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[Use of the computer in intensive care. A program for instruction and diagnosis of changes in acid-base equilibrium].

A method for assessing the acid-base balance in patients admitted to the Intensive Care Department, making use of the Graphic Display option of a minicomputer is presented. Patient condition can be plotted on present graphs whose coordinates are the pH and PACO2 measured at successive moments. It is thus possible to visualise the behavior of acid-base balance over a period, as well as the extent of renal or respiratory compensation. The data relating to a group of patients are reported by way of illustration.

Acid-Base Equilibrium↗

A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors.

BACKGROUND AND PURPOSE: Little is known about the relative efficacy of supervised versus unsupervised community exercise programs for stroke survivors. This study compared the effectiveness of a 10-week supervised strengthening and conditioning program (supervised) with a 1-week supervised instruction program followed by a 9-week unsupervised home program (unsupervised) and evaluated retention of changes at 6 months and 1 year after program completion. METHODS: Seventy-two subjects retained at baseline (27 women, 45 men; mean+/-SD age, 64.6+/-11.8 years) were randomly allocated to receive the supervised or unsupervised program. The primary outcome was walking speed over 6 minutes, and secondary outcome measures were Human Activity Profile, Medical Outcome Study 36-Item Short-Form survey (SF-36), Physiological Cost Index, and lower extremity muscle strength. RESULTS: The 6-minute walking speed increased significantly in both groups and remained significantly improved by 1 year. The Human Activity Profile demonstrated an increasing trend only in the supervised group that was significant by 1 year. The SF-36 Physical Component summary score increased significantly in the supervised group and remained improved by 1 year; the unsupervised group showed significant improvement at 1 year. Women made greater gains in supervised programs, but men made greater gains in unsupervised programs. CONCLUSIONS: Supervised exercise programs and unsupervised programs after initial supervised instruction were both associated with physical benefits that were retained for 1 year, although supervised programs showed trends to greater improvements in self-reported gains. Gender differences require further research.

Activities of Daily Living↗

Status of menu item forecasting in dietetic education.

The status of forecasting techniques included in educational programs and the need for instructional material on this topic were investigated. A survey instrument was developed to determine which forecasting techniques were included in instructional programs. The validated questionnaire was mailed to directors of coordinated undergraduate programs or to Plan IV representatives at all universities with programs approved or accredited by the ADA. The response rate was 59%, or 156 dietetic programs. Analysis of the survey data revealed that mathematical techniques (Box-Jenkins, regression, exponential smoothing, moving average) were not taught in the majority of educational programs. Educators responded that forecasting was an important concept and that continuing education concerning forecasting techniques that may be employed in foodservice management was needed. As a result of the analysis of the data, two self-instructional modules that could be utilized by both practitioners and educators to enhance the level of practice and education were developed. Graduate and undergraduate students at 11 universities and 35 randomly selected practitioners tested the self-instructional modules. For all groups--undergraduate, graduate, and practitioners--the t-statistic was significant at the p less than .0000 level; thus the modules were effective in teaching foodservice forecasting concepts.

Dietary Services↗

A comparison of human and automated instruction of autistic children.

While it appears reasonable to assume that the autistic child might benefit from the development of programmed instruction and teaching machines to teach imitation, concepts, and receptive vocabulary skills, no systematic research to date has seriously investigated such possibilities. The purpose of this study was to compare the effects of automated versus teacher-controlled instruction in the education of autistic children. Four autistic children, each with extreme deficits in language, social, and self-care behaviors, were trained on a matching-to-sample task under three different instructional situations within an intrasubject replication design and multiple baseline procedure. Analysis of the data showed the following results: (1) The teacher, manually operating the teaching machine, was able to teach and maintain the matching-to-sample task; (2) the same autistic children did not acquire or maintain the task when taught by the machine alone; and (3) the teacher alone (without the machine) was able to teach and maintain the task. The results suggest that automated instruction may, at least, serve as a valuable aid to teachers of autistic children. However, before machines can be used without the participation of a trained teacher, further research appears necessary. Several areas, including the role of motivation in automated instructional settings, the saliency and effectiveness of reinforcers, and the importance of controlling antecedent stimulus conditions and off-task behavior are discussed as areas of primary concern in the development of automated instruction for autistic children.

