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At least 667 records · Page 37Linked to original sources
PubMed1998

Using multimedia virtual patients to enhance the clinical curriculum for medical students.

Changes in the environment in which clinical medical education takes place in the United States has profoundly affected the quality of the learning experience. A shift to out-patient based care, minimization of hospitalization time, and shrinking clinical revenues has changed the teaching hospital or "classroom" to a degree that we must develop innovative approaches to medical education. One solution is the Virtual Patient Project. Utilizing state-of-the-art computer-based multimedia technology, we are building a library of simulated patient encounters that will serve to fill some of the educational gaps that the current health care system has created. This project is part of a newly formed and unique organization, the Harvard Medical School-Beth Israel Deaconess Mount Auburn Institute for Education and Research (the Institute), which supports in-house educational design, production, and faculty time to create Virtual Patients. These problem-based clinical cases allow the medical student to evaluate a patient at initial presentation, order diagnostic tests, observe the outcome and obtain context-sensitive feedback through a computer program designed at the Institute. Multimedia technology and authoring programs have reached a level of sophistication to allow content experts (the teaching faculty) to design and create the majority of the program themselves and to allow students to adapt the program to their individual learning needs.

Computer Simulation↗
PubMed1984

A school-, hospital- and university-based adolescent pregnancy prevention program. A cooperative design for service and research.

Based upon prior service and research findings, a program was designed to reduce the incidence of early childbearing among a high-risk, inner-city junior and senior high school population. Combining a strong research design with medical and educational service in a school- and clinic-based program, the project team sought to develop a replicable model the individual components of which could be evaluated against baseline data collected from 1,709 male and female students before the program began. This paper reports levels of sexual activity, contraceptive use and pregnancy in the student population, using data from anonymous, self-administered questionnaires, and outlines the program's objectives and major features. It also suggests variables that can be used in the measurement of program impact.

Adolescent↗
PubMed2004

Campaigning for melanoma prevention: a model for a health education program.

Melanoma incidence and mortality rates are rising in many countries. This has led to the development of a variety of education programs designed for either early detection of melanoma when it can be easily cured, or prevention by taking a long term approach. Australia has been leading in these areas running programs such as Slip! Slop! Slap! for over 20 years. Data now show that attitudes towards sunlight and suntans have changed substantially. Sunburn rates have decreased as photoprotection has increased. Melanoma mortality rates are decreasing in the younger cohorts as a result of earlier detection of tumours that can be easily cured. Finally, incidence rates for melanoma in the younger cohorts are starting to level out and go down. Thus health education programs can be successful if they are well-designed and evaluated. In Australia we are now extending these programs beyond melanoma and into education programs on other common skin diseases such as acne, atopic dermatitis, warts, tinea, and a variety of other common conditions, depending on the level at which the education program is being delivered. This is the first time that coordinated public education programs on skin diseases, apart from skin cancer, have occurred anywhere in the world.

Australia↗
PubMed1991

The design of CAST (Computer-Aided Speechreading Training).

The underlying theoretical assumptions, goals, design, and implementation of a Computer-Aided Speechreading Training system (CAST) are described as a case study in program design. This computerized speechreading assessment and training system simulates face-to-face intervention and is designed to be one component of a comprehensive aural rehabilitation program for preretirement adults with acquired mild-to-moderate hearing loss. The interactive, automated course consists of eight training lessons, each focusing on a particular viseme that is practiced by a modified discourse tracking method using viseme-specific texts. Three basic speechreading skills are emphasized: visual speech perception, use of linguistic redundancy, and use of feedback between message sender and receiver. These skills are evaluated separately by means of CAST tracking rate, receiver strategy, and inferred error type. Four example case assessments are provided to illustrate the potential applications of CAST as a standardizable rehabilitative tool. An independent program evaluation is provided in a companion paper (Gagné, Dinon, & Parsons, 1991). Comparisons between CAST, face-to-face tracking procedures, and natural discourse are presented and discussed with reference to theoretical and clinical issues in speechreading and program evaluation.

Computer-Assisted Instruction↗
PubMed1996

VMD: visual molecular dynamics.

