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Review of effective advanced cardiac life support training using experiential learning.

AIMS AND OBJECTIVES: This paper examines issues of contention regarding current practices and suggests the application of the experiential theory of learning (incorporating reflective practice) to advanced cardiac life support (ACLS) training. BACKGROUND: The need for formalized training in cardiopulmonary resuscitation (CPR) and ACLS is well documented. However, the effectiveness of traditional training programmes has not been firmly established. The question still remains - how to best ensure transfer of learning enabling learners to apply classroom knowledge successfully in the clinical setting. It is argued that educators can no longer rely on traditional teaching methods and more effective learner-centred education techniques are required. METHOD: A review of available literature regarding ACLS training has been conducted for this discussion. DATA SOURCES AND SELECTION: MEDLINE, CINAHL, OVID, Expanded Academic and Proquest were searched using textwords. English-language articles related to CPR and ACLS practices and also experiential learning were reviewed. Additional references were also reviewed from the bibliographies and from citation searches on key articles. Articles related to CPR/ACLS and experiential learning practices published within the last 10 years were reviewed. RESULTS: There is evidence that past ACLS training programmes have proven inconsistent and inadequate, with numerous studies reporting trainees have poor retention; and, therefore, ineffective ACLS skills as a result. CONCLUSIONS: The reviewed literature demonstrates that the need for effective ACLS training is clear. Increasing numbers of critically ill patients in hospitals means that it has never been more important to ensure the competence of healthcare professionals. Training must give learners a chance to pull together all aspects of ACLS and the use of experiential learning has the potential to achieve this aim. RELEVANCE TO CLINICAL PRACTICE: It is argued that providing training designed and implemented using experimental learning enhances learning through critical thinking and reflection, and subsequently should improve ACLS outcomes.

Advanced Cardiac Life Support↗

Age-related effects of blocked and random practice schedules on learning a new technology.

Computer technology is pervasive in today's society. Issues of training must be investigated to ensure that older individuals are capable of interacting with such technology. In the present research a simulated automatic teller machine (ATM) served as a prototypical technology for which issues of training and transfer could be investigated. The focus of the study was on the potential benefits of a random practice schedule (wherein trial types are intermixed) relative to a blocked practice schedule (wherein trial types are grouped together). Both younger and older adults benefited from random practice for the acquisition of the ability to perform transactions on an ATM. Moreover, random practice was beneficial for both age groups in the transfer of learning to novel tasks on a novel ATM. These data have general implications for theories of training and specific implications for the development of training protocols for older adults and new technologies.

Adolescent↗

[X-ray combined with cytosine deaminase suicide gene therapy enhances killing of colorectal carcinoma cells in vitro].

OBJECTIVE: To study the effect of X-ray on gene transfer and the antitumoral effect of X-ray combined with suicide gene therapy on colorectal carcinoma cells. METHODS: Green fluorescent protein (GFP) was seen under fluorescent microscope. GFP gene was used for reporting gene to learn gene transfer efficiency and gene expressing time under the influence of radiation. G418 was used to select cytosine deaminase (CD) positive neoplasm cells and CD gene transfer efficiency was tested by cloning efficiency. Antitumoral effect of X-ray combined with CD and 5-FC on colorectal carcinoma cells was tested by MTT. RESULTS: 4 Gy radiation could improve supercoiled plasmid DNA transfer efficiency for about 2 - 4 times and 30 times for linearized plasmid DNA. The mean durations of GFP gene expression treated with 4 Gy radiation were 14 d for supercoiled plasmid and 21 and for linearized plasmid, while in control group, the time was 12 d. Middle-dose radiation combined with CD and 5-FC could kill 99 percent of colorectal carcinoma cells, while in the control group, 5-FC only killed 15 percent of colorectal carcinoma cells which were transduced with CD gene. CONCLUSIONS: X-Ray combined with suicide gene therapy may be used as a promising method for treating colorectal neoplasm.

Antimetabolites↗

Comparison of compound and cross-modal training on postoperative visual relearning of visual decorticate rats.

