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PubMedDate not supplied

Improving performance with clinical standards: the impact of feedback on compliance with the integrated management of childhood illness algorithm in Niger, West Africa.

The joint BASICS/Quality Assurance Project tested several research-based interventions in three districts in Niger, West Africa to improve case management of sick children. The research design was a non-concurrent, prospective case control design. Quality of care was determined as the degree of compliance of health care workers with the Integrated Management of Childhood Illness (IMCI) standards of assessment, treatment and counselling of sick children and their caretakers. The interventions tested were (1) structured feedback of health worker performance data and (2) formal IMCI training and (3) team-based quality improvement. Performance feedback had a significant effect on compliance. Performance feedback alone created a significant short-term impact on health care worker compliance, which improved between 34% and 85% in areas of assessment of sick children (p < 0.05). In addition, performance feedback was significantly cheaper than formal training ($108 per health worker versus $430 per worker for IMCI training). However, this impact was not universal over all areas of compliance following each feedback. Instead, performance feedback had the greatest effect in areas in which health care workers performed poorly, while areas in which compliance was high eventually saw declines. In settings such as Niger, which has the highest child mortality in the world according to UNICEF figures, low-cost techniques for supporting health workers once they have been trained in clinical standards are sorely needed. Performance feedback shows promise as a technique for improving quality of care with clinical algorithms such as IMCI.

Algorithms↗
PubMed1999

Feedback control of gonadotropins in Atlantic salmon, Salmo salar, male parr.II. Aromatase inhibitor and androgen effects.

Both positive and negative feedback on the (hypothalmus)- pituitary-gonad axis occur in salmonids. The aim of the present study was to investigate the role of different androgens, and in particular the involvement of aromatization of androgens to estrogens in feedback mechanisms. Previously mature Atlantic salmon, Salmo salar, male parr were studied in two experiments. In the first experiment, intact fish were implanted with Silastic capsules filled with the aromatase inhibitor 1,4,6-androstatriene-3,17-dione (ATD) in spring and sampled in the autumn when the rematuring males were starting to display running milt. In the second experiment, castrated males were implanted with capsules containing ATD, the androgens testosterone (T) and 11-ketoandrostenedione (11KA), or ATD and T combined in spring. These fish were sampled in the summer when rematuring fish were starting to show signs of gonadal growth. Pituitary and plasma gonadotropins (GTH I and GTH II) were studied using radioimmunoassay. In autumn, ATD treatment reduced pituitary and plasma GTH II levels. In summer, GTH II was consistently nondetectable in plasma. Castration diminished pituitary GTH II content. Treatment with T increased pituitary GTH II content, an effect that was attenuated when T treatment was combined with ATD. All these results are consistent with the presence of an aromatase-dependent positive feedback of T on GTH II. 11KA also had a stimulatory effect on GTH II, although weaker than that of T. Testicular size and spermiation was reduced by ATD in autumn; the latter of these results is likely to be due to the inhibitory effect of ATD on GTH II. Positive effects of ATD on plasma GTH I were found in autumn, indicative of an aromatase-dependent negative feedback in this phase. On the other hand, castration increased plasma and pituitary GTH I levels in summer, indicating that the gonads in this phase exert a predominantely negative control of GTH I. In summer, negative effects of T on GTH I pituitary levels were not suppressed, but were rather enhanced, by the combined treatment with ATD. Furthermore, plasma GTH I levels were lower after treatment with T in combination with ATD than with T or ATD separately. These negative effects of T were not diminished by ATD, so that they are nonaromatase-dependent. Furthermore, since they were actually more pronounced in the presence of ATD it is suggested that there is also a positive aromatase-dependent feedback component in this phase. In addition, 11KA had a negative effect on plasma and pituitary GTH I in castrated previously mature males. Thus, GTH I secretion is controlled by both aromatase-dependent and nonaromatase-dependent feedback effects, of which at least the former may be positive or negative depending on season. In summary, the feedback control of GTH I appears to be more complex than that of GTH II.

