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PubMed1989

The role of endoscopic retrograde cholangiopancreatography injection training sessions for the gastroenterology nurse and associate.

Pancreatitis is a recognized serious complication of endoscopic retrograde cholangiopancreatography (ERCP). The pressure with which contrast media are injected may be a risk factor for developing pancreatitis. We, therefore, designed a study to determine if there were differences in pressures generated by experienced and inexperienced gastroenterology nurses and how much training would be required to instruct individuals to inject to a specific pressure. With the use of manometrically guided practice sessions, it was determined that inexperienced operators initially inject with significantly high pressure but can learn to inject accurately to a specific pressure as rapidly as experienced operators. Injection training sessions may be beneficial in minimizing the potential risk factor of hydrostatic pressure induced endoscopic retrograde cholangiopancreatography-associated pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1983

Gonorrhea.

The gonococcus has become an extremely important organism in obstetrics and gynecology. It is associated with a wide array of clinical syndromes that frequently confront the practitioner. The diagnostic modalities available are many and are rapidly increasing. Therapy likewise is becoming complex as we learn more about the infections associated with this microbe. The basic principles of care still include a high index of suspicion of infection; clinical evaluation of the potentially infected patients; laboratory support of the clinical diagnosis; specifically directed antimicrobial therapy of adequate dosage and duration; treatment of sexual partners; and follow-up test-of-cure evaluation in all patients.

Adolescent↗
PubMed2001

HIV testing among young adults and older adolescents in the setting of acute substance abuse treatment.

OBJECTIVES: To examine the feasibility and acceptance of HIV testing among youth in acute substance abuse treatment. METHODS: Youth, aged 18 to 25 years old, in state-funded inpatient detoxification completed a confidential demographic/risk behavior questionnaire, and were offered a choice of no testing, serum-based testing, or oral fluid (Orasure, Epitope, Inc., Beaverton, OR, U.S.A.) HIV testing. RESULTS: In all, 74% of 204 participants accepted HIV testing. In a multivariate model, female gender (odds ratio [OR], 0.32; 95% confidence interval [CI] 0.14-0.74) and having been recently tested (OR, 0.11; 95% CI, 0.05-0.26) were independently associated with refusing testing. Recent sexual activity (OR, 5.4; 95% CI, 1.5-20.4), recent use of methamphetamines (speed) or a combination of cocaine and heroin (speedball) (OR, 3.8; 95% CI, 1.6-9.0), and a recent perceived risk for HIV (OR, 4.6; 95% CI, 1.9-10.9) were independently associated with test acceptance. Thus, 150 of 150 (100%) chose the Orasure test. Overall, 64.6% (97 of 150) of those tested received their results, but among participants requiring a follow-up appointment to learn test results, only 9.2% (8 of 87) returned. CONCLUSIONS: HIV testing is feasible and acceptable in this population. All patients preferred Orasure testing to a serum enzyme-linked immunosorbent assay (ELISA). Most youth tested in detoxification will only learn their results if they are provided during treatment. Rapid HIV testing with same-day results could improve follow-up rates.

Adolescent↗
PubMed1991

Percutaneous laparoscopic cholecystectomy: the first fifty.

A series of 50 percutaneous laparoscopic cholecystectomies was performed by one surgeon between 7 June and 25 October 1990 using a modified technique as described by Dubois. There were 42 females and 8 males, the average age being 44 years with a range of 14-76 years. The average operating time was 80 min, ranging from 35 to 210 min. Postoperative stay averaged 2.9 days and there was an average of 11 days to return to work. Complications consisted of a subhepatic bile collection requiring open drainage, one minor wound infection and one minor abdominal wall haematoma. Laparoscopic cholecystectomy is a safe technique for removing the gall-bladder resulting in a rapid convalescence and early return to work. The initial learning curve is long and careful case selection should be carried out in this phase.

Adolescent↗
PubMed1964

METHOD FOR DISCRIMINATIVE AVOIDANCE TRAINING.

Experiments were performed in which the typical procedure for obtaining discriminated avoidance behavior with rats in a lever-pressing apparatus was compared with a new procedure which allowed only avoidance but not escape from the shock. When either escape or avoidance is possible, the rats make a majority of escape responses, but where escape is impossible avoidance behavior is rapidly established.

