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PubMed1998

High rates of discitis following surgery for prolapsed intervertebral discs at a hospital in Pakistan.

OBJECTIVES: To confirm the presence of an outbreak of postoperative infections following laminectomy and to determine the infection rate after interventions were instituted. DESIGN: Retrospective cohort study. Medical records were reviewed, personnel interviewed, and premises examined. SETTING: Surgical unit of hospital A in Pakistan. SUBJECTS: Patients who had surgical laminectomy between January 1993 and July 1994. INTERVENTION: Instructive program for nursing and medical staff in December 1993. RESULTS: From January to December 1993, 6 (15%) of 41 laminectomy patients developed postoperative discitis. The risk of discitis varied significantly by surgeon (P = .016); patients who had one particular surgeon, surgeon A, were nine times more likely to develop postoperative infections than patients who did not have surgeon A. Patients were not consistently cleaned or shaved before coming to the operating room, and personnel moved back and forth between the operation theater and other parts of the hospital without changing their gowns or slippers. After the instructional intervention, between January and July 1994, 2 (6%) of 31 laminectomy patients developed postoperative discitis, a rate not significantly lower than in the preceding 12 months (P = .45). Overall, from January 1993 through July 1994, female patients were more likely to develop discitis than males (31% vs 7%; relative risk, 4.4; 95% confidence interval, 1.3-15.6; P < .032). CONCLUSION: Endemic conditions require that laminectomy at hospital A be limited to those situations where the benefits of the surgery exceed the considerable risk of postoperative discitis.

Cohort Studies↗
PubMed1988

Training self-advocacy skills to adults with mild handicaps.

We developed and empirically evaluated an instructional program to teach self-advocacy skills to eight young adults with mild handicaps. Participants were taught to discriminate whether or not possible violations of legal rights occurred in socially validated scenarios and, if so, to role-play how to redress rights violations. Experimental control was demonstrated with a multiple probe design across four general legal rights categories for the discrimination component of training, and a multiple probe across groups of subjects for the redressing legal rights component of training. Participants' behavior was probed in simulations and deceptions of legal rights violations in natural settings. There were marked increases in dependent measures after instruction. Difficulties in assessing generalization and maintenance of low-rate behaviors and suggestions for future research are presented.

Adult↗
PubMed1993

A comparison of methods for alcohol and marijuana anticipatory guidance with adolescents.

The purpose of this study was to compare adolescents' knowledge of alcohol after receiving either a computer-assisted instruction program or physician-delivered anticipatory guidance or no intervention. In addition, adolescents' satisfaction was compared between intervention groups. A total of 89 adolescents attending a general medical clinic were randomly assigned to one of three conditions. The participants were from low-to-middle income families, and the mean age was 15.5 years. A two-way analysis of variance found significant main effects for both group and sex. Those adolescents in both intervention groups were significantly more knowledgeable, and males demonstrated the highest knowledge scores. There was a significant interaction between group and sex, with females more satisfied with the computer-assisted instruction as compared to males who preferred anticipatory guidance. These data suggest that the use of computer technology during a well-adolescent health visit is effective and efficient in transmitting drug-related information.

Adolescent↗
PubMed1993

Effects of self-modeling on self-efficacy and balance beam performance.

The purpose of this investigation was to assess the effect of self-modeling on self-efficacy and performance of balance beam routines. Subjects were intermediate-level female gymnasts who were randomly assigned to one of two groups, a self-modeling or a control group. For the self-modeling group, self-modeling videotapes were made of each subject performing her balance beam routine. During a 6-wk. period, self-modeling group subjects viewed the videotape of themselves three times a week prior to practice. During this time, the control group and self-modeling group participated in their normal instructional program. All subjects completed self-efficacy inventories and balance beam skill tests at four intervals, a pretest, a 2-wk. test, a 4-wk. test, and a 6-wk. posttest. Although no significant differences in ratings of self-efficacy or balance beam performance between the groups were found, the correlation between subjects' self-rated performance scores and actual performance scores for the self-modeling group was significant (r = .92). This correlation was not significant for the control group (r = .02). This significant correlation suggests that self-modeling may enhance performers' ability to assess their own performance realistically, improving their understanding and use of instructional feedback to enhance performance.