The effects of postoperative bimodal compound conditioning and cross-modal transfer of learning on behavior were compared by training rats prior to visual decortication to avoid shock with visual intensity cues. On Postop Day 6, rats were given avoidance training in one of three cue conditions: auditory intensity cues (cross-modal), paired auditory and visual cues (compound conditioning), or no cues (no-training control). On Postop Day 7 rats in the no-training control and the cross-modal transfer conditions were retrained with the visual discrimination while rats in the compound conditioning group were either retrained with the visual intensity cue or trained with the auditory intensity cue. Postoperative cross-modal transfer training enhanced visual relearning whereas bimodal compound conditioning interfered with relearning. However, compound conditioning facilitated subsequent auditory discrimination learning. These results support the notion of an injury-induced neurological bias that is increased after bimodal compound conditioning and reduced after cross-modal training. Potential implications for neurological rehabilitation are also discussed.

Acoustic Stimulation↗

Implementing guidelines and innovations in general practice: which interventions are effective?

BACKGROUND: It is crucial that research findings are implemented in general practice if high-quality care is to be achieved. Multifaceted interventions are usually assumed to be more effective than single interventions, but this hypothesis has yet to be tested for general practice care. This review evaluates the effectiveness of interventions in influencing the implementation of guidelines and adoption of innovations in general practice. A systematic literature study was carried out using MEDLINE searches for the period from January 1980 until June 1994, and 21 medical journals were searched manually. Randomized controlled trials and controlled before and after studies (with pre- and post-intervention measurements in all groups) were selected for the analysis. Clinical area, interventions used, methodological characteristics and effects on clinical behaviour were noted independently by two researchers using a standardized scoring form. Of 143 studies found, 61 were selected for the analysis, covering 86 intervention groups that could be compared with a control group without the intervention. Information transfer alone was effective in two out of 18 groups, whereas combinations of information transfer and learning through social influence or management support were effective in four out of eight and three out of seven groups respectively. Information linked to performance was effective in 10 out of 15 groups, but the combination of information transfer and information linked to performance was effective in only three out of 20 groups. Some, but not all, multifaceted interventions are effective in inducing change in general practice. Social influence and management support can improve the effectiveness of information transfer, but information linked to performance does not necessarily do so. The variation in the effectiveness of interventions needs further analysis.

Family Practice↗

Proportional and nonproportional transfer of movement sequences.

Two experiments were designed to determine participants' ability to transfer a learned movement sequence to new spatial locations. A 16-element dynamic arm movement sequence was used in both experiments. The task required participants to move a horizontal lever to sequentially projected targets. Experiment 1 included 2 groups. One group practised a pattern in which targets were located at 20, 40, 60, and 80 degrees from the start position (long sequence). The other group practised a pattern with targets at 20, 26.67, 60, and 80 degrees (mixed sequence). Both groups were tested 24 hours later on the long, mixed, and short sequence. The short sequence was considered a proportional transfer for the long acquisition group because all the amplitudes between targets were reduced by the same proportion. Nonproportional transfer occurred when the amplitudes between targets did not have the same proportions as those for their practice sequence (e.g., long sequence to mixed sequence or vice versa). The results indicated that participants could effectively transfer to new target configurations regardless of whether the transfer required proportional or nonproportional spatial changes to the movement pattern. Experiment 2 assessed the effects of extended practice on proportional and nonproportional spatial transfer. The data indicated that while participants can effectively transfer to both proportional and nonproportional spatial transfer conditions after 1 day of practice, they are only effective at transferring to proportional transfer conditions after 4 days of practice. The results are discussed in terms of the mechanism by which response sequences become increasingly specific over extended practice in an attempt to optimize movement production.

Analysis of Variance↗

Across the great divide: bridging the gap between understanding of toddlers' and older children's thinking.

