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PubMed1977

Generalizing articulation training with trainable mentally retarded subjects.

A multiple-baseline technique was used to evaluate generalization effects during articulation training with trainable mentally retarded subjects. Four target words were selected for each subject on the basis of whether the subject could articulate the word correctly when it was modelled but could not articulate the word correctly in response to a picture of it. Five different settings were selected for generalization probing and training for each subject. In Setting 1, Experimenter 1 initiated training sequentially on all four target words for each subject. Other experimenters probed for correct articulation generalization in four other settings. Training was initiated in these four other settings sequentially only if correct responding failed to generalize to a setting. Results indicated that it was necessary to initiate training on at least three of the four selected target words in at least one additional setting with an additional trainer before correct responding generalized to untrained settings.

Education of Persons with Intellectual Disabilitie↗

PubMedDate not supplied

Psychiatric consultation services in the large general hospital: a review and a new report.

Studies are reviewed documenting increased interest in psychiatric consultation services in the general hospital, and disparities between the need for and the availability/utilization of consultation services are examined. The emergence of the eclectrically trained psychiatrist as the most acceptable consultant in the general hospital is discussed. An exploratory attiduinal questionnaire, developed and circulated to a sample of attending physicians in a midwestern university teaching hospital, yielded the following data. Thirty-nine per cent (N=96) of the 244 physicians who received the questionnaire responded. Ninety-nine per cent of the respondents agreed that readily available psychiatric consultation services should be fully operative in all large general hospitals; 88% agreed that psychiatric consultations in the general hospital must be performed by a physician with special training in psychological medicine; 50% indicated a preference for a biologically-oriented psychiatrist, and 26% preferred a family practitioner or internist who had subsequently become a psychiatrist. The majority of respondents indicated that between July 1974 and July 1975, 1-5% of their private hospitalized patients received inhospital psychiatric consultation. Eighty-six per cent of the respondents felt the patients should be billed directly at a rate equal to other medical/surgical consultations. These data are correlated with issues involved in the utilization of psychiatric consultation in the general hospital.

Aftercare↗

PubMed1979

General surgeons and their surgical practices.

The work characteristics of general surgeons were studied as part of a national study of surgeon manpower. General surgeons were found to work long hours relative to other surgical specialists. Although general surgeons' operative workloads ranked fourth among the 10 surgical specialties, they were only modest in comparison with the surgeons with the highest operative loads (thoracic surgeons). The major conclusion is that the supply of general surgeons is more than adequate to meet the need for general surgeon consultants.

Certification↗

PubMed1979

Determinants of the ability of general practitioners to detect psychiatric illness.

This study of psychiatric illness among 4098 patients attending 91 general practitioners compares 2 methods of case identification: 'conspicuous morbidity' by the doctor's own assessments, and 'probable prevalence' by the patients' responses to the General Health Questionnaire (GHQ). In general, the latter gives somewhat higher estimates than the former, but there are wide variations in morbidity between practices. The ability of each general practitioner to detect psychiatric illness was measured by computing Spearman's correlation coefficient between his assessments and the GHQ scores of his patients. The mean correlation coefficient was + 0.36, but the range was very wide (0.09-0.60). The first part of the study deals with various demographic characteristics of the patients themselves which are associated with an increased likelihood of the doctor detecting a psychiatric illness; such factors include unemployment, female sex, and marriages which have ended by separation, divorce or death. The second part of the study examines characteristics of the doctors themselves in an attempt to account for the wide variation between them in their ability to detect psychiatric illness. A research psychiatrist made detailed observations on 2098 interviews carried out by 55 general practitioners. Each doctor's verbal and non-verbal styles were recorded minutely, and in addition various global ratings were made. The doctors completed personality inventories and supplied details of training and professional background. It was possible to account for 67% of the variance of correlation coefficient mainly in terms of 2 dimensions: 'interest and concern' and 'conservatism'. The way in which the doctor interviews his patients is shown to be important, but there are interactions between interview style and the doctor's personality.

Adolescent↗

PubMed1979

Postgraduate training for general practice in the United Kingdom.