Adolescent↗
PubMed2000

Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points.

BACKGROUND AND PURPOSE: Myofascial trigger points (TPs) are found among patients who have neck and upper back pain. The purpose of this study was to determine the effectiveness of a home program of ischemic pressure followed by sustained stretching for the treatment of myofascial TPs. SUBJECTS: Forty adults (17 male, 23 female), aged 23 to 58 years (mean=30.6, SD=9.3), with one or more TPs in the neck or upper back participated in this study. METHODS: Subjects were randomly divided into 2 groups receiving a 5-day home program of either ischemic pressure followed by general sustained stretching of the neck and upper back musculature or a control treatment of active range of motion. Measurements were obtained before the subjects received the home program instruction and on the third day after they discontinued treatment. Trigger point sensitivity was measured with a pressure algometer as pressure pain threshold (PPT). Average pain intensity for a 24-hour period was scored on a visual analog scale (VAS). Subjects also reported the percentage of time in pain over a 24-hour period. A multivariate analysis of covariance, with the pretests as the covariates, was performed and followed by 3 analyses of covariance, 1 for each variable. RESULTS Differences were found between the treatment and control groups for VAS scores and PPT. No difference was found between the groups for percentage of time in pain. CONCLUSION AND DISCUSSION: A home program, consisting of ischemic pressure and sustained stretching, was shown to be effective in reducing TP sensitivity and pain intensity in individuals with neck and upper back pain. The results of this study indicate that clinicians can treat myofascial TPs through monitoring of a home program of ischemic pressure and stretching.

Adult↗
PubMedDate not supplied

Mathematics education and students with learning disabilities: introduction to the special series.

The prevalence of students with mathematics learning disabilities has triggered an interest among special education researchers and practitioners in developing an understanding of the needs of this group of students, and in identifying effective instructional programming to foster their mathematical performance during the school years and into adulthood. Research into the characteristics of students with mathematics learning disabilities is being approached from different perspectives, including developmental, neurological and neuropsychological, and educational. This diversity helps us develop a broader understanding of students' learning needs and difficulties. Special education assessment practices encompass a variety of approaches, including norm-referenced, criterion-referenced, and nonstandardized procedures, depending on the specific assessment questions professionals seek to answer. Students' mathematical knowledge and conceptual understanding must be examined to determine their strengths and weaknesses, curriculum-based progress, and use of cognitive strategies to arrive at mathematical solutions. Research findings have identified empirically validated interventions for teaching mathematics curricula to students with mathematics learning disabilities. Research studies have been grounded in behavioral theory and cognitive psychology, with an emergent interest in the constructivist approach. Although research studies have focused primarily on computational performance, more work is being conducted in the areas of story-problem solving and technology. These areas as well as other math curricular skills require further study. Additionally, the needs of adults with math LD have spurred educators to examine the elementary and secondary math curricula and determine ways to infuse them with life skills instruction accordingly. As the field of mathematics special education continues to evolve, special educators must remain cognizant of the developments in and influences on the field of mathematics education. Reform efforts have shaped the field significantly since the 1950s, contributing to the curriculum offered in mathematics textbooks and the pedagogical practices taught in higher education courses. Mathematics educators continue to search for a better understanding of how children learn mathematics; this process is shaped by the prevailing theoretical orientations and research methodologies. This special series in mathematics special education provides readers with information about the characteristics of students with mathematics learning disabilities, assessment procedures, mathematics programming, teacher preparation, and future directions for the field. The series originated as a result of discussions with Dr. Lee Wiederholt and Dr. Judith K. Voress, who saw a need for the compilation of recent research and best practices in mathematics special education. I thank them for their support of and thoughtful insights about the development of this series. I also appreciate the support of Dr. George Hynd and his editorial assistant, Kathryn Black, in finalizing the details for publication. Finally, I am most appreciative of the authors' contributions to this series; their work continues to significantly influence the development of the field of mathematics special education and programming for students with mathematics learning disabilities.