Androgens↗
PubMed1999

Evolutionary feedback: a new mechanism for stasis and punctuated evolutionary change based on integration of the organism.

This paper argues that organisms are integrated, holistic systems whose phenotypic traits and genes interact with each other and natural selection. More than this, organisms are feedback systems. I introduce the term integration of the organism to refer to this idea that organisms are such interacting systems. Integration of the organisms is a major reason why most mutations are deleterious, and why the larger a mutation's effect, the greater the probability that a mutation will be deleterious. Yet, it is also why macromutations can occasionally be adaptive. Such adaptive mutations of large effect, an example of which is neoteny, must be coordinated with the generic system and ontogeny of the organism. Integration of the organism and the ability of both the phenotype and genotype to influence and interact with natural selection means a species can undergo sequential evolution, a term I coin in this paper to refer to a change in a trait causing a change in selection on a second trait, which leads to a change in the second trait, which in turn causes a change in selection on a third trait, changing it, and so on. Sequential evolution can sometimes result in closed feedback loops, in which a trait farther down the sequence affects a trait earlier in the sequence of traits. I call this process evolutionary feedback. Both sequential evolution and evolutionary feedback can sometimes cause punctuated evolutionary change. Evolutionary feedback can also act as a mechanism for stasis. Hence, evolutionary feedback is a mechanism for punctuated equilibrium. I propose that species to a large extent influence, even drive, their own evolution. This, of course, is not to suggest they do so willfully or consciously. It is proposed that there are three mechanisms for punctuated evolutionary change; these are described. Examples of and evidence for sequential evolution and punctuated evolution by evolutionary feedback are presented.

Adaptation, Physiological↗
PubMed1975

Tubuloglomerular feedback in rat kidneys of different renin contents.

Variations in flow rate through the loop of Henle in the range of 0--50 nl/min were induced using pressure controlled microperfusion. Simultaneously, with the aid of a second pressure-microperfusionsystem, the glomerular function of the same nephron was studied by continuous measurement of two parameters, early proximal flow rate (EPFR) and/or stop flow pressure (SFP). Elevation of loop perfusion above physiological values (40 nl/min) resulted in a drop of EPFR and SFP, whereas lowering perfusion rates had no effect. This feedback behaviour was studied in kidneys with different renin contents to test the role of the renin-angiotensin system in the mediation of the macula densa signal to the adjacent glomerular vessels. Renal renin content, measured after micropuncture experiments by incubation with substrate followed by radioimmunoassay of angiotensin I, was unaltered in control (Ia) and heminephrectomized rats (Ib), lowered in contralateral kidneys of 2 kidneys Goldblatt hypertensive rats (IIa), in DOCA- and salt-loaded rats (IIb), and in DOCA-, salt-loaded and heminephrectomized rats (IIc), and it was evaluated in clipped kidneys of Goldblatt hypertension rats (IIIa). Micropuncture evaluation of the tubuloglomerular feedback behaviour in these experimental groups revealed the following results: 1. a feedback response under all conditions independent of the widely varying renin contents (1000-fold), 2. an asymmetrical behaviour of the feedback response in all kidneys as demonstrated by suppression of EPFR and SFP at elevated loop flow rates, but no change of these parameters when loop flow was interrupted. 3. compared to controls the decrease of each GFR parameter between 0 and 40 nl/min loop perfusion was lower in DOCA- and salt-loaded rats (IIb, IIc). Additional heminephrectomy (IIc) had no further influence on the reduced feedback response in DOCA- and salt-loaded rats, whereas this maneuver reduced the renal renin content drastically. A somewhat higher response than in controls was found in heminephrectomized rats (IIb) and in clipped kidneys of Goldblatt hypertensive rats (IIIa). These different magnitudes of feedback responses do not correlate with the renal renin content. It has been concluded, therefore, that renal renin activity is not the sole determinant of the effectiveness of the tubuloglomerular feedback response.