Research on very young children's cognitive development differs greatly from research on cognitive development in older children. The differences include the questions that are asked, the methods that are used to address them, the measures that are employed to provide relevant evidence, and the level of detail at which children's knowledge is represented. The research approaches are so different that they create an impression that infants' and toddlers' thinking differs qualitatively from that of preschoolers and older children. This impression, however, may reflect differences in research approaches rather than differences in children's thinking. In the present study, we attempted to bridge this gap by applying to toddlers a type of process analysis that has proved fruitful in studies of older children. Overlapping waves theory, trial-by-trial strategy assessments, and microgenetic methods were used to analyze 1.5- and 2.5-year-olds' problem solving and learning. The results demonstrated that changes in toddlers' strategies could be assessed reliably on a trial-by-trial basis, that the changes followed the basic form predicted by the overlapping waves model, and that analyses of toddlers' strategies could tell us a great deal about both qualitative and quantitative aspects of their learning. A componential analysis of learning that previously had been applied to older children also proved useful for understanding toddlers' learning. The analysis specified that cognitive change frequently involves five components: acquisition of new strategies; strengthening of the strategies in their original context; improved mapping of strategies onto novel problems; increasingly refined choices among variants of the strategies; and increasingly skillful execution of the strategies. Independent measures of these components indicated that strategic development in toddlers involves improvements in all five components. Analyses of individual differences in learning showed that the effects of distal variables, such as age and sex, could be partially explained in terms of their influence on mastery of the components, but that the distal variables exercised additional direct effects as well. The process of learning in toddlers closely resembled that of older children in other ways as well. Like older children, toddlers use multiple strategies over the course of learning; their choices among strategies are quite adaptive from early on; their choices become progressively more adaptive as they gain experience with the task; they switch strategies not only from trial to trial but within a single trial; their transfer of learning from one problem to the next is primarily influenced by structural relations between problems but also is influenced by superficial features; they show utilization deficiencies early in learning that they gradually overcome; and they show individual differences in learning that fall into a few qualitatively distinct categories. Perhaps most striking, the 1.5- and 2.5-year-olds emerged as active learners, who continued to work out the lessons of previous instruction in the absence of further instruction. That is, they integrated the lessons of their own problem-solving efforts with the previous instruction in ways that magnified the initial effects of the instruction. Overall, the findings indicated that the gap can be bridged; that theories, methods, measures, and representations of knowledge typically used with older children can improve our understanding of toddlers' problem solving and learning as well.

Child Behavior↗

Multiple motor learning experiences enhance motor adaptability.

Traditional motor learning theory emphasizes that skill learning is specific to the context and task performed. Recent data suggest, however, that subjects exposed to a variety of motor learning paradigms may be able to acquire general, transferable knowledge about skill learning processes. I tested this idea by having subjects learn five different motor tasks, three that were similar to each other and two that were not related. A group of experimental subjects first performed a joystick-aiming task requiring adaptation to three different visuomotor rotations, with a return to the null conditions between each exposure. They then performed the same joystick-aiming task but had to adapt to a change in display gain instead of rotation. Lastly, the subjects used the joystick-aiming task to learn a repeating sequence of movements. Two groups of control subjects performed the same number of trials, but learned only the gain change or the movement sequence. Experimental subjects showed generalization of learning across the three visuomotor rotations. Experimental subjects also exhibited transfer of learning ability to the gain change and the movement sequence, resulting in faster learning than that seen in the control subjects. However, transient perturbations affected the movements of the experimental subjects to a greater extent than those of the control subjects. These data demonstrate that humans can acquire a general enhancement in motor skill learning capacity through experience, but it comes with a cost. Although movement becomes more adaptable following multiple learning experiences, it also becomes less stable to external perturbation.

Adaptation, Physiological↗

The concepts of 'sameness' and 'difference' in an insect.

Insects process and learn information flexibly to adapt to their environment. The honeybee Apis mellifera constitutes a traditional model for studying learning and memory at behavioural, cellular and molecular levels. Earlier studies focused on elementary associative and non-associative forms of learning determined by either olfactory conditioning of the proboscis extension reflex or the learning of visual stimuli in an operant context. However, research has indicated that bees are capable of cognitive performances that were thought to occur only in some vertebrate species. For example, honeybees can interpolate visual information, exhibit associative recall, categorize visual information and learn contextual information. Here we show that honeybees can form 'sameness' and 'difference' concepts. They learn to solve 'delayed matching-to-sample' tasks, in which they are required to respond to a matching stimulus, and 'delayed non-matching-to-sample' tasks, in which they are required to respond to a different stimulus; they can also transfer the learned rules to new stimuli of the same or a different sensory modality. Thus, not only can bees learn specific objects and their physical parameters, but they can also master abstract inter-relationships, such as sameness and difference.