Adolescent↗
PubMed1993

Computer-assisted instruction in emergency ophthalmological care.

The use of computer-assisted instruction in medical education has increased steadily in the last decade with the availability of personal computers. Many computer-assisted instruction programs train the user to handle various forms of disease or injury. Our intent was to provide medical students with more experience in managing ophthalmological emergencies, and we therefore designed a computerized teaching system for emergency ophthalmological care. The system makes it possible for inexperienced students to develop these skills, without jeopardizing the patient's health during training. Colour illustrations help teach the student to judge clinical signs. First, two classes of altogether 35 students used the teaching system. The students were shown to have gained significantly better knowledge of conditions which had been presented to them by the computerized teaching, than of conditions which had not been presented in this way. After having used the system, two other classes were asked about their attitudes towards this teaching modality. A majority regarded it as a valuable or very valuable addition to traditional methods of teaching. This type of instruction system may improve the quality of ophthalmic teaching without increasing teaching staff requirements.

Attitude of Health Personnel↗
PubMed2002

Using a decade of data on medical student computer literacy for strategic planning.

PURPOSE: From 1991 through 2000, incoming medical students (M-Is) at the School of Medicine at Virginia Commonwealth University have been surveyed with a written questionnaire on their computer literacy. The survey's purpose is to learn the students' levels of knowledge, skill, and experience with computer technology to guide instructional services and facilities. METHODOLOGY: The questionnaire was administered during M-I orientation or mailed to students' homes after matriculation. It evolved from sixteen questions in 1991 to twenty-three questions in 2000, with fifteen questions common to all. RESULTS: The average survey response rate was 81% from an average of 177 students. Six major changes were introduced based on information collected from the surveys and advances in technology: production of CD-ROMs distributed to students containing required computer-based instructional programs, delivery of evaluation instruments to students via the Internet, modification of the lab to a mostly PC-based environment, development of an electronic curriculum Website, development of computerized examinations for medical students to prepare them for the computerized national board examinations, and initiation of a personal digital assistant (PDA) project for students to evaluate PDAs' usefulness in clinical settings. CONCLUSION: The computer literacy survey provides a snapshot of students' past and present use of technology and guidance for the development of services and facilities.

Computer Literacy↗
PubMed1996

The interaction of syntactic competence and vocabulary during reading by deaf students.

This research studied whether deaf students' component reading processes may interact with other in a competitive manner. Vocabulary and syntax, two processes known to directly and adversely affect the comprehension of many deaf readers, were studied to determine if they may influence each other, affecting the contribution that each one makes separately to reading comprehension. Multiple regression analyses were conducted on predictor variables that included measures of vocabulary and syntactic competence, as well as a variable summarizing the interaction of vocabulary and syntax. The criterion variable was a composite of comprehension performance on a cloze procedure and on a more traditional reading test. Results were cross-validated by separate regressions on data samples from three populations of profoundly deaf readers: 100 adolescents from oral school programs, 113 adolescents from total communication programs, and 211 students entering a postsecondary institution that used total communication. In each regression, the Vocabulary &times; Syntax interaction variable emerged as the most critical of the three predictors. Further analyses of the interaction revealed that among subjects in the highest quartile of syntactic competence, the correlation between vocabulary competence and reading was significantly greater than it was in the lower three syntax quartiles. In contrast, the relationship between syntax and comprehension remained stable across all four quartiles of vocabulary competence. This suggests that unless deaf readers have achieved a reasonable level of syntactic competence it may be difficult for them to capitalize fully on their vocabulary knowledge. The finding that limitations in one reading process can interfere with the application of another is consistent with the theory of Capacity Constrained Comprehension of M. Just and P. Carpenter (1992). Because syntax can exert both a direct and an indirect influence on comprehension, it should be an important focus in instructional programs.