VMD is a molecular graphics program designed for the display and analysis of molecular assemblies, in particular biopolymers such as proteins and nucleic acids. VMD can simultaneously display any number of structures using a wide variety of rendering styles and coloring methods. Molecules are displayed as one or more "representations," in which each representation embodies a particular rendering method and coloring scheme for a selected subset of atoms. The atoms displayed in each representation are chosen using an extensive atom selection syntax, which includes Boolean operators and regular expressions. VMD provides a complete graphical user interface for program control, as well as a text interface using the Tcl embeddable parser to allow for complex scripts with variable substitution, control loops, and function calls. Full session logging is supported, which produces a VMD command script for later playback. High-resolution raster images of displayed molecules may be produced by generating input scripts for use by a number of photorealistic image-rendering applications. VMD has also been expressly designed with the ability to animate molecular dynamics (MD) simulation trajectories, imported either from files or from a direct connection to a running MD simulation. VMD is the visualization component of MDScope, a set of tools for interactive problem solving in structural biology, which also includes the parallel MD program NAMD, and the MDCOMM software used to connect the visualization and simulation programs. VMD is written in C++, using an object-oriented design; the program, including source code and extensive documentation, is freely available via anonymous ftp and through the World Wide Web.

Computer Graphics↗
PubMed1993

The Adult Day Health Care Evaluation Study--impact on VA programs.

The research study in Adult Day Health Care (ADHC) has had a fourfold impact on the Veterans Administration: 1) It defined the health care focus of ADHC and shaped consequent program design; 2) It forged a partnership between research and clinical staff in ADHC programmatic development; 3) It enhanced the perception of research in program development in long-term care; and 4) It provided VA with direction for program redesign to render ADHC more cost-effective. With careful planning, the program is expected to grow in the future as a part of VA's continuum of long-term care programs.

Adult↗
PubMed1998

Tools for immunization guideline knowledge maintenance. I. Automated generation of the logic "kernel" for immunization forecasting.

IMM/Def is a prototype computer program designed to facilitate the building and maintenance of a rule-based program which performs childhood immunization forecasting. An immunization forecasting program takes as input a child's immunization history and produces recommendations as to which vaccinations are due and which should be scheduled next. A significant amount of the knowledge required for immunization forecasting can be expressed in tabular form, including the parameters that indicate the minimum age when each dose may be given and the minimum intervals between doses. The choice of which of these sets of parameters apply to a particular case depends upon additional clinical logic. To perform forecasting, this logic must be applied in three temporal contexts: (1) a dose is due now, (2) a dose is not yet due, and (3) a dose must be scheduled to follow a dose which is due now. Building and maintaining this logic by hand is a formidable challenge. IMM/Def demonstrates how this task can be simplified by first defining immunization "definition logic" which can be automatically translated into if-then rules for each of the three contexts. The approach has been applied successfully to the six childhood vaccination series which are routinely administered. A key advantage is that IMM/Def allows one to have two specifications of the logic that can be examined independently and that can be cross-checked to help assure completeness, consistency, and accuracy of the logic. The paper describes how IMM/Def performs its translation and discusses several design issues and lessons learned.

Child↗
PubMed1993

Thirty-month evaluation of a popular very-low-calorie diet program.

OBJECTIVE: To analyze weight maintenance, cost, and predictors of weight maintenance in a formula-based very-low-calorie diet program. DESIGN AND SETTING: Consecutive sample of patients evaluated at 30 months after program entry at a community hospital in Orange Park, Fla. PATIENTS: Consecutive sample of 306 patients who entered a very-low-calorie diet program. Of these, 255 met inclusion criteria. INTERVENTION: Patients entered a 26-week very-low-calorie diet program. At 30 months after program entry, questionnaires were mailed. Data were collected via telephone interview, as needed. MAIN OUTCOME MEASURES: Initial and maintained weight loss, and association of weight loss to the following factors: insurance coverage, continued exercising, weeks attended, exit weight in relation to ideal weight, and cost per kilogram of weight loss. RESULTS: Medically significant weight loss of 10% was initially achieved by 90% of patients and maintained by 33%. The average initial weight loss was 21.4 kg and the maintained weight loss was 6.5 kg for all patients. For those who remained in the program 19 weeks (61%), the initial weight loss was 25.6 kg and the maintained weight loss was 9.2 kg. Exercisers maintained more than twice as much weight loss as nonexercisers. Men lost a larger percentage of weight (22% vs 19%) and maintained more of that loss (29.5% vs 8.3%). Maintenance was not associated with insurance coverage and at how close patients came to achieving ideal weight. The cost was $396 per kilogram of weight loss maintained. An improved sense of well-being was expressed by 71% of patients. CONCLUSIONS: Very-low-calorie diet programs can be effective in maintaining a medically significant weight loss in some patients at 30 months after program entry. Longer attendance and regular exercise help weight maintenance. The high costs and rate of weight regain indicate the need to find a more affordable and effective strategy for weight loss and maintenance.