Avoidance Learning↗
PubMed2003

A transcultural ethos underpinning curriculum development: a master's programme in disaster relief nursing.

This article discusses the development and implementation of a masters' degree programme in disaster relief nursing by cooperating partners in European countries. It aims to enhance the provision of aid by endorsing the role of nurses at the forefront of health care in disaster-stricken areas around the world. As an attempt to address the implications of globalization in health care, the programme was established as a recognition of the rapidly developing specialty of transcultural/transnational nursing. Innovative teaching and learning strategies used include e-learning, simulation exercises, and competency portfolio development. A rigorous evaluation of programme outcomes is ongoing.

Clinical Competence↗
PubMed2005

Context-specific adaptation of saccade gain is enhanced with rest intervals between changes in context state.

Dual-state adaptation of motor responses has been known for some time. A more recent development is a form of dual-state adaptation known as "context-specific adaptation," which was explored through the use of saccade gain adaptation. In this model, two different adapted saccade gains are associated with two different states of a context cue, and the gain switches between the two adapted states when the context cue changes state. Such adaptation is imposed by alternating context/adaptation states over the course of an adaptation session. Here, vertical eye position as a context cue for adaptation of horizontal saccade gain is used: gain increase is induced with the eyes up 10 degrees, and gain decrease with the eyes down 10 degrees. This context cue is not very effective: there is interference between context/adaptation conditions such that gain-decrease adaptation with eyes down transfers to the eyes-up (gain-increase) context. It was hypothesized that the juxtaposition in time of the alternating adaptation states exacerbated this interference. In order to test this, one-minute rest breaks were inserted between each change in context/adaptation state. The resulting context-specific adaptation improved dramatically: gain-increase and gain-decrease adaptations were more rapid and more complete. This resembles consolidation of motor learning, which, however, occurs over much longer time spans (hours rather than minutes). Thus, the results may reflect the operation of a novel "short-term" motor consolidation process.

Acclimatization↗
PubMed2004

Persistent accumulation of calcium/calmodulin-dependent protein kinase II in dendritic spines after induction of NMDA receptor-dependent chemical long-term potentiation.

Calcium/calmodulin-dependent protein kinase II (CaMKII) is a leading candidate for a synaptic memory molecule because it is persistently activated after long-term potentiation (LTP) induction and because mutations that block this persistent activity prevent LTP and learning. Previous work showed that synaptic stimulation causes a rapidly reversible translocation of CaMKII to the synaptic region. We have now measured green fluorescent protein (GFP)-CaMKIIalpha translocation into synaptic spines during NMDA receptor-dependent chemical LTP (cLTP) and find that under these conditions, translocation is persistent. Using red fluorescent protein as a cell morphology marker, we found that there are two components of the persistent accumulation. cLTP produces a persistent increase in spine volume, and some of the increase in GFP-CaMKIIalpha is secondary to this volume change. In addition, cLTP results in a dramatic increase in the bound fraction of GFP-CaMKIIalpha in spines. To further study the bound pool, immunogold electron microscopy was used to measure CaMKIIalpha in the postsynaptic density (PSD), an important regulator of synaptic function. cLTP produced a persistent increase in the PSD-associated pool of CaMKIIalpha. These results are consistent with the hypothesis that CaMKIIalpha accumulation at synapses is a memory trace of past synaptic activity.

Adenylyl Cyclases↗
PubMed2006

Rapid acquisition in concurrent chains: evidence for a decision model.

Pigeons' choice in concurrent chains can adapt to rapidly changing contingencies. Grace, Bragason, and McLean (2003) found that relative initial-link response rate was sensitive to the immediacy ratio in the current session when one of the terminal-link fixed-interval schedules was changed daily according to a pseudorandom binary sequence (e.g., Schofield & Davison, 1997). The present experiment tested whether the degree of variation in delays across sessions had any effect on acquisition rate in Grace et al.'s (2003) rapid-acquisition procedure. In one condition ("minimal variation"), the left terminal link was always fixed-interval 8 s and the right terminal link was either fixed-interval 4 s or fixed-interval 16 s. In the other condition ("maximal variation"), a unique pair of fixed-interval values was used in each session. Responding was sensitive to the current-session immediacy ratio in both conditions, but across subjects there was no systematic difference in sensitivity. These results challenge the view that initial-link responding in the rapid-acquisition procedure is determined by changes in the learned value of the terminal-link stimuli, and suggests instead that a process resembling categorical discrimination may control performance. A decision model based on the assumption that delays are categorized as short or long relative to the history of delays provided a good account of the data and shows promise in being able to explain other choice phenomena.