Journal Article↗
PubMed2003

[Mothers know best].

BACKGROUND: Nutrition has a critical effect on the infant's brain development during pregnancy and the first 18 months of life. Inappropriate diet can cause infant mortality. Research has shown that medical professionals lack the required knowledge regarding nutrition and that there are no suitable instructional programs on this subject for them. OBJECTIVES: To examine the knowledge and attitudes of gynecologists, pediatricians and nurses who work in mother and child health clinics of "Maccabi" Healthcare Services in Israel concerning infants' and pregnant women's nutrition and to compare these findings to the public's general knowledge. METHODS: The study population consisted of gynecologists and pediatricians who work in "Maccabi" Healthcare Services throughout the country and all the nurses at the family healthy clinics. In addition, a sample of mothers attending six different family health clinics was recruited. Four structured questionnaires were created for each group in the study population (gynecologist, pediatricians, nurses and mothers). The questionnaires included questions that evaluated the knowledge and attitudes toward infants' nutrition. RESULTS: The mothers showed high level of knowledge (67% correctly answered 3 or more of the 4 questions, compared to 51% of nurses, 27% or pediatricians, 38% of gynecologists, p < 0.01). The physicians showed a higher level of knowledge in the questions related to their specialty. When asked about the effect of nutritional instruction on the infants' health, the pediatricians answered correctly at a higher rate than the other study groups (74% of pediatricians answered correctly 3 out of 3 questions, compared to 60% of gynecologists, 47% nurses, p < 0.01). Professionals believe that they can train mothers on nutritional issues. CONCLUSIONS: Appointing a nutritionist to the mother and child clinics should be considered, as the professional caregivers of pregnant women and infants were found to be lacking in sufficient knowledge in certain aspects of nutrition for these populations.

Female↗
PubMed2005

Relative effectiveness of worker safety and health training methods.

OBJECTIVES: We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries). METHODS: Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training). RESULTS: As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements. CONCLUSIONS: Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Humans↗
PubMed2004

Video breast health kits: testing a cancer education innovation in older high-risk populations.

BACKGROUND: The Breast Health Kit for Women Over 60 project was a 3-year study funded by NCI to develop and field test video self-instruction programs designed to increase breast cancer screening for older black and white women. METHODS: Impact of kit use on knowledge about breast cancer risk/screening, breast self-examination (BSE) proficiency, and mammography use was assessed with 439 women in Massachusetts and Georgia. BSE proficiency was measured by demonstration of inspection/palpation skills and detection of lumps in a simulation model. Analysis with a noncompliant mammography user subsample (N = 143) tested the effectiveness of kit use on mammography screening. The sample was predominantly black (76%) with mean age of 71.6 years and mean education of 10.6 years. RESULTS: Analyses of covariance revealed that women who used the kits had significantly better knowledge about breast cancer risk/screening (F = 23.6, P < or =.001) and were more proficient at BSE than kit nonusers as measured by both skills (F = 47.9, P < or =.001) and detection of lumps (F = 36.8, P < or =.001). No significant differences were found between subsample groups in receiving a poststudy mammogram, but a trend toward having mammograms was noted in the subsample who used the kits (chi(2) = 1.7, P < =.09). CONCLUSIONS: Age and ethnically sensitive self-instructional breast health kits were found to be effective in increasing knowledge about breast cancer risk and BSE proficiency in older women. Future research is needed to explore how other strategies combined with kit use can assure mammography compliance in this population.

Age Factors↗
PubMed2004

Faculty members acceptance of web-based education.