Angiotensin II↗
PubMed2003

Effects of object shape and visual feedback on hand configuration during grasping.

Normal subjects gradually preshape their hands during a grasping movement in order to conform the hand to the shape of a target object. The evolution of hand preshaping may depend on visual feedback about arm and hand position as well as on target shape and location at specific times during the movement. The present study manipulated object shape in order to produce differentiable patterns of finger placement along two orthogonal "dimensions" (flexion/extension and abduction/adduction), and manipulated the amount of available visual information during a grasp. Normal subjects were asked to reach to and grasp a set of objects presented in a randomized fashion at a fixed spatial location in three visual feedback conditions: Full Vision (both hand and target visible), Object Vision (only the object was visible but not the hand) and No Vision (vision of neither the hand nor the object during the movement). Flexion/extension angles of the metacarpophalangeal and proximal interphalangeal joints of the index, ring, middle and pinkie fingers as well as the abduction/adduction angles between the index-middle and middle-ring fingers were recorded. Kinematic analysis revealed that as visual feedback was reduced, movement duration increased and time to peak aperture of the hand decreased, in accord with previously reported studies. Analysis of the patterns of joint flexion/extension and abduction/adduction per object shape revealed that preshaping based on the abduction/adduction dimension occurred early during the reach for all visual feedback conditions (approximately 45% of normalized movement time). This early preshaping across visual feedback conditions suggests the existence of mechanisms involved in the selection of basic hand configurations. Furthermore, while configuration changes in the flexion/extension dimension resulting in well-defined hand configurations occurred earlier during the movement in the Object Vision and No Vision conditions (45%), those in the Full Vision condition were observed only after 75% of the movement, as the moving hand entered the central region of the visual field. The data indicate that there are at least two control mechanisms at work during hand preshaping, an early predictive phase during which grip selection is attained regardless of availability of visual feedback and a late responsive phase during which subjects may use visual feedback to optimize their grasp.

Adult↗
PubMed2003

Postural feedback responses scale with biomechanical constraints in human standing.

We tested whether human postural responses can be described in terms of feedback control gains, and whether these gains are scaled by the central nervous system to accommodate biomechanical constraints. A feedback control model can describe postural responses for a wide range of perturbations, but biomechanical constraints-such as on the torque that can be exerted on the ground-make a single set of feedback gains inappropriate for all perturbations. To observe how postural responses change with perturbation magnitude, we applied fast, backward perturbations of magnitudes 3-15 cm to 13 healthy young volunteers (4 men, 9 women, aged 20-32 years). We used a 3-segment, sagittal-plane biomechanical model and a linear state feedback controller to reproduce the observed postural responses. Optimization was used to identify the best-fit feedback control gains for each trial. Results showed that trajectories of joint angles and joint torques were scaled with perturbation magnitude. This scaling occurred gradually, rather than abruptly changing at magnitudes where biomechanical constraints became active. Feedback gains were found to fit reasonably well with data ( R(2)=0.92) and to be multivariate and heterogenic in character, meaning that the torque produced at any joint is generally a function of motions not only at the same joint, but other joints as well. Hip gains increased and ankle gains decreased nearly linearly with perturbation magnitude, in accordance with biomechanical limitations on ground reaction torque. These results indicate that postural adjustments can be described as a single feedback control scheme, with scalable heterogenic gains that are adjusted according to biomechanical constraints.

Adult↗
PubMed2003

A multimodal brain-based feedback and communication system.

The Thought Translation Device (TTD) is a brain-computer interface based on the self-regulation of slow cortical potentials (SCPs) and enables completely paralyzed patients to communicate using their brain potentials. Here, an extended version of the TTD is presented that has an auditory and a combined visual and auditory feedback modality added to the standard visual feedback. This feature is necessary for locked-in patients who are no longer able to focus their gaze. In order to test performance of physiological regulation with auditory feedback 54 healthy participants were randomly assigned to visual, auditory or combined visual-auditory feedback of slow cortical potentials. The training consisted of three sessions with 500 trials per session with random assignment of required cortical positivity or negativity in half of the trials. The data show that physiological regulation of SCPs can be learned with auditory and combined auditory and visual feedback although the performance of auditory feedback alone was significantly worse than with visual feedback alone.