Animals↗
PubMed1996

Current view of risk factors for periodontal diseases.

Peridontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Diseases in which neutrophil dysfunction occurs include the lazy leukocyte syndrome associated with localized juvenile periodontitis, cyclic neutropenia, and congenital neutropenia. Recent studies also point to several potentially important periodontal risk indicators. These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease.

Actinobacillus Infections↗
PubMed1977

A color image hierarchy.

There is renewed interest by psychologists in mental imagery. While practical uses of imagery are being rapidly developed, there still remains a great deal to learn about imaging itself. One aspect of imaging is color. A review of the literature provided no research data as to which colors were easiest or hardest to image. Using the method of pair comparisons, an interval scale was devised, indicating the relative ease with which various colors could be imaged. The final scale, from easiest to most difficult to image, was black, red, yellow, blue, green, white, orange and finally purple. Implications for image training are suggested.

Color↗
PubMed2002

Bidirectional priming in infants.

In associative priming, the direct activation of one concept indirectly activates others that are associated with it, depending on the directionality of the association. We asked whether associative priming in preverbal infants is bidirectional. Infants associated a puppet imitation task with an operant train task by watching an adult model target actions on the puppet in the incidental context of the train. Later, priming of the forgotten memory of the train task reactivated the infants' memory of the puppet task (Experiment 1), and priming of the infants' forgotten memory of the puppet task reactivated their memory of the train task (Experiment 2). The finding that associative priming was bidirectional offers new insights into the nature of the mnemonic networks formed early in infancy. Additionally, the fact that the present association was formed rapidly and incidentally suggests that a fast mapping, general learning mechanism, like that posited to mediate word-object learning, was responsible for its encoding.

Female↗
PubMed1993

Computer-assisted instruction in Australian medical schools.

OBJECTIVE: To survey the use of computer-assisted instruction (CAI) in undergraduate medical student education in Australia. SETTING AND DESIGN: A postal questionnaire survey of medical school deans, and department heads, in all Australian medical schools. RESULTS: 90% of deans, and 88% of department heads responded to the questionnaires. There were considerable variations between departments and faculties in the use of CAI. Overall, 36% of departments were using CAI and 65% of those not currently using it were either developing CAI or would like to introduce it into their teaching programs. Some medical faculties had well-developed policies for CAI, and provided considerable resources, while others did not. Some departments had large numbers of student work stations (up to 64), and multiple teaching packages (up to 200). CAI packages were generally thought to be popular with students, and to have improved the standard of learning. CONCLUSION: This form of teaching is currently undergoing rapid expansion, but in an uncoordinated manner that is likely to lead to greatly increased overall development costs.

Australia↗
PubMed1988

Client participation in mental handicap services.

This article reports the results emerging from our work into improving clients participation in the planning and management of mental handicap services in the Rhondda District of Mid-Glamorgan, Wales. The Rhondda is one of the two "Vanguard Districts" in Wales which were selected for more rapid service developments in order that other districts could learn from some of their successes and mistakes. Many of the Griffiths proposals for community care are already in operation in this service. This article describes and analyses some of the problems which have arisen, and outlines the structures for participation which are being developed.

Community Participation↗
PubMed2000

HIV/AIDS managed care program.