Adult↗
PubMed1997

Medical students act as Big Brothers/Big Sisters to support human immunodeficiency virus-infected children's psychosocial needs.

OBJECTIVE: To address the special psychosocial and emotional needs and concerns of human immunodeficiency virus-infected children through a medical student-based Big Brother/Big Sister program. DESIGN: A telephone survey of 9 medical students who participated in the program in the last 4 years was undertaken to assess their experiences and feelings about the program. RESULTS: The experiences resulting from participation in the program were unanimously positive. The medical students stated that in no other medical setting were they able to develop a better understanding of the feelings and emotions of living with a terminal illness. The volunteers also believed that the program increased the benefits for the child and the medical student. CONCLUSIONS: Initial evaluation of the Big Brother/Big Sister program for human immunodeficiency virus-infected children suggests that it helped establish a strong, supportive relationship between the affected child and the medical student. A modified program in other medical schools may help to serve many other communities affected by the human immunodeficiency virus epidemic.

Adult↗
PubMed2000

National survey of internal medicine residency program directors regarding problem residents.

CONTEXT: Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. A problem resident is defined by the American Board of Internal Medicine as "a trainee who demonstrates a significant enough problem that requires intervention by someone of authority." Data are sparse regarding identification and management of such residents. OBJECTIVE: To gain more understanding of the prevalence, identification, management, and prevention of problem residents within US internal medicine residency programs. DESIGN, SETTING, AND PARTICIPANTS: Mailed survey of all 404 internal medicine residency program directors in the United States in October 1999, of whom 298 (74%) responded. MAIN OUTCOME MEASURES: Prevalence of problem residents; type of problems encountered; factors associated with identification and management of problem residents. RESULTS: The mean point prevalence of problem residents during academic year 1998-1999 was 6.9% (SD, 5.7%; range, 0%-39%), and 94% of programs had problem residents. The most frequently reported difficulties of problem residents were insufficient medical knowledge (48%), poor clinical judgment (44%), and inefficient use of time (44%). Stressors and depression were the most frequently identified underlying problems (42% and 24%, respectively). The most frequent processes by which problem residents were discovered included direct observation (82%) and critical incidents (59%). Chief residents and attending physicians most frequently identified problem residents (84% and 76%, respectively); problem residents rarely identified themselves (2%). Many program directors believed that residents who are from an underrepresented minority, are international medical graduates, or are older than 35 years are at increased risk of being identified as a problem resident (P<.05). Program directors believed that frequent feedback sessions (65%) and an assigned mentor for structured supervision (53%) were the most helpful interventions. CONCLUSION: Nearly all internal medicine residency programs in this sample had problem residents, whose presenting characteristics and underlying issues were diverse and complex. JAMA. 2000;284:1099-1104

Administrative Personnel↗
PubMed2001

Effectiveness of antidepressant pharmacotherapy: the impact of medication compliance and patient education.

This study was designed to investigate the impact of a time-phased patient education program (RHYTHMS) on medication compliance and treatment outcomes of primary care patients diagnosed with major depression and started on antidepressant pharmacotherapy. Two hundred forty-six depressed patients, diagnosed and treated at one of three outpatient clinics affiliated with the Kaiser-Permanente Northwest Region (KPNW) healthcare system, were randomly assigned to either receive or not receive (usual care) the educational materials by mail. Depression severity and functional impairment affecting patients' quality of life were assessed at baseline and 4, 12, and 30 weeks later. Self-reported impressions of improvement and patient satisfaction with treatment were also assessed at follow-up. Clinical assessment data were obtained using an interactive voice response (IVR) system. Study subjects were compensated $5, $10, $15, and $25 for completing each assessment (Baseline to Week 30, respectively). Upon study completion, prescription fill data of the subjects were extracted from the KPNW Pharmacy System for analysis of medication compliance. Most of the study subjects (63.5%) responded to the pharmacotherapy treatment by study end-point. Few statistically significant differences in either treatment outcomes or duration of medication compliance were found between the treatment groups, and significant differences found were of fairly small magnitude. Patients not receiving the educational materials initially exhibited a more positive response to treatment (Week 4), but this difference did not persist at later follow-ups and was associated with significantly higher relapse rates. A strong time-dose relationship was evident between the duration of the initial treatment episode and treatment outcomes at follow-up, but randomized treatment assignment did not influence the duration of initial medication compliance. Educational programs designed to encourage depressed patients to obtain adequate pharmacotherapy likely provide medical benefits. Such benefits appear to be relatively subtle and methodological differences between studies contribute to inconsistent conclusions concerning observed benefits. The intent of providing time-phased educational materials to patients is to maximize the relevance of such information by synchronizing it with typical recovery processes and issues. This study suggests that additional efforts at engaging patients earlier after the initiation of treatment might be of most benefit.