Although the role of general practice is well established in the United Kingdom's National Health Service, formal postgraduate training for primary care practice is a recent development. Trainees may enter three-year programs of coordinated inpatient and outpatient training or may select a series of independent posts. Programs have been developed to train general practitioners as teachers, and innovative courses have been established. Nevertheless, there is a curious emphasis on inpatient experiences, especially since British general practitioners seldom treat patients in the hospital. In their outpatient experiences trainees are provided with little variety in their instructors, practice settings, and medical problems. The demands on this already strained system will soon be increased due to recent legislation requiring postgraduate training for all new general practitioners. With a better understanding of training for primary care in the National Health Service, those planning American primary care training may avoid the problems and incorporate the attributes of British training for general practice.

Certification↗

PubMed1978

An evaluation of a course for undergraduate teaching of general practice.

This paper presents an evaluation of the undergraudate fifth year course of teaching in general practice in the Queen's University, Belfast. Two Modified Essay Question papers were randomly selected from those used for some years past in the Department of General Practice, as learning aids and class tests. These were administered to twelve randomly selected groups of students before and after completion of a five week course of teaching. Results show that the composite mean MEQ scores doubled between pre- and post-course tests. The correlation coefficients tabulated do not indicate that the marked improvement in mean scores before and after the course in general practice was influenced to any extent by knowledge acquired in other disciplines. The overall findings clearly establish the value of small group clinical teaching of general practice based on a problem orientated approach to learning. They suggest that the intellectual skills and attitudes required in the 'holistic' approach to problem solving in general practice may differ in some ways from the skills required in specialized areas of medicine. The evaltion justifies the time spent on clarifying the undergraudate educational objectives.

Education, Medical, Undergraduate↗

PubMed1978

Evaluation and peer review of the role of specialist and general medical units in a teaching hospital.

The trend toward increasing specialization in the medical wards of teaching hospitals has important implications for future health care delivery and student teaching. A study of the likely implications of a change to a specialty oriented medical admission system at the Royal Adelaide Hospital has shown that already the general physicians are seeing little renal and endocrine disease and, that work satisfaction is greater on the specialty units than on the general medical units. Patient satisfaction marginally favoured the specialty units. A peer review audit method was introduced to try and discern whether the quality of care was significantly different on the two types of units. Most physicians cooperated in at least one or two audits which involved them in judgements about adequacy of casenotes, management decisions, follow-up arrangements, length of stay and investigations in randomly assigned specialty pairs of patients (cared for by specialist or general units). No clear-cut trend was discerned favouring specialist or generalist care amongst 17 randomly selected pairs, but this part of the study was never completed, perhaps partly because of lack of enthusiasm for it by busy clinicians. The importance of maintaining a model of generalism for medical students on the teaching hospital campus is discussed discussed in the light of the decline of the role of general physicians.

Australia↗

PubMed1978

Generalized epilepsy with bilateral synchronous spike and wave discharge. New findings concerning its physiological mechanisms.

A hypothesis for the mechanism of generalized spike and wave discharge in human generalized epilepsy is proposed in the light of findings obtained in feline generalized penicillin epilepsy. It is postulated that generalized bilaterally synchronous spike and wave discharge depends upon a diffuse and relatively mild state of cortical hyperexcitability which increases the responsiveness of cortical neurons. Afferent thalamo-cortical volleys normally involved in the genesis of spindles and recruiting responses are most likely to precipitate spike and wave discharges under these conditions. The spike and wave pattern probably results from the activation of a recurrent intracortical inhibitory pathway which becomes activated when cortical neurons discharge in greater number and more repetitively than is normally the case. During spike and wave discharges a large number of neurons oscillate between short periods of excitation, corresponding to the spike, and longer periods of inhibition, corresponding to the slow wave component of the spike and wave complex. This disrupts the normal transactional processes of cortical neurons which are presumably responsible for mental activity, particularly for the close integration of perception, cognition and voluntary motor responsiveness. The degree of this interference varies greatly and in mild absence seizure it is not justified to speak of "loss of consciousness". The fundamental disturbance in absence seizures brought about by the generalized cortical spike and wave discharges is therefore better regarded as a "clouding of the mind". Loss of consciousness can be said to occur only when the interference with mental activity becomes particularly intense. Loss of consciousness in absence seizures can therefore not be used as an argument in favor of primary involvement of higher brain-stem mechanisms.

Animals↗

PubMed1979

[Education and training of the general physician].

