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[Marital feedback behavior: relations between feedback activity of the partner and feedback quality, duration of the marriage and ability of the marriage to function].

The effect of the quality of feedback and the feedback activity of partners on the feedback behavior of married controls, who differed with regard to the duration and the functioning of their marriages, was investigated. 106 married couples were divided into a group of disturbed marriages in the first half of life (GJE), a group of disturbed marriages in the second half of life (GAE), and harmonious marriages (HAE). During a conflict-conversation that was structured according to the technique of revealed differences the partners exchanged positive and negative feedback optically and acoustically. Corresponding to the frequency of the feedback active and less active partners were differentiated. In comparison with the couples of the HAE group, couples of the GAE group gave less feedback, especially less positive feedback. The less active partner of the GAE group gave significantly more negative feedback than the comparable partner of the HAE group. Differences between the GAE and the GJE group that can be called statistically significant do not exist. The results have been discussed with respect to their application.

Adult↗

Simple feedback notes enhance specificity of feedback to learners.

BACKGROUND: Learners reported that physician educators give insufficient and general feedback. OBJECTIVE: This study analyzed faculty's use of 3 x 5-inch feedback notes (preprinted with "well done" or "needs improvement") for quantity and specificity of feedback. Learners evaluated these notes compared with other feedback methods. DESIGN/METHODS: Seven experienced clinician educators presented the feedback notes to learners during the 10-month trial. A carbonless duplicate was retained for qualitative analysis of content. The specificity of comments was categorized as general (no clarifiers) or detailed if it contained 1 or more clarifiers. Additionally, the learners were surveyed regarding utility of notes on the basis of characteristics of effective feedback. RESULTS: A total of 770 notes containing 1607 individual comments were presented to learners, with significantly more (P <.001) "well done" comments (69%) than "needs improvement" comments (31%). Eleven content areas emerged. The most frequently coded "well done" content areas were assessment (n = 258), treatment (n = 208), and physical examination (n = 176). The most frequently coded "needs improvement" content areas were documentation (n = 161) and expanding knowledge (n = 102). Eighty-two percent of the comments were specific, and the specificity increased significantly from 24% in the initial 4-month time frame to 46% in the last 3 months (P <.001, Pearson chi-square test). Learners agreed that feedback notes provided more constructive (94%), timely (92%), and concrete (94%) feedback when compared with other feedback methods. Learners preferred feedback given face-to-face (96%) or by written notes (96%) rather than by e-mail (30%). CONCLUSIONS: Cued feedback notes provided learners with detailed feedback in a format that learners prefer. Over time, simple feedback notes lead to more specific feedback for trainees.

Education, Medical↗

Audit and feedback: effects on professional practice and health care outcomes.

BACKGROUND: Audit and feedback has been identified as having the potential to change the practice of health care professionals. OBJECTIVES: To assess the effects of audit and feedback on the practice of health professionals and patient outcomes. SEARCH STRATEGY: We searched MEDLINE up to June 1997, the Research and Development Resource Base in Continuing Medical Education, and reference lists of related systematic reviews and articles. SELECTION CRITERIA: Randomised trials of audit and feedback (defined as any summary of clinical performance of health care over a specified period of time). The participants were health care professionals responsible for patient care. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Thirty-seven studies were included, involving more than 4977 physicians. The reporting of study methods was inadequate for almost all studies. In 31 out of 37 studies the randomisation process could not be determined. Information regarding data analysis was also lacking. For example, power calculations were not mentioned in 27 out of 37 studies. A variety of behaviours were targeted including the reduction of diagnostic test ordering, prescribing practices, preventive care, and the general management of a problem, for example hypertension. Twenty-eight studies measured physician performance, one study targeted patient outcomes in diabetes and the remaining eight studies measured both physician performance and patient outcomes. The relative percentage differences ranged from -16% to 152%. The clinical importance of the changes was not always clear. REVIEWER'S CONCLUSIONS: Audit and feedback can sometimes be effective in improving the practice of health care professionals, in particular prescribing and diagnostic test ordering. When it is effective, the effects appear to be small to moderate but potentially worthwhile. Those attempting to enhance professional behaviour should not rely solely on this approach.

Education, Medical, Continuing↗

A learning prescription permits feedback on feedback.