OBJECTIVE: To assess the effect of the WebCLS project on clinical laboratory science (CLS) faculty members including improvement of participating CLS educators' skills in designing, developing, delivering, and evaluating interactive, Web-based instructional programs. DESIGN: A survey was developed that included 24 statements related to respondents' perceptions of how their participation in the project: a) improved their course development skills, b) developed their evaluation skills, and c) affected them personally. Four open-ended questions asked the respondents to comment on the project's effect on their traditional course development skills, plans for future usage of WebCLS-produced course materials, the most beneficial outcomes of their participation, any problems that participation in the project caused them, and any unexpected positive or negative outcomes that could be attributed to their participation. SETTING: The survey was sent to 27 individuals who had participated in the project. RESULTS: Twenty-four participants completed the survey for an 89% response rate. The mean response was 6.82 (S.D. 2.32) with sixteen respondents' (73%) reporting participation at the mean or above. CONCLUSION: Overall, the WebCLS project accomplished its objective of improving CLS educators' Web-based, distance education course development skills. One of the most positive outcomes of the project was the survey respondents' belief that their participation in the project expanded their contacts with colleagues in CLS education as well as with instructional design experts, computer programmers, and other technical support personnel. Furthermore, this outcome prompted several participating faculty to report that this enhanced collegial relationship will sustain their interest in curriculum development over time.

Attitude of Health Personnel↗
PubMed1997

Clinical trials of interactive computerized patient education: implications for family practice.

A systematic review of randomized clinical trials was conducted to evaluate the acceptability and usefulness of computerized patient education interventions. The Columbia Registry, MEDLINE, Health, BIOSIS, and CINAHL bibliographic databases were searched. Selection was based on the following criteria: (1) randomized controlled clinical trials, (2) educational patient-computer interaction, and (3) effect measured on the process or outcome of care. Twenty-two studies met the selection criteria. Of these, 13 (59%) used instructional programs for educational intervention. Five studies (22.7%) tested information support networks, and four (18%) evaluated systems for health assessment and history-taking. The most frequently targeted clinical application area was diabetes mellitus (n = 7). All studies, except one on the treatment of alcoholism, reported positive results for interactive educational intervention. All diabetes education studies, in particular, reported decreased blood glucose levels among patients exposed to this intervention. Computerized educational interventions can lead to improved health status in several major areas of care, and appear not to be a substitute for, but a valuable supplement to, face-to-face time with physicians.

Adolescent↗
PubMed2006

Comparison of three interventions to increase mammography screening in low income African American women.

BACKGROUND: Low-income African American women are more likely to die of breast cancer than their Caucasian counterparts, and at least part of the difference in mortality results from differential screening adherence. The purpose of this study was to identify more efficacious methods of promoting routine mammography screening in underserved populations. METHODS: A prospective randomized intervention study of 344 low income African American women compared the impact of three interventions on mammography adherence and stage of readiness: (1) pamphlet only; (2) culturally appropriate video; and (3) interactive computer-assisted instruction program. RESULTS: The interactive computer intervention program produced the greatest level of adherence to mammography (40.0%) compared to the video group (24.6%) and the pamphlet group (32.1%). When subjects in the pamphlet and video groups were combined to form a non-interactive group, this group had a significantly lower adherence than the group who received the interactive computer intervention (27.0% versus 40.0%). There was also significantly more forward movement in mammography stage of readiness among participants in the computer group (52.0%) compared to those in the pamphlet group (46.4%) or the video group (31.3%). When combining the non-interactive technology (pamphlet and video) there was also more forward movement in mammography stage of readiness for those in the interactive intervention group (52.0% moved 1 or 2 stages) compared to those in the non-interactive group (36.2%). CONCLUSIONS: These data indicate that tailored approaches are more effective than targeted messages either in print or video format. Another finding of this study is that interactive interventions are more effective than non-interactive interventions in increasing adherence and moving African American women forward in their mammogram stage of readiness.

Adult↗
PubMed1995

Physicians and nurses can be effective educators in coronary risk reduction.