Adult↗
PubMed1976

Towards the simulation of clinical cognition. Taking a present illness by computer.

Remarkably little is known about the cognitive processes which are employed in the solution of clinical problems. This paucity of information is probably accounted for in large part by the lack of suitable analytic tools for the study of the physician's thought processes. Here we report on the use of the computer as a laboratory for the study of clinical cognition. Our experimental approach has consisted of several elements. First, cognitive insights gained from the study of clinicians' behavior were used to develop a computer program designed to take the present illness of a patient with edema. The program was then tested with a series of prototypical cases, and the present illnesses generated by the computer were compared to those taken by the clinicians in our group. Discrepant behavior on the part of the program was taken as a stimulus for further refinement of the evolving cognitive theory of the present illness. Corresponding refinements were made in the program, and the process of testing and revision was continued until the program's behavior closely resembled that of the clinicians. The advances in computer science that made this effort possible include "goal-directed" programming, pattern-matching and a large associative memory, all of which are products of research in the field known as "artificial intelligence". The information used by the program is organized in a highly connected set of associations which is used to guide such activities as checking the validity of facts, generating and testing hypotheses, and constructing a coherent picture of the patient. As the program pursues its interrelated goals of information gathering and diagnosis, it uses knowledge of diseases and pathophysiology, as well as "common sense", to dynamically assemble many small problem-solving strategies into an integrated history-taking process. We suggest that the present experimental approach will facilitate accomplishment of the long-term goal of disseminating clinical expertise via the computer.

Computers↗
PubMed2002

Inclusion of heterozygotes for cystic fibrosis in the egg donor pool.

OBJECTIVE: To describe and discuss our experience with cystic fibrosis (CF) carrier testing in a donor egg program. DESIGN: Retrospective review. SETTING: Community hospital-based assisted reproductive technology (ART) program. PATIENT(S): Forty anonymous white oocyte donor applicants. INTERVENTION(S): Testing with a DNA mutation analysis panel. MAIN OUTCOME MEASURE(S): Frequency of heterozygotes for CF mutation among the donor applicants and the likelihood of carriers and noncarriers being selected by recipients. RESULT(S): Five of 40 egg donor applicants (12.5%) were found to be heterozygous for a CF mutation; 35 women (87.5%) tested negative. Two of the five CF carriers (40.0%) were selected by five recipient couples and underwent four donation cycles after the recipients' male partners tested negative. Twenty-nine of the 35 noncarrier donors (82.9%) were matched and underwent 81 egg donation cycles. The likelihood of being selected was lower for CF carriers than for noncarriers. CONCLUSION(S): Our experience strongly supports the recommendation of routine CF testing of prospective white egg donors. Whereas heterozygosity lowers the probability of a donor being matched, it need not exclude her from the donor pool provided the recipient's partner is not a carrier. Empowering recipients to choose their own donors, focused patient education, and genetic counseling with precise determination of residual risk are important prerequisites for inclusion of CF carriers.

California↗
PubMed1998

Effect of evaluator and resident gender on the American Board of Internal Medicine evaluation scores.

OBJECTIVE: To examine the effects of resident and attending physician gender on the evaluation of residents in an internal medicine training program. DESIGN: Cross-sectional study. SETTING: Large urban academic internal medicine residency program. PARTICIPANTS: During their first 2 years of training, 132 residents (85 men, 47 women) received a total of 974 evaluations from 255 attending physicians (203 men, 52 women) from 1989 to 1995. MEASUREMENTS: The primary measurements were the numerical portions of the American Board of Internal Medicine evaluation form. Separate analyses were performed for each of the nine evaluation dimensions graded on a scale of 1 to 9. The primary outcome was the difference in the average scores received by each resident from male versus female attending physicians. RESULTS: Compared with female trainees, male residents received significantly higher scores from male attending physicians than from female attending physicians in six of the nine dimensions: clinical judgment, history, procedures, relationships, medical care, and overall. Similar trends, not reaching conventional levels of statistical significance, were observed in the other three categories: medical knowledge, physical exam, and attitude. These differences ranged from 0.24 to 0.60 points, and were primarily due to higher grading of male residents by male attending physicians than by female attending physicians. CONCLUSIONS: In one academic training program, we found a significant interaction in the grading process between the gender of internal medicine residents and the gender of their attending evaluators. This study raises the possibility that subtle aspects of gender bias may exist in medical training programs.