Acoustic Stimulation↗
PubMed2002

Why has postal prescriber feedback no substantial impact on general practitioners' prescribing practice? A qualitative study.

OBJECTIVE: To better understand the reasons for lack of impact of sending feedback on prescribing pattern to general practitioners (GPs). METHODS: Semi-structured interviews with GPs who had all participated in intervention studies addressing effects of prescriber feedback. Interviews were audiotaped and fully transcribed. Transcripts were studied repeatedly and coded into categories in order to produce meaningful patterns. RESULTS: None of the GPs believed they altered prescribing practice after they received prescriber feedback. Unsolicited prescriber feedback was perceived as violating the GPs' autonomy. The GPs wanted to decide for themselves what data should be sent to them. Aggregated data were difficult to interpret, and GPs did not regard it as a problem that their practice pattern deviated from that of other practices. There was a mistrust of the validity of data, and the GPs wanted to be able to identify the patients with a need for optimised therapy directly from the information provided in the prescriber feedback. In addition they wanted advice on how to optimise therapy. CONCLUSION: Postal prescriber feedback (not revealing the patients' identities) is not effective because it does not motivate GPs to change nor does it address the barriers to change. Prescriber feedback requested by the GPs may be more effective, however, if it includes identities of inappropriately treated patients combined with relevant advice on how to optimise prescribing.

Attitude of Health Personnel↗
PubMed2002

Adaptation of reflexive feedback during arm posture to different environments.

In this study we have examined the ability of the central nervous system (CNS) to use spinal reflexes to minimize displacements during postural control while continuous force perturbations were applied at the hand. The subjects were instructed to minimize the displacements of the hand from a reference position that resulted from the force perturbations. The perturbations were imposed in one direction by means of a hydraulic manipulator of which the virtual mass and damping were varied. Resistance to the perturbations came from intrinsic and reflexive stiffness, and from the virtual environment. It is hypothesized that reflexive feedback during posture maintenance is optimally adjusted such that position deviations are minimal for a given virtual environment. Frequency response functions were estimated, capturing all mechanical properties of the arm at the end point (hand) level. Intrinsic and reflexive parameters were quantified by fitting a linear neuromuscular model to the frequency responses. The reflexive length feedback gain increased strongly with damping and little with the eigenfrequency of the total combined system (i.e. arm plus environment). The reflexive velocity feedback gain decreased slightly with relative damping at the largest eigenfrequency and more markedly at smaller eigenfrequencies. In the case of highest reflex gains, the total system remained stable and sufficiently damped while the responses of only the arm were severely underdamped and sometimes even unstable. To further analyse these results, a model optimization was performed. Intrinsic and reflexive parameters were optimized such that two criterion functions were minimized. The first concerns performance and penalized hand displacements from a reference point. The second one weights afferent control effort to avoid inefficient feedback. The simulations showed good similarities with the estimated values. Length feedback was adequately predicted by the model for all conditions. The predicted velocity feedback gains were larger in all cases, probably indicating a mutual gain limiting relation between length and velocity afferent signals. The results suggest that both reflex gains seem to be adjusted by the CNS, where in particular the length feedback gain was optimal so as to maximize performance at minimum control effort.

Adult↗
PubMed2007

The effect of escalating feedback on the acquisition of psychomotor skills for laparoscopy.