Adolescent↗

A continuing education program for rural communities: evaluating cognitive and behavioral change.

A total of 133 laboratory workers from 60 institutions participated in a unique continuing education project in North Dakota. Cognitive and behavioral changes of the participants were measured in an attempt to evaluate the effectiveness of the Laboratory Education for North Dakota (LEND) program, which included self-instructional programs (SIPs), telelectures, and workshops. The effects of variables such as institutional size, educational level of participants, topic presented, and type of participation were studied. Institutional size had no significant effect on cognitive change (P greater than .05) but had some effect on behavioral change. Educational level was found to significantly affect pretest scores (P less than .05), but was not a major factor in post-test scores. Certain topics presented (i.e., quality assurance and microbiology) resulted in significantly more behavioral changes than other categories. Behavioral changes and degree of cognitive change did not always correspond. Significant correlation was shown between attendance at wet workshops and the number of behavioral changes.

Behavior↗

Summary of findings of the School Health Education Evaluation: health promotion effectiveness, implementation, and costs.

A summary of important findings from the School Health Education Evaluation (SHEE) are reported. This paper focuses on the four principal outcome scores of Overall Knowledge, Attitude, Practice, and Program-Specific Knowledge. The relationship of those scores to measures of program implementation and cost also is described. A consistent pattern of findings emerged across the participating health instruction programs, suggesting that health instruction was effective in meeting program objectives as taught in the study classrooms, and that school health program effectiveness was strongly related to the level of implementation. Significant increases in Overall Knowledge and Program-Specific Knowledge were found for treatment classrooms when compared with control classrooms. Smaller, yet statistically significant, increases were found for attitudes and self-reported practices. Curriculum implementation measures were related to program effectiveness. A higher level of program implementation produced greater increases in all scores, but was most strongly related to improvement in attitudes and self-reported practices. Analysis of cost data revealed wide variation across the program. Implementation costs (those associated directly with the number of classroom instruction hours) accounted for more than 90% of the total costs and were, in turn, related to program effectiveness. Analysis of effects-to-classroom hours revealed that, while relatively few hours of instruction can produce large effects for knowledge, more hours are required for the development of attitude and practice effects, and that stable effects are established for all three domains at about 40-50 classroom hours.

Attitude to Health↗

Programming for articularion modification.

Within the past decade, principles and techniques of programmed instruction have been applied to the procedures of articulation modification in a number of preconstructed programs. The analysis of nine of these programs reveals that the majority of them are characterized by precisely stated objectives, ordered sequences of materials and procedures, clearly established criteria and rigorously controlled methods of reinforcement and recording of responses. Evaluation of the preconstructed programs raises some questions about the appropriateness of certain aspects of the technology to the process of articulation modification.

Evaluation Studies as Topic↗

Effectiveness of self-instruction for arthritis patient education.

Self-instruction is one means of providing patient education, allowing the health professional to teach a larger number of persons than with one-to-one or group instruction and at a lower cost. The purpose of this study was to examine the effects of self-instruction on learning, satisfaction with the teaching approach, and health status of persons with rheumatoid arthritis (RA). A control-group pretest-posttest design was used. Thirty subjects receiving care at a rheumatology clinic who met study criteria were randomly assigned to two groups: self-instruction and control. One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pretest as covariate, was used to examine the difference in learning between the self-instruction and control groups. There was a significant difference between the groups (P = 0.01). Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability. t-Test demonstrated no significant difference between the groups in health status. Significant correlations were found between subjects' test scores and selected variables.

Arthritis, Rheumatoid↗

Evaluation of a patient education program for chronic obstructive pulmonary disease.

An audiovisual instructional program for patients with chronic obstructive pulmonary disease was evaluated in 65 patients with this disease and 20 patients without lung disease. We found that the program was successful in increasing the factual knowledge about chronic obstructive pulmonary disease, with the attainment of mean scores of 88 and 95% on postteaching tests. Patients with varying educational backgrounds achieved similar gains in knowledge.

Adult↗