The authors of this paper, part of which was presented at the Seventh Pan American Conference on Medical Education (New Orleans, October 1978), recognize that training programs for general physicians should relate to the particular socioeconomic conditions and characteristics of the individual country and region. They propose that the general physician in developing countries be prepared in graduate courses to provide primary care, in order to give service immediately after graduation and because opportunities elsewhere for recent graduates are limited. After outlining new curriculum proposals for the general physicians, they argue against the establishment of departments of family medicine in Latin American medical schools. It is suggested that the general physician's training take place in outpatient clinics, health centers, and community and teaching hospitals, to make possible the integration of the medical education and medical care. Until such time when integration is achieved, the teaching hospital should afford medical education and care on a small scale, offering outpatient general clinics, nonspecialized services, and community health activities.

Brazil↗

PubMed1977

Psychological health in general medical practice: a survey.

The information gained from the National Morbidity Survey (1962-63) and the Australia Morbidity Survey (commenced 1969) indicates that there has been a general increase in the number of patients attending a general practitioner for mental disorders. This study was a survey to attempt to gain some insight into the incidence of both primary and secondary emotional/psychological problems in general medical practice. A sample of eight general practitioners completed questionnaires giving information on three areas: (I) Variables of sex, age, marital status and occupation (II) The form and incidence of concomitant somatic/psychological problems (III) The form and incidence of psychological problems. Each general practitioner completed the questionnaire for 200 consecutive patients, giving a total sample of 1600 doctor-patient contacts.

Adult↗

PubMed1978

U.S. fatal general aviation accidents due to cardiovascular incapacitation: 1974-75.

A study was undertaken to determine the relative impact of inflight cardiovascular incapacitation among general aviation pilots with respect to general aviation flight safety. During calendar years 1974-75, the National Transportation Safety Board reports reveal that 13 U.S. general aviation pilots died of cardiovascular incapacitation during flight. The analysis of these accidents will bear on any suggested changes in pilot medical screening procedures for cardiovascular disease, as well as on pilot safety education programs. Of the 13 cases noted above, nine pilots were flying alone. Of the remaining multiple occupant cases, the nonpilot wife of one deceased victim managed to land the aircraft. Eighteen deaths resulted from the inflight incapacitations. The ages of the pilots ranged from 33-68 years, with both a mean and a median of 52. Postmortem examinations revealed extensive coronary disease (atherosclerosis) in 12 cases (no pilot autopsy data is available in the case where the passenger landed the aircraft). Of these 12 cases, five demonstrated recent occlusions. In four more, evidence of old infarcts was revealed by the postmortem examination. It is concluded that these 13 inflight cardiovascular incapacitations, occurring among a total of 1,404 fatal general aviation accidents in the 1974-75 period, constitute such a small proportion (0.93%) of the documented fatal general aviation accidents that extensive additional cardiovascular screening procedures are not justified at present on cost/yield basis.

Accidents, Aviation↗

PubMed1977

An experimental analysis of peer social initiations on the behavior of withdrawn preschool children: some training and generalization effects.

In this study, positive social initiations by an age-peer was evaluated as an intervention for isolate preschool children in training and generalization sessions. During baseline, the confederate made few social approaches to the target subjects. The confederate greatly increased his rate of positive social initiations during the first intervention, decreased social approaches during a second baseline, and increased social approaches again in a second intervention phase. Increases in confederate initiations resulted in an immediate acceleration in the frequency of subjects' positive social behavior during training sessions. Additionally, for two of the three subjects, positive social behaviors were also observed to increase during generalization sessions. The results suggest that (a) peers may be trained successfully to set the occasion for positive social behaviors by withdrawn classmates, (b) increased social responding by withdrawn children in the presence of frequent peer social initiations may also generalize beyond the training setting, and (c) the magnitude of direct and generalization effects appears to be related to the entry-level repertoire of target children.

Behavior Therapy↗

PubMed1977

Establishing generalization effects among autistic children.

Although elusive, generalization of behavior change in autistic children is essential to obtaining maximum treatment effects. Using behaviorally based treatment and teachers and parents as trainers, generalization effects between home and school were measured on four behaviors: following instructions, washing, wiping bottom, and sharing toys. The results indicate that both settings were effective in establishing generalization. Behaviors treated in one setting generalized to another when children were provided with an opportunity for daily practice. Treatment with practice in other settings is possible in contrast to providing treatment on the same behavior in both settings.