BACKGROUND: Students consistently identified inadequate feedback as a deficiency in our third-year clerkship. METHODS: We asked students to solicit one faculty and one resident every 2 weeks for written feedback on a "feedback prescription pad." Each prescription requested four comments: two things the student did well and two things the student needs to improve. Students rated feedback using a five-point scale. A three-point categorization scheme was employed to assess the quality of feedback. RESULTS: Students' rating of feedback improved significantly compared with a previous time period (3.5 +/- 1.2 versus 2.6 +/- 1.2, P <0.01). Interrater reliability of our categorization scheme was high (kappa > or =0.75, P <0.01) and demonstrated that only 10% of comments were specific enough to qualify as effective feedback. CONCLUSIONS: Feedback prescription pads were a simple method to facilitate feedback. Although students appreciated feedback, most feedback was inadequate. Faculty development programs to enhance student feedback should be a priority of clinical medical education.

Clinical Clerkship↗

Self-controlled feedback: does it enhance learning because performers get feedback when they need it?

This paper examines whether self-controlled feedback schedules enhance learning, because they are more tailored to the performers' needs than externally controlled feedback schedules. Participants practiced a sequential timing task. One group of learners (self-control) was provided with feedback whenever they requested it, whereas another group (yoked) had no influence on the feedback schedule. The self-control group showed learning benefits on a delayed transfer test. Questionnaire results revealed that self-control learners asked for feedback primarily after good trials and yoked learners preferred to receive feedback after good trials. Analyses demonstrated that errors were lower on feedback than no-feedback trials for the self-control group but not for the yoked group. Thus, self-control participants appeared to use a strategy for requesting feedback. This might explain learning advantages of self-controlled practice.

Adult↗

The influence of force feedback and visual feedback in grasping tissue laparoscopically.

BACKGROUND: Due to the limited force feedback provided by laparoscopic instruments, surgeons may have difficulty in applying the appropriate force on the tissue. The aim of this study was to determine the influence of force feedback and visual feedback on the exerted pinch force. METHODS: A grasper with a force sensor in the jaws was developed. Subjects with and without laparoscopic experience grasped and pulled pig bowel with a force of 5 N. The applied pinch force was measured during tasks of 1-s and 1-min duration. Visual feedback was provided in half the measurements. Force feedback was adjusted by changing the mechanical efficiency of the forceps from 30% to 90%. RESULTS: The mean pinch force applied was 6.8 N (+/-0.5), whereas the force to prevent slippage was 3.0 N (+/-0.4). Improving the mechanical efficiency had no effect on the pinch force for the 1-s measurements. The amount of excessive pinch force when holding tissue for 1 min was lower at 30% mechanical efficiency compared with 90% (105% vs 131%, p = 0.04). The tissue slipped more often when the subject had no visual feedback (2% vs 8%, p = 0.02). CONCLUSION: Force feedback and visual feedback play a more limited role than expected in the task of grasping tissue with laparoscopic forceps.

Animals↗

Susceptibility to delayed auditory feedback and dependence on auditory or oral sensory feedback.

Studies of the delayed auditory feedback (DAF) effect have consistently reported marked individual differences in susceptibility to DAF among normal speakers. It has been suggested that speakers showing extreme susceptibility to DAF may be differentially dependent on auditory feedback in regulating their speech production. Assuming this is the case, then a reduction in sensory feedback would also be expected to produce differential effects on these speakers. To test this hypothesis, normative data on the actual range of susceptibility to 180 msec DAF were first obtained from a group of 400 normal male speakers. Subjects from the extremes of this distribution were then tested under conditions that selectively reduces sensory feedback. Auditory masking, whispering and local anaesthesia were used separately and in combination to achieve a reduction in one or more feedback channels (air-conducted, bone-conducted and oral sensory feedback). The results obtained did not support the feedback dependence hypothesis. Measures of reading duration, disfluency and correct syllabel rate revealed similar changes in the speech of high and low susceptible speakers when auditory and/or oral feedback was reduced. Alternative explanations of individual differences in DAF susceptibility are considered.

Adult↗

Effects of multisource feedback and a feedback facilitator on the influence behavior of managers toward subordinates.

The authors compared a feedback workshop with both a no-feedback control group and a comparison group of managers who received a feedback report but no feedback workshop. The multisource feedback was based on ratings of a manager's influence behavior by subordinates, peers, and bosses. Managers in the feedback workshop increased their use of some core influence tactics with subordinates, whereas there was no change in behavior for the control group or for the comparison group. The feedback was perceived to be more useful by managers who received it in a workshop with a facilitator than by managers who received only a printed feedback report.

Feedback↗

Mathematical analysis of activation thresholds in enzyme-catalyzed positive feedbacks: application to the feedbacks of blood coagulation.