BACKGROUND: In the acquisition of new skills that are difficult to master, such as those required for laparoscopy, feedback is a crucial component of the learning experience. Optimally, feedback should accurately reflect the task performance to be improved and be proximal to the training experience. In surgery, however, feedback typically is in vivo. The development of virtual reality training systems currently offers new training options. This study investigated the effect of feedback type and quality on laparoscopic skills acquisition. METHODS: For this study, 32 laparoscopic novices were prospectively randomized into four training conditions, with 8 in each group. Group 1 (control) had no feedback. Group 2 (buzzer) had audio feedback when the edges were touched. Group 3 (voiced error) had an examiner voicing the word "error" each time the walls were touched. Group 4 (both) received both the audio buzzer and "error" voiced by the examiner All the subjects performed a maze-tracking task with a laparoscopic stylus inserted through a 5-mm port to simulate the fulcrum effect in minimally invasive surgery (MIS). A computer connected to the stylus scored an error each time the edge of the maze was touched, and the subjects were made aware of the error in the aforementioned manner. Ten 2-min trials were performed by the subjects while viewing a monitor. At the conclusion of training, all the subjects completed a 2-min trial of a simple laparoscopic cutting task, with the number of correct and incorrect incisions recorded. RESULTS: Group 4 (both) made significantly more correct incisions than the other three groups (F = 12.13; df = 3, 28; p < 0.001), and also made significantly fewer errors or incorrect incisions (F = 14.4; p < 0.0001). Group 4 also made three times more correct incisions and 7.4 times fewer incorrect incisions than group 1 (control). CONCLUSIONS: The type and quality of feedback during psychomotor skill acquisition for MIS have a large effect on the strength of skills generalization to a simple MIS task and should be given serious consideration in curriculum design for surgical training using simulation tasks.

Adult↗
PubMedDate not supplied

The adrenocortical axis in the aged rat: impaired sensitivity to both fast and delayed feedback inhibition.

Aged rats secrete excessive amounts of the species-typical glucocorticoid, corticosterone, under basal conditions, following the end of stress and during habituation to mild stressors. Furthermore, the aged rat is resistant to the inhibitory effects of the synthetic glucocorticoid dexamethasone upon subsequent corticosterone secretion. These observations have led to the hypothesis that the aged adrenocortical axis is desensitized to the inhibitory effects of glucocorticoids. In the present study, we have defined this negative-feedback deficit more precisely. The aged adrenocortical axis is subject to both rate-sensitive fast feedback regulation by corticosterone and to level-sensitive delayed feedback. Moreover, there is no age difference in the maximal extent of feedback inhibition which can be attained. However, the sensitivity to both forms of feedback regulation is diminished in aged rats, in that the aged adrenocortical axes are responsive under feedback conditions which completely inhibit corticosterone secretion in young animals. Such insensitivity is likely to underlie the incidences of hyperadrenocorticism apparent in the aged rat; we speculate that progressive degeneration in the aged hippocampus might be the cause of this dampened sensitivity to feedback inhibition.

Adrenocorticotropic Hormone↗
PubMedDate not supplied

Optimal control mode of a biochemical feedback system.

An optimal feedback system for constant-value control of biochemical reaction system was investigated by computer simulations. A feedback system containing a cyclic enzyme system where two enzyme types share a substrate in a cyclic manner, was found to be the most reliable one. This feedback system has a capability to keep the stationary value of the end product at a desired level against not only exogenous substrate supply but also endogenous parametric disturbances. The cyclic enzyme system installed as a control element of this feedback system played the role of comparator in this feedback system. The control mode of this feedback system was in good agreement with that of a system established by means of optimization technique based on the maximum principle. Also bang - bang control could be performed in this biochemical feedback system as well as in electrical one.

Enzymes↗
PubMed2006

Safety implications of providing real-time feedback to distracted drivers.

