside side by side, if not in overlapping structures, of the limbic system. However, the limbic system concept is no longer acceptable as an account of the neural basis of memory or emotion and is being replaced with specific circuit accounts of specific emotional and memory processes. Emotional memory, a special category of memory involving the implicit (probably unconscious) learning and storage of information about the emotional significance of events, is modeled in rodent experiments using aversive classical conditioning techniques. The neural system underlying emotional memory critically involves the amygdala and structures with which it is connected. Afferent inputs from sensory processing areas of the thalamus and cortex mediate emotional learning in situations involving specific sensory cues, whereas learning about the emotional significance of more general, contextual cues involves projections to the amygdala from the hippocampal formation. Within the amygdala, the lateral nucleus (AL) is the sensory interface and the central nucleus the linkage with motor systems involved in the control of species-typical emotional behaviors and autonomic responses. Studies of cellular mechanisms in these pathways have focused on the direct relay to the lateral amygdala from the auditory thalamus. These studies show that single cells in AL respond to both conditioned stimulus and unconditioned stimulus inputs, leading to the notion that AL might be a critical site of sensory-sensory integration in emotional learning. The thalamo-amygdala pathway also exhibits long-term potentiation, a form of synaptic plasticity that might underlie the emotional learning functions of the circuit. The thalamo-amygdala pathway contains and uses the amino acid glutamate in synaptic transmission, suggesting the possibility that an amino-acid mediated form of synaptic plasticity is involved in the emotional learning functions of the pathway. We are thus well on the way to a systems level and a cellular understanding of at least one form of emotional learning and memory.

Animals↗

PubMed2002

Acquisition and retention of verbal and nonverbal information in children with heavy prenatal alcohol exposure.

BACKGROUND: Memory deficits are reported commonly in children with fetal alcohol syndrome. However, little is known about nonverbal memory performance in this population. METHODS: The current study examined learning and memory abilities in alcohol-exposed children and nonexposed controls. Multiple verbal and nonverbal measures were used that incorporated repeated learning trials and delayed recall trials. The alcohol-exposed group included children with heavy prenatal alcohol exposure with and without fetal alcohol syndrome. Children ranged in age from 8 to 16 years, and groups were matched on age, sex, ethnicity, and socioeconomic status. RESULTS: Children with heavy prenatal alcohol exposure displayed deficits in learning and recall of verbal and nonverbal information across all measures. On learning trials, they recalled fewer words and displayed a lower rate of acquisition. However, when we analyzed delayed verbal recall data after controlling for initial verbal learning, group differences were not apparent. The same pattern did not occur for nonverbal information; children with prenatal alcohol exposure recalled less on delayed recall even when we accounted for initial learning. CONCLUSIONS: These data are consistent with previous studies that indicate immediate memory deficits but suggest that, at least for verbal information, delayed recall deficits in this population are better accounted for by deficits in initial learning. Importantly, a different pattern of results was demonstrated for verbal versus nonverbal information, which suggests the need for additional research in this area.

Adolescent↗

PubMed1999

Hippocampal formation lesions produce memory impairment in the rhesus monkey.

There is much debate over the role of temporal lobe structures in the ability to learn and retain new information. To further assess the contributions of the hippocampal formation (HF), five rhesus monkeys received stereotactically placed ibotenic acid lesions of this region without involvement of surrounding ventromedial temporal cortices. After surgery, the animals were trained on two recognition memory tasks: the Delayed Non-Match to Sample (DNMS) task, which tests the ability to remember specific trial unique stimuli, and the Delayed Recognition Span Task (DRST), which tests the ability to remember an increasing array of stimuli. Relative to normal control monkeys, those with HF lesions demonstrated significant impairments in both learning and memory stages of the DNMS task. Additionally, the HF group was significantly impaired on spatial, color, and object versions of the DRST. Contrary to suggestions that damage to the entorhinal and parahippocampal cortices is required to produce significant behavioral deficits in the monkey, these results demonstrate that selective damage to the HF is sufficient to produce impairments on tasks involving delayed recognition and memory load. This finding illustrates the importance of the HF in the acquisition and retention of new information.