A hierarchy of enzyme-catalyzed positive feedback loops is examined by mathematical and numerical analysis. Four systems are described, from the simplest, in which an enzyme catalyzes its own formation from an inactive precursor, to the most complex, in which two sequential feedback loops act in a cascade. In the latter we also examine the function of a long-range feedback, in which the final enzyme produced in the second loop activates the initial step in the first loop. When the enzymes generated are subject to inhibition or inactivation, all four systems exhibit threshold properties akin to excitable systems like neuron firing. For those that are amenable to mathematical analysis, expressions are derived that relate the excitation threshold to the kinetics of enzyme generation and inhibition and the initial conditions. For the most complex system, it was expedient to employ numerical simulation to demonstrate threshold behavior, and in this case long-range feedback was seen to have two distinct effects. At sufficiently high catalytic rates, this feedback is capable of exciting an otherwise subthreshold system. At lower catalytic rates, where the long-range feedback does not significantly affect the threshold, it nonetheless has a major effect in potentiating the response above the threshold. In particular, oscillatory behavior observed in simulations of sequential feedback loops is abolished when a long-range feedback is present.

Blood Coagulation↗

The impact of computer-tailored feedback and iterative feedback on fat, fruit, and vegetable intake.

A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

Adult↗

A comparison of direct blood pressure feedback and electromyographic feedback on the blood pressure of normotensives.

Groups of 20 normotensive subjects were assigned to one of three conditions to help them lower their blood pressure: (1) intermittent visual feedback of blood pressure; (2) continuous analogue auditory feedback of frontal EMG; (3) an instructed, no-feedback condition. Both groups receiving feedback showed greater within-session lowering of systolic blood pressure than the no-feedback control group. Although the group receiving intermittent visual feedback of blood pressure lowered blood pressure more than the EMG feedback group at the first session, in three subsequent sessions, the two feedback groups did not differ.

Adolescent↗

Psychological effects of dietary fat analysis and feedback: a randomized feedback design.

Excess consumption of dietary fat promotes chronic disease such as heart disease and cancer. Dietary analysis and feedback are often used to motivate dietary change; however, little is known about how people process, react to, and use this feedback to change behavior. This study used a randomized feedback design to examine psychological reactions to dietary fat feedback. Subjects were assessed for fat consumption and then randomly assigned to a high, moderate, or low percentage of calories from fat feedback group. Findings indicate that there are strong emotional, cognitive, and behavioral reactions to providing high-fat dietary feedback. Subjects that were told their diets were high in fat reported stronger negative emotional reactions and also reported they had stronger intentions to change than the other two feedback categories. These results are compared with studies providing nonrandomly assigned risk factor feedback.

Adolescent↗

Does perceptual intake speed reflect intelligent use of feedback in an inspection-time task? The effect of restricted feedback.

To examine whether the development of effective strategies during inspection time (IT) required active learning processes, we gave subjects an IT task involving false feedback. This IT task (ADIT) started at an exposure duration of 20 ms and gradually increased until subjects could reliably discriminate IT stimuli. False feedback about correctness of discrimination was introduced to make the ADIT task particularly difficult for individuals who were attempting to develop and refine an IT-related strategy. There was no difference between ITs derived from the ADIT and a standard IT task (VIT). There were no differences in ITs for subjects given either truthful or false feedback on the ADIT task. However, an interaction did exist between the feedback condition and the two IT tasks. This interaction indicated that subjects with ostensibly better VITs had poorer performance on ADIT, compared with those subjects who had truthful feedback. This finding suggests that false feedback can disrupt effective performance on IT. Self-reported strategy use had a significant independent effect on the observed IT measures. Individuals who reported strategies were not significantly higher in IQ than those who did not report strategies.

Adult↗

Effects of mood state and favorability of feedback on reactions to performance feedback.

An experimental simulation involving 55 women assessed the main and interactive effects of experimentally induced mood state (positive vs negative) and favorability of performance feedback (positive vs negative) on the perceived accuracy of feedback. The study was conducted in two sessions. During Session I the subjects role-played the position of an advertising agent and worked on an advertising task. In Session II they were administered either a positive or negative mood induction, given positive or negative feedback on the advertising task, and completed a measure of the perceived accuracy of feedback. Regression analyses indicated support for hypothesized main and interactive effects, suggesting that mood state and favorability of feedback interactively affect the perceived accuracy of received feedback.

Adult↗

Role of feedback mechanism in renal autoregulation and sensing step in feedback pathway.