A driving simulator study was conducted to assess whether real-time feedback on a driver's state can influence the driver's interaction with in-vehicle information systems (IVIS). Previous studies have shown that IVIS tasks can undermine driver safety by increasing driver distraction. Thus, mitigating driver distraction using a feedback mechanism appears promising. This study was designed to test real-time feedback that alerts drivers based on their off-road eye glances. Feedback was displayed in two display locations (vehicle-centered, and IVIS-centered) to 16 young and 13 middle-aged drivers. Distraction was observed as problematic for both age groups with delayed responses to a lead vehicle-braking event as indicated by delayed accelerator releases. Significant benefits were not observed for braking and steering behavior for this experiment, but there was a significant change in drivers' interaction with IVIS. When given feedback on their distracted state, drivers looked at the in-vehicle display less frequently regardless of where feedback was displayed in the vehicle. This indicates that real-time feedback based on the driver state can positively alter driver's engagement in distracting activities, helping them attend better to the roadway.

Adolescent↗
PubMed2004

Phasic heart rate responses to performance feedback in a time production task: effects of information versus valence.

This study examined the cardiac concomitants of feedback processing in a time production task derived from [Mittner et al., J. Cogn. Neurosci. 9 (1997) 788]. Participants performed the time production task (i.e. 1-s intervals) under two conditions. In the experimental condition, feedback informed them that the produced interval was within or outside the acceptable range (too long or too short). In the other, yoked-control, condition feedback was unrelated to the actual estimate. The performance findings indicated that in the experimental condition, participants tended to adjust the new interval in the direction indicated by the feedback. In the control condition, however, the adjustments were largely unrelated to the information provided by the feedback. Heart rate slowed to feedback stimuli indicating that the estimate was outside the acceptable range. Surprisingly, cardiac slowing did not discriminate between experimental and control conditions. This finding seems to suggest that heart rate is sensitive to the valence rather than the information provided by the feedback. This finding is discussed vis-à-vis current neuroimaging and psychophysiological studies of performance monitoring.

Adolescent↗
PubMed2006

Impact of isolated clinical performance feedback on clinical productivity of an academic surgical faculty.

BACKGROUND: There is increasing financial pressure to maximize clinical productivity for academic physicians. We examined whether clinical performance feedback alone could contribute to improving the clinical productivity of surgeons in an academic department of surgery. STUDY DESIGN: We implemented a clinical performance feedback program in January 2003. We then compared clinical productivity in terms of relative value units (RVUs) of surgeons for 18 months before and 18 months after this intervention, using each surgeon as his or her own control. Regression was performed with dependent variable ln (monthly RVUs) and independent variables "calendar month," "pre/post" January 2003, and "surgeon." The coefficient on "pre/post" reflected average change in RVUs. We also surveyed faculty on their use of and attitudes toward this feedback. RESULTS: There was a 58% survey response. Ninety-two percent of responding faculty reported that they viewed and used the performance feedback, and that it affected their practice. Ninety-two percent believed the information accurately reflected their performance, 89% thought that the comparisons were useful, and 79% desired more feedback information, specifically, comparisons with external benchmarks. When RVU data were examined, the coefficient on change pre- and postintervention indicated a 7.4% increase in productivity (p < 0.001), or a 6.0% increase (p=0.003) after exclusion of outliers. CONCLUSIONS: Performance feedback was associated with a small (6.0%) but significant improvement in productivity in this academic surgical faculty group. Performance feedback can be useful and should be used in conjunction with other management tools for this population.

Academic Medical Centers↗
PubMed2004

Guidance hypothesis with verbal feedback in learning a palpation skill.