Bias↗
PubMed2001

Assessment of body composition change in a community-based weight management program.

OBJECTIVE: The purpose of this study was to validate the use of the leg-to-leg bioelectrical impedance analysis (BIA) system in assessing change in body composition over 32 weeks in overweight and obese women participating in a community weight management program. DESIGN: Intervention, with subjects prescribed an energy-restriction diet and exercise program for 32 weeks and body composition measured pre-study and after 12 and 32 weeks. SUBJECTS AND SETTING: Overweight and obese premenopausal women (n=201) with no overt disease were recruited at six sites into community-based weight loss programs. One hundred and twenty-four women completed all aspects of the study. INTERVENTION: Energy intake was set at 0.8 x resting metabolic rate (RMR) for weeks 1 through 12, 1.0 x RMR for weeks 13 through 20 and 1.2 x RMR for weeks 21 through 32. Energy intake was based on a food exchange table, with the number of food exchanges adjusted to encourage a percent distribution of 55% carbohydrate, 30% fat and 15% protein. Subjects increased their daily walking distance by 3.2 km above pre-study levels. MEASURES OF OUTCOME: Underwater weighing, seven skinfolds, and leg-to-leg BIA tests were used to assess body composition. RESULTS: A 3 x 3 repeated measures ANOVA revealed no significant difference in detecting change in FFM at 12 and 32 weeks among underwater weighing, BIA and skinfold, (F(4,492)=1.73, p=0.141) (decrease in FFM of 1.0+/-3.3 kg, 1.7+/-2.2 kg, and 1.4+/-3.3 kg respectively, 32 weeks). CONCLUSIONS: The leg-to-leg BIA system provides a valid measure of body composition change in overweight premenopausal women during a 32-week community-based weight loss program.

Adipose Tissue↗
PubMed2003

Conformational changes of G protein-coupled receptors during their activation by agonist binding.

The superfamily of G protein-coupled receptors (GPCRs) is the largest and most diverse group of transmembrane proteins involved in signal transduction. Many of the over 1000 human GPCRs represent important pharmaceutical targets. However, despite high interest in this receptor family, no high-resolution structure of a human GPCR has been resolved yet. This is mainly due to difficulties in obtaining large quantities of pure and active protein. Until now, only a high-resolution x-ray structure of an inactive state of bovine rhodopsin is available. Since no structure of an active state has been solved, information of the GPCR activation process can be gained only by biophysical techniques. In this review, we first describe what is known about the ground state of GPCRs to then address questions about the nature of the conformational changes taking place during receptor activation and the mechanism controlling the transition from the resting to the active state. Finally, we will also address the question to what extent information about the three-dimensional GPCR structure can be included into pharmaceutical drug design programs.

Animals↗
PubMed1998

When science and politics listen to each other: good prospects from a new school breakfast program in Peru.

This article provides an overview of a school breakfast program implemented in 1993 in the Peruvian Andes. The program, designed by the Instituto de Investigación Nutricional in Lima and supported by the government of Peru, constitutes a clear departure from previous school feeding programs, which were heavily politicized and poorly documented. From the program's inception, nutritionists, managers, and social scientists have collaborated to produce a sound nutritional design, efficient distribution mechanisms, and effective evaluation methods. During the program's first year, controlled evaluations conducted in several Andean regions documented improved dietary intake and a significant decline in the prevalence of anemia. An educational evaluation also found improved verbal skills, higher school attendance, and lower dropout rates among recipients of the school breakfast. The results have prompted the Peruvian government to continue supporting the program, thus setting a new standard for the effective management of social expenditure in the context of economic adjustment.

Anemia↗
PubMed1992

North of Market: Older Women's Alcohol Outreach Program.

The North of Market Older Women's Alcohol Program is an innovative outreach program designed to assist isolated and impoverished alcohol-dependent older women. The program utilized service components focused on "building up" the clientele and developing support networks rather than the traditional approach of first "breaking down" an alcoholic's defense barriers. Sobriety (complete abstinence) was attained by 60% of the women for a minimum of 3 months (not necessarily consecutive).

Aged↗