The unique morphology of the juxtaglomerular complex has resulted in many investigations evaluating its potential physiological roles. One hypothesis that has stimulated considerable interest is that feedback signals originating from distal tubule cells, presumably at the macula densa segment, participate in the phenomenon of renal autoregulation. Data obtained from dog experiments indicate tha autoregulation of single nephron glomerular filtration rate (SNGFR) is most consistently observed when fluid delivery to the early distal tubule is not interrupted. In contrast, techniques that interfere with normal orthograde fluid delivery to the distal nephron have usually resulted in increases in SNGFR and an inability to exhibit appropriate autoregulatory responses to decreases in arterial pressure. There is considerable uncertainty concerning the nature of the intraluminal component of the early distal tubule fluid responsible for initiating feedback responses. The studies reported in this paper have indicated that feedback mediated decreases in stop-flow pressure and SNGFR in response to increases in distal microperfusion rate can occur with a variety of artificial perfusion solutions, including solutions that contain low concentrations of chloride, sodium, or total electrolytes. Microperfusion studies in the rat have demonstrated that feedback mediated decreases in stop-flow pressure can occur in the absence of associated increases in distal tubule fluid chloride concentration. These results are consistent with the concept that some function of distal tubule fluid osmolality or distal tubule solute delivery may participate in the initiation of feedback signals.

Animals↗

Experimental studies on the positive feedback effect of progesterone, 17 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone on the pituitary release of LH and FSH in the human female. The estrogen priming of the progesterone feedback on pituitary gonadotropins in the eugonadal woman.

Administration of progesterone eugonadal women during the midfollicular phase of the menstrual cycle failed to induce a positive feedback effect on the serum concentrations of LH and FSH. The levels of estradiol in serum decreased following the injection of progesterone without a parallel change in LH and FSH concentrations indicating a direct ovarian effect of the exogenous progesterone. In the late follicular phase of the cycle, when preovulatory levels of estradiol were present in serum, or under a ethinyl estradiol treatment progesterone was able to induce an LH discharge indicating the requirement of an estradiol priming of the positive feedback of progesterone in eugonadal women. In order to establish the time required for a sufficient estrogen priming with preovulatory levels of estradiol in serum 3 mg of estradiol-benzoate were administered i.m. 1, 12 and 24 h prior to the administration of 30 mg of microcristalline progesterone in the midfollicular phase of the menstrual cycle, when progesterone alone did not cause an LH surge. Only when estradiol-benzoate was injected 24 h prior to the progesterone administration an LH surge reproducible in time course and magnitude occurred. Administration of estradiol-benzoate alone under these conditions did not cause an LH surge within the elapse of time after the injection when the progesterone induced LH surge occurred. Thus, these experiments demonstrate that a defined estrogen priming is required for the positive feedback effect of progesterone on the gonadotropin release in eugonadal women. Furthermore, progesterone levels in serum of about only 1--2 ng/ml were required for the induction of an LH surge indicating that under physiological conditions progesterone may have an supplementory effect on the primarily estradiol induced LH midcycle peak. 17-hydroxyprogesterone administered during the mid follicular phase of the menstrual cycle and under pretreatment with ethinyl estradiol failed to induce a positive feedback effect on the serum concentrations of LH and FSH, indicating that this steroid does not play a regulatory role on the midcycle LH release in women. 20alpha-dihydroprogesterone administered under the same experimental conditions as 17-hydroxyprogesterone seems to be able to induce an LH surge in serum provided there is an adequate estrogen priming.

20-alpha-Dihydroprogesterone↗

Does prolactin modify testosterone feedback in the hamster? Suppression of plasma prolactin inhibits photoperiod-induced decreases in testosterone feedback sensitivity.

The hormonal changes during the photoperiodically driven annual reproductive cycle of the male golden hamster can be explained partially by a change in the sensitivity of the hypothalamo-pituitary axis to negative feedback by testosterone (T). The present studies test the hypothesis that the increases in plasma levels of LH and FSH that follow photo-stimulation are due to decreasing feedback sensitivity and examine if this change in sensitivity is dependent upon increasing PRL levels. Adult males were exposed to a lighting schedule of 5 h of light, 19 h of darkness (5:19) for 12 weeks to induce gonadal regression. The animals were castrated; treated with an inhibitor of PRL release, bromocriptine (CB-154), or oil; and received a Silastic capsule that was empty or filled with T. Subsequently, the animals were transferred to 14:10 and killed 9 or 31 days later. There were no significant changes in FSH and LH in animals receiving oil injections and empty implants between days 9 and 31, suggesting no steroid-independent changes in gonadotropin secretion during this time period. However, 4-mm T implants were more effective in suppressing LH and FSH levels on day 9 than on day 31. This suggests that there is a gradual decrease in feedback sensitivity to T following photostimulation. T was more effective in inhibiting LH and FSH levels in CB-154-treated than in oil-treated animals on both day 9 and day 31. Thus, increases in PRL release are instrumental in causing decreases in feedback sensitivity following photostimulation.

Animals↗