OBJECTIVES: 1) To compare the impact of a brief physician or nurse education session with the impact of education provided by dietitians on patient knowledge regarding coronary risk factors, dietary recommendations, and compliance, and 2) to determine the value of additional formal dietary counseling on knowledge, dietary fat, and serum lipids. DESIGN: Primary care physicians and their office nurses were compared with inpatient dietitians by evaluating patient performance on a standardized test and three-day dietary food choices. Neither the educators nor the patients were aware of the study. Supplemental information was provided by a study dietitian and patients were reevaluated six weeks later. SETTING: Preventive cardiology program in a university-affiliated teaching hospital. PARTICIPANTS: Fifty consecutive patients referred to a preventive cardiology program who had received dietary and cardiac risk factor information within the preceding six weeks by a physician and office nurse (27) or an inpatient dietitian (23) were enrolled. Forty-five patients completed the study objectives. INTERVENTIONS: The patients completed a three-day food record, fasting lipids, and a test of knowledge of coronary risk factors and dietary concepts. The correct answers were discussed and a standard American Heart Association phase I diet was recommended. Six weeks later dietary food records, fasting lipids, and the test were repeated. MEASUREMENTS AND MAIN RESULTS: By participant recall, the dietitians (group II) spent an average of 30.6 +/- 25 minutes, compared with 8.2 +/- 14.4 minutes by the physicians and nurses (group I) (p < 0.05). Group II patients had a higher total knowledge score, but they were no better in risk factors, weight control, or calculated dietary fat or cholesterol. There was no correlation between time spent and percentage of calories from fat or total test score. Six weeks after the program instruction the mean cholesterol level for all the participants was reduced, and group II had a lower fat intake than did group I, which was associated with significantly lower serum cholesterol, not present at entry. CONCLUSION: Primary care physicians and their office nurses, using less time than do dietitians, can be effective educators in providing patient education for coronary risk reduction and dietary fat intake. A second formal dietary consultation appears beneficial in improving compliance and lipid control.

Cholesterol↗
PubMed1985

Signal averaging by microcomputer using a program written in a high-level language.

A program, written in the language Pascal, is described for signal averaging with a microcomputer. The program instructs the computer to acquire data from two channels on-line. For up to 3 channels of extracellular or intracellular recording analysed simultaneously, it was found not to be necessary to employ machine code or an assembler to provide adequate temporal resolution.

Action Potentials↗
PubMed1993

An automatized computer-method utilizing Procomm Plus and DataEase (4.2) PC and SAS (6.06) mainframe software for isolated, perfused guinea-pig heart studies.

A powerful, time sharing and automatized method of a comprehensive data analysis for isolated, perfused guinea-pig heart studies is described. Data are collected using DataEase PC software (version 4.2) into forms with data fields specified for vital parameters consistently recorded in isolated, perfused heart studies (HR, CBF, PEAKPRESSURE, DPDT, MVO2). After running, DataEase reports the data and information is uploaded to an IBM 3081D mainframe computer on each day of heart experiment and data collection. The uploading process, the data archival and the statistical analyses are automatized by Procomm Plus commands written in Aspect Source Program (.ASP) Files for logging, data transforming and file management procedures. The ASPCOMP.EXE compiler compiles these .ASP files into Aspect Script eXecutable (.ASX) programs, which run on the PC in our laboratory and activate WYLBUR (IBM 3081D Batch-job service and Command file processor) edited files in the mainframe's electronic devices then upload, backup and save data into these files. SAS EXE files containing program instructions for the data analyzing system are then forced by Procomm Plus to operate over the data just uploaded. SAS reads the DATA files by its INFILE facility and performs comprehensive statistical analyses and produces hard output including graphics and JOB reports of dose-response- and logaritmic scale curves for delivery to team members. This computerized and automatized method developed for isolated, perfused guinea-pig heart studies is capable of performing multiple file transfer, sophisticated statistical analyses and graphic procedures after one keystroke on the PC (Alt-F5 in Procomm Plus section) and also facilitates a consistent and convenient method for planning, controlling and standardizing experiments. The method is based on an interactive computer conversation between the PC in the laboratory and the remote's WYLBUR editor. No human presence is needed; however, in case of failure, Procomm Plus gives one of the team members supervising the system a phone call in order to get human help.

Animals↗