Animals↗

PubMed2004

Changes in student approaches to learning with the introduction of computer-supported problem-based learning.

OBJECTIVES: To study changes in student approaches to learning following the introduction of computer-supported, problem-based learning. SETTING: Medical students at the University of Oslo undertake a 12-week period of clinical placement during their 10th term. In this period they continue to undertake problem-based learning (PBL) in the form of distributed problem-based learning (DPBL) in a computer-supported learning environment. DESIGN: A questionnaire focusing on learning styles, PBL, and information and communication technology (ICT) was distributed before and after the DPBL period. SUBJECTS: All students in their 10th term at the University of Oslo (n = 61). RESULTS: The introduction of DPBL did not seem to affect the participants' use of regulating strategies or their mental models of learning. After the DPBL period, group discussion and tutor input were reported to have less influence on students' self-study, while the students perceived themselves as being less active in groups and as expecting less from tutors. There was a relationship between perceived tutor influence and students' familiarity with ICT. The DPBL period seemed to increase students' task-related web accesses and use of experts, and to decrease their task-related use of textbooks and discussions with students outside the group. CONCLUSIONS: Students' general approaches to learning were not affected by the introduction of DPBL. However, there was a decrease in students' expectations concerning activity in the group and the importance of the tutor. These changes were related to students' familiarity with the use of computers. Web-based resources and experts became more important resources to the students during the DPBL period.

Adult↗

PubMed2004

The Human Rights Act 1998 and medical treatment: time for re-examination.

There was much speculation about the potential impact of the Human Rights Act 1998 on established principles of health care practice. Now the statute has been "bedded in", predictions that existing good practice would not fall foul of the legislation provided it was demonstrable, have proved to be broadly accurate. This paper illustrates the approach of the courts to areas of difficulty related to medical treatment and highlights, in particular, possible challenges under the Act by the mature minor whose refusal of treatment has been overridden. This includes a discussion of those with learning disabilities, and reference is also made to the implications of the legislation in relation to confidentiality and child protection.

Child↗

PubMed1999

Assessment of the radiographic image: recognition of abnormal features.

Radiographs, due to their ability to pass through materials differentially, are used in dental practice to obtain information that is not available by other means. Recognition of the presence of a variation from normal is the first step to accurate interpretation of abnormalities. This article presents an outline of a method for examining radiographs in order to recognize that an abnormality is present, and to learn from the visual information some of the characteristics of the abnormality. A number of clinical examples are used to illustrate the conclusions that we can draw from the radiographic changes.

Adolescent↗

PubMed1975

Brainstem substrates of sensory information processing and adaptive behavior.

Emerging clinical and experimental data suggest that the brainstem may be an important part of the functional matrix from which normal mental development and behavior evolve. Although the brainstem has not been a focal point in considering etiologies of mental retardation nor even in analyses of adaptive behavior, information processing within both the brainstem sensory nuclei and adjacent reticular formation may indeed be one of the most critical and relevant areas for such investigations. Data are summarized from several ongoing experiments which are designed to explore the capacity of the brainstem to encode sensory, especially acoustic, stimuli and to modulate the resultant sensory information so as to produce a "learned" response. Such data indicate that in the absence of forebrain or even midbrain structures, a simple conditioned response can be supported by the brainstem. The reticular neuropil is considered particularly important to this response acquisition and is conceptualized as a structure which can receive and transmit acoustic information with retention of specific stimulus coding. It is further suggested that independent associative and reflex functions of the reticular formation may be highly significant in neonatal behavior but, with the development of descending influences from higher centers during maturation, these functions may become largely masked. In order to develop a temporal frame of reference for brainstem structures potentially involved in sensory information processing and learning phenomena "time constants of response plasticity" are being established for different levels of the brainstem system.

Adaptation, Psychological↗

PubMed2006

Case-based exercises fail to improve medical students' information management skills: a controlled trial.