Approximately one-half of all patients with HIV infection who are under care have Medicaid as the third party payor. Unlike Medicare, Medicaid is a state-specific program that has huge variations in reimbursement strategies. Multiple studies have shown that care for persons with AIDS is about $20,000/year, but reimbursement through various state Medicaid programs varies about $100/m/m to $2800/m/m despite the fact that expectations for care are identical. Hopkins has a major commitment to persons with HIV infection with a program that now includes 30 faculty members and a support staff of 170. With the introduction of mandatory managed care for Medicaid recipients in July, 1997, we were confronted with the issue of substantial downsizing with abandonment of over half of our patients, or learning the transition to managed care. This has been a steep learning curve involving negotiations with the state Medicaid office, reorganization of our clinic, careful scrutiny of our database regarding resource utilization and cost, education of providers, and longitudinal collection of new information and integration of the rapid changes in the field. In the process of this transition, we learned that there are precious few resources to provide guidance and that there is a perceived need for assistance by HIV providers throughout the country. Consequently, we have now established the "HIV Managed Care Network" with substantial funding from diverse sources to support education, data collection, and public policy review. It is premature to evaluate performance since most of these activities have just begun, but we expect that this Network will serve as a demonstration model for methods to deal with chronic diseases under managed care.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Predictable provisionalization: achieving psychological satisfaction, form, and function.

UNLABELLED: The dentition is the foundation of the human face and is far more than just a masticatory apparatus. The smile, which is the definition of humankind, crosses all gender, age, cultural, and religious boundaries to express emotion. When enhancing or restoring a smile with aesthetic dentistry, the provisionalization phase is critical in conveying information regarding function, occlusion, phonetics, and the patient's expectations among the members of the restorative team. This presentation details a predictable process for rapidly fabricating provisional restorations with optimal fit and performance. LEARNING OBJECTIVES: This article describes the role of provisionalization and a protocol for fabrication of temporary prostheses for optimal results. Upon reading this article, the reader should: Understand the role of provisionalization on the surrounding soft and hard tissue structures. Recognize the role provisionalization plays in patient education and communication.

Dental Restoration, Temporary↗
PubMed2002

Anesthesiology Point of Care project.

We are developing a dynamic prototype visual communication system for the operating room environs. This has classically been viewed as an isolated and impenetrable workplace. All medical experiences and all teaching remain in a one to one closed loop with no recall or subsequent sharing for the training and education of other colleagues. The "Anesthesia Point of Care" (APOC) concept embraces the sharing of, recording of, and presentation of various physiological and pharmacological events so that real time memory can be shared at a later time for the edification of other colleagues who were not present at the time of the primary learning event. In addition it also provides a remarkably rapid tool for fellow faculty to respond to obvious stress and crisis events that can be broadcast instantly at the time of happening. Finally, it also serves as an efficient and effective means of paging and general communication throughout the daily routines among various healthcare providers in anesthesiology who work as a team unit; these include the staff, residents, CRNAs, physician assistants, and technicians. This system offers a unique opportunity to eventually develop future advanced ideas that can include training exercises, presurgical evaluations, surgical scheduling and improvements in efficiency based upon earlier than expected case completion or conversely later than expected case completion and even as a unique window to development of improved billing itemization and coordination.

Academic Medical Centers↗
PubMed1984

Campylobacter jejuni enteritis; a review.

Campylobacter jejuni has recently been recognized as an important cause of human gastroenteritis in many countries. The clinical features of C. jejuni infections vary from those of a mild gastroenteritis to a severe enterocolitis. The most common symptoms of the disease are fever, abdominal pain and bloody diarrhoea. The small intestine is the main site of infection, but the colon may also be involved. The main pathogenesis of C. jejuni appears to be invasion of the wall of the gut as in salmonellosis. Isolation of the organism from faeces requires culture in a selective medium containing antibiotics and incubation under reduced oxygen tension at 42 degrees C. Most cases of campylobacter enteritis are sporadic and it is often difficult to confirm their source. Although cross infection between humans occurs rarely, the disease is mainly a zoonosis with many possible routes of infection. Human infections have been associated with the consumption of contaminated food, especially poultry, unpasteurized milk, and water, as well as contact with domestic animals such as dogs and cats. In most cases campylobacter enteritis is a selflimiting disease and therefore decision on treatment should be taken on clinical grounds. When considered necessary, erythromycin is the drug of choice. Information about C. jejuni infection has accumulated rapidly in recent years, but much remains to be learned, especially about its epidemiology.

Adolescent↗