OBJECTIVE: To investigate whether a force application of a novel motor skill was simple or complex and to determine the appropriate level of feedback during training. The objective was to determine the effects of various amounts of knowledge of results (KR) on learning a novel skill that is frequently taught in chiropractic for the assessment of vertebral motor unit dysfunction. METHODS: Thirty-five active subjects were taught the novel skill of spring testing to a particular force range through 9 or 10 teaching sessions over a 2-week period (a school holiday limited some to only 9 sessions). To determine the particular force range, an initial phase of the study involved a licensed and practicing clinician performing motion palpation spring testing of the thoracic spine of a prone subject. The data from a total of 47 pushes throughout the thoracic spine were recorded, and the mean force and standard deviation were calculated. The second phase of the study used the obtained mean and standard deviation for teaching the force of prone thoracic spine motion palpation to 35 active subjects by administering spring testing to 35 passive subjects. The active subjects were randomly divided into 4 groups, with each receiving a varying amount of verbal feedback to move toward the target force of their learned skill. Each passive subject was laid prone on an instrumented adjusting table. Group 1 received the least amount of feedback while learning the novel skill. Groups 2 and 3 received more frequent, intermittent feedback while learning the skill, and group 4 received constant, frequent feedback during each of the 10 teaching sessions. All subjects returned within 2 weeks for 2 retention trials to determine the efficacy of the learned skill. RESULTS: The mean force determined was 143 N with a standard deviation of 14 N. Each subject was taught spring testing within this target range. The 2 final retention trials showed group 3 to have demonstrated the most targeted retention of the learned motor skill. These subjects exhibited the closest force range to the target for the motor skill learned and fewer changes in standard deviation compared with their acquisition trials and thus the highest retention. Group 4, receiving 100% feedback, demonstrated the most accurate spring testing during the acquisition trials, but the subjects did not effectively demonstrate when compared on acquisition and retention trials. CONCLUSION: The results of this study show data to be consistent with the guidance hypothesis in learning a novel motor skill. The constant KR feedback is beneficial for learning when used to reduce error during practice but detrimental when relied upon for retention and learning. These data suggest the necessity of using motor skill development learning theory in the teaching of chiropractic.

Adult↗
PubMed2004

The parietal role in the sense of self-ownership with temporal discrepancy between visual and proprioceptive feedbacks.

One hypothesis on how we recognize an image of, for example, an arm as our own is through the co-occurrence of multiple sensory feedbacks, especially visual and proprioceptive feedbacks, in this process. It has been suggested that the parietal lobe is the region where proprioceptive and visual information of one's own body is integrated. This study investigated parietal cortical activity during a visual-proprioceptive synchrony judgment task in which visual feedback of the subjects' own passively moving hand was delayed. The subjects were required to judge whether or not there was a delay between the proprioceptive and visual feedbacks. Parietal cortical activity, which was measured using a 48-channel near-infrared spectroscopy (NIRS) apparatus, appeared to be modulated by the length of the delay between the visual and proprioceptive feedbacks. The bilateral superior/middle parietal areas were involved in experiencing the synchrony between the visual and proprioceptive feedbacks, whereas the right inferior parietal areas were strongly activated when discrepancy between the two feedbacks was detected. We postulate that the superior portion of the parietal lobe is essential for maintaining one's own body image, while the right inferior portion is involved in detecting movements of others.

Adolescent↗
PubMed2005

Twelve-month retention of CPR skills with automatic correcting verbal feedback.

AIM: To evaluate the retention of CPR skills 12 months after initial training, using a manikin equipped with a computer-based voice advisory feedback system. METHODS: Thirty-five volunteers had individual 20 min training sessions without an instructor on a manikin with computer-based voice advisory feedback. The feedback depended on the performance as measured by the manikin computer system versus set limits for ventilation and compression variables. Twelve of the volunteers received additional ten 3-min self-training sessions during the following month making a total of 50 min training. All ventilation and compression variables when the volunteers were tested before, immediately after and 6 months after training have previously been reported. The volunteers were now tested 12 months after the initial training session with activated feedback. RESULTS: There were virtually no changes in CPR skills when tested with active feedback 12 months after initial training versus immediately or 6 months post-training. The only exception was a slightly lower number of compressions per minute at 12 months versus immediate post-training in the subgroup with 20 min of initial training, 47+/-4 versus 52+/-4, p = 0.008. There were no differences between the 20 and 50 min training subgroups at 12 months. CONCLUSIONS: Computer-based voice advisory feedback can improve the performance of basic life support skills on a manikin with no deterioration in feedback supported performance after 12 months.

Cardiopulmonary Resuscitation↗