BACKGROUND: Tomorrow's physicians must learn to access, retrieve, integrate and apply current information into ambulatory patient encounters, yet few medical schools teach 'real time' information management. METHODS: We compared two groups of clerkship students' information management skills using a standardized patient case. The intervention group participated in case-based discussions including exercises that required them to manage new information. The control group completed the same case discussions without information management exercises. RESULTS: After five weeks, there was no significant difference between the control and intervention groups' scores on the standardized patient case. However, third rotation students significantly outperformed first rotation students. CONCLUSION: Case-based exercises to teach information management failed to improve students' performance on a standardized patient case. Increased number of clinical rotations was associated with improved performance.

Adult↗

PubMed2004

Task repetition can affect functional magnetic resonance imaging-based measures of language lateralization and lead to pseudoincreases in bilaterality.

Repeated functional magnetic resonance imaging (fMRI) during learning and recovery can inform us about functional reorganization in the brain. We examined how, in the absence of reorganization, simple task repetition affects measures of fMRI activation. We studied fMRI activation over 10 consecutive sessions of silent word generation in a healthy subject. Additionally, we performed functional transcranial Doppler sonography (fTCD) to learn about the temporal pattern of corresponding changes in cerebral blood flow velocity (CBFV) and pulsatility. With repetition, word generation-associated increases in heart rate diminished steadily. Task repetition also led to a net increase in CBFV bilaterally and to a bilateral increase in the number of activated voxels on fMRI. As a result, whereas the absolute interhemispheric difference of activated voxels remained constant, there was a decrease in the standard fMRI index for language lateralization [LIfMRI = 100 (activated voxels in left hemisphere - voxels in right)/(voxels in left + voxels in right)]. Thus task repetition can lead to changes in task-related autonomic drive and an augmentation of bihemispheric blood flow. This can mimic increasing bilaterality of brain activation.

Adult↗

PubMed2006

Theory-based categorization under speeded conditions.

It is widely accepted that similarity influences rapid categorization, whereas theories can influence only more leisurely category judgments. In contrast, we argue that it is not the type of knowledge used that determines categorization speed, but rather the complexity of the categorization processes. In two experiments, participants learned four categories of items, each consisting of three causally related features. Participants gave more weight to cause features than to effect features, even under speeded response conditions. Furthermore, the time required to make judgments was equivalent, regardless of whether participants were using causal knowledge or base-rate information. We argue that both causal knowledge and base-rate information, once precompiled during learning, can be used at roughly the same speeds during categorization, thus demonstrating an important parallel between these two types of knowledge.

Association Learning↗

PubMed2006

Too much teaching, not enough learning: what is the solution?

The curriculum is packed with so much content that teachers resort to telling students what they know and students simply commit facts to memory. The packed curriculum leaves little time for students to acquire a deep understanding of the subject or to develop life-long skills such as critical thinking, problem solving, and communication. However, learning is not committing a set of facts to memory, but the ability to use resources to find, evaluate, and apply information. This paper addresses these concerns by discussing "how we learn" and reviewing the literature on what works to improve learning. It is clear that active processing of information, not passive reception of information, leads to learning. That is, students must construct their own understanding of concepts, relationships, and procedures. Teachers can encourage this process by carefully considering the type and organization of information as well as instructional strategies. Specifically, teachers should reduce the total amount of factual information students are expected to memorize, reduce our use of the passive lecture format, and devote much more effort to helping students become active, independent learners and problem solvers. Collaborative learning activities, interactive models, educational games, and establishing a culture of inquiry/scholarship are critical for achieving these goals.

Comprehension↗

PubMed2006

Spatial relational learning persists following neonatal hippocampal lesions in macaque monkeys.

The hippocampus is important for the acquisition of spatial representations of the environment and consequently in contextual memory. This suggests that the neural substrates underlying spatial cognition might be essential for remembering specific life episodes. Indeed, hippocampal lesions prevent spatial relational learning in adult rodents and monkeys, and result in profound amnesia in adult humans. In contrast, we show here that monkeys with neonatal hippocampal lesions learned new spatial relational information. Our experiments suggest that early hippocampal damage leads to functional brain reorganization that enables spatial information to be acquired through the use of brain regions that normally do not subserve this function.

Adaptation, Physiological↗