Animals↗

Generalization from school to home with autistic children.

This investigation assessed the generalization of verbal behavior from school to home with three autistic boys. The study attempted to expand upon previous research by Handleman (1979) by analyzing the effects of single versus multiple trainers on generalization. By the use of a multiple-baseline design counterbalanced for treatment condition, the three youngsters were taught responses to common questions in two school settings and were probed to determine transfer of learning to their homes. All three children demonstrated greater generalization when they received training at varied locations as opposed to instruction in a single setting. Results of the study suggest that manipulating the school environment to more closely simulate home conditions may facilitate transfer of treatment gains to the natural setting.

Autistic Disorder↗

Does stress training generalize to novel settings?

Many high-stress task environments are complex and dynamic, and it is often difficult during training to anticipate the exact conditions that may be encountered in these settings. We conducted an empirical study to examine whether the positive effects of stress training that addressed one specific type of stressor and task would remain when trainees performed under a novel stressor or performed a novel task. Participants performed a laboratory task under stress conditions. Measures of task performance and self-reported stress were obtained at three performance trials: (a) prior to stress training, (b) after a stress training intervention targeted to that specific task environment, and (c) under novel stressor/task conditions. Results indicated that the beneficial effects of stress training were retained when participants performed under a novel stressor and performed a novel task. We discuss the implications of this study with regard to their application in the design of stress training and the transfer of learning to complex, dynamic task environments.

Adolescent↗

Unilateral storage of monocular engram in day-old chick.

Efficient interocular transfer of a one-trial passive avoidance task by the day-old domestic chicken, for whom the optic nerves decussate completely, raised the question of whether memory for the task was held in one or both sides of the forebrain. Intracranial injection of ouabain or cycloheximide to the trained hemisphere immediately after learning suppressed avoidance behaviour learned monocularly, while injection to the untrained side did not. Memory for the task was established in the side of the brain served by the eye used in learning. Interocular transfer was therefore achieved by the untrained hemisphere borrowing information from the other side's store. The presence of memories in the trained side was not sufficient to establish memory in the naive side.

Age Factors↗

Improving productivity in the dental practice: a starting point.

Materials, patients, and information flow through the business, but all must pass through the dentist's hands. Thus they are the constraint within the dental practice. Dentists therefore must pay close attention to streamlining and simplifying clinical processes, delegating administration wherever possible, and outsourcing technical services. It is recommended that techniques such as four-handed dentistry, tray-batching of instruments, computerisation of records, and efficient scheduling of appointments, be adopted to improve through-put. Measures used to assess decision-making and performance-evaluation include the use of a computerised cashbook, appointment-book analysis, comparison of actual versus budgeted income and expenditure, net profit, and return on investment. These measurements are, however, an adjunct to intuition and experience. There must be an awareness that, if patient perceptions fall short of their expectations because of the improvement in clinical efficiencies, such optimisation would be to the detriment of the practice. To achieve on-going improvement, the dentist must create a learning environment where motivated team members are willing to engage in systematic problem solving, experimentation, and the learning and transfer of knowledge.

Appointments and Schedules↗

Effects of imitation on language comprehension and transfer to production in children with mental retardation.

This study investigated the effects of verbal imitation on the comprehension of novel object-location responses and subsequent transfer of these responses to production. A matrix training procedure was used to teach 2 children with moderate mental retardation syntactic rules for combining known and unknown words into two-word utterances. An alternating treatments design was used with two conditions: receptive teaching with imitation of the target phrase and no imitation of the phrase. Findings suggested that the use of imitation facilitated both generalized receptive learning and transfer to production in both subjects.

Child↗