Adolescent↗

PubMed1979

Local versus general anesthesia: which is safer for performing suction curettage abortions?

The relative safety of suction curettage abortions performed with either local or general anesthesia has not been clearly established. To compare the safety of these two anesthetic techniques, we studied 36,430 women who received local anesthetics and 17,725 who received general anesthetics for this operation in the United States from 1971 through 1975. The aggregated major complication rates for the two groups were similar, but there were significant differences between local and general anesthesia for specific complications and treatments. Local anesthesia was associated with higher rates of febrile and convulsive morbidity; however, general anesthesia was associated with higher rates of hemorrhage, cervical injury, and uterine perforation. Both anesthetic techniques appear to be safe, with similar degrees of overall safety, although each is associated with a different spectrum of complications.

Abdomen↗

PubMed1979

Influence of acoustic experience on the ontogeny of frequency generalization gradients in the chicken.

The role of auditory experience in the ontogeny of perceptual coding was investigated in hatching chickens. In Experiment 1, auditory frequency generalization gradients were determined by using a habituation-generalization paradigm and an orienting response. One-day and 3-4 day chicks were habituated to 800-Hz tones and then tested at five frequencies ranging from 800 to 1,000 Hz. One-day chicks displayed reliably flatter generalization gradients than 3-4-day chicks. In Experiment 2 an auditory deprivation method is described in which an ear impression compound was injected into the external ear. This method (a) is fully calibrated and provides approximately 40 dB of attenuation across a .125- to 4.0-kHz range, (b) appears to be fully reversible, and (c) is applicable prior to normal auditory experience as well as at subsequent stages. In Experiment 3, this method was used to investigate the effects of auditory deprivation on the "perceptual sharpening" described in Experimental 1. Chicks were deprived from Embryonic Day 18 1/2 to 3-4 days posthatch, at which time normal, deprived, and sham-operated chicks were tested as in Experiment 1. The generalization gradients of the deprived chicks were significantly flatter than those of the 3-4 day normal and sham-operated chicks and were similar to those of 1-day chicks. This effect cannot be attributed to (a) operative procedures, (b) changes in auditory thresholds, or (c) changes in response rate with age or condition. Thus the perceptual sharpening normally occurring between 1 and 3-4 days posthatch fails to occur during that time in the absence of a normal acoustic environment.

Acoustic Stimulation↗

PubMed1979

Open-access endoscopy service for general practitioners.

An open-access general-practitioner referral service for endoscopy of the upper gastrointestinal tract was established in a district general hospital, and the impact of the service over three years was assessed. The reason for referral, duration of symptoms, and amount of disease detected were the same in patients referred by general practitioners and those attending from hospital outpatient departments. Despite a steady increase in the number of patients referred for endoscopy, the number of barium-meal examinations performed did not correspondingly decrease. The number of ulcers and cancers detected in each six-month period of the study did not increase, and the combined overall pick-up rate for these two conditions fell from 25% to 13%. All general practitioners in the area were sent questionnaires. Most thought that clinic referral had been reduced and patient management helped as a result of the introduction of the service. While the value of negative endoscopic findings cannot be assessed, there is little objective evidence of benefit. Hence the large increase in numbers of endoscopies performed as a result of the introduction of the service cannot be justified.

Diagnostic Services↗

PubMedDate not supplied

Implications of the effects of general anesthesia on basal tear production.

Ophthalmic preparations are frequently instilled topically to protect the eye during general anesthesia. The purpose of this study was to determine if such prophylactic precautions are warranted, as determined by the effect of general surgical anesthesia on basal tear production by the Schrimer I test. As general surgical anesthesia produced a marked depression of basal tear production, both mechanical protection and topical medications are recommended for the ocular care of patients undergoing general surgical anesthesia.

Adolescent↗

PubMed1979

Generalization by autistic-type children of verbal responses across settings.

Generalization of verbal behavior by autistic-type children across physically different settings was assessed. Four boys learned responses to common questions in two settings at school and were probed to determine transfer of learning to home. Three of the children demonstrated little generalization to home when trained in a cubicle. Greater generalization was indicated when they received training at varied locations. The fourth child generalized most responses to his home regardless of training setting. Simple manipulations of the school environment to more closely simulate home conditions may facilitate transfer of training to the natural environment.

Autistic Disorder↗