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PubMed1977

A programmed training technique that uses reinforcement to facilitate acquisition and retention in brain-damaged patients.

Hospitalized brain-damaged patients were Ss in a study designed to evaluate the effectiveness of a treatment technique used with contingent reinforcement to facilitate acquisition and retention of environmentally relevant information. Ss were divided into three groups that were equated diagnostically and demographically. Group I received the treatment technique with contingent material and verbal reinforcement. Group II received the treatment technique with only contingent verbal reinforcement, and Group III was a control. Both treatment groups showed significant acquisition of the experimental information, and 1 week after training the two treatment groups showed no significant loss of acquired information. None of the groups showed any significant change in ward behavior during the experiment. It was concluded that the treatment technique used with contingent reinforcement can be used in the retraining of memory in brain-damaged patients.

Achievement↗
PubMed1994

Drug therapy and memory training programs: a double-blind randomized trial of general practice patients with age-associated memory impairment.

A double-blind randomized trial was performed involving 162 patients with age-associated memory impairment (AAMI) selected and followed by their general practitioners. Two intervention methods--a drug and a cognitive therapy--were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and over, were followed and treated for 3 months. After a placebo wash-out period of 10 days, one group received 2.4 g of piracetam, another group, 4.8g, and the third, a placebo. A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with 4.8 g of piracetam, especially when training sessions began after 6 weeks of drug treatment. This result was confirmed by the global impression of the principal investigator.

Aged↗
PubMedDate not supplied

Port catheter placement by nephrologists in an interventional nephrology training program.

We retrospectively reviewed all subcutaneous single- and double-lumen port catheters (PCs) inserted by interventional nephrologists at our institution to determine the success rate, immediate and late complications, and functional life. From January 2000 to August 2002, 187 PCs were placed in 187 patients (42% males, 51% Caucasians, mean age 50 +/- 14 years). There were no immediate complications related to the procedure such as hemorrhage, pulmonary embolism, or pneumothorax. There were a total of 35,078 catheter-days of follow-up. Sixteen catheters were removed during the observation period: three because of infection, seven after completion of chemotherapy, and six for other reasons. The remaining PCs are either functioning or the patients have died. The initial success rate was 100%. Kaplan-Meier analysis showed a 30-day survival of 97% and a 1-year survival of 92%. Interventional nephrologists, who have adequate training in central venous tunneled cuffed catheter placements, can successfully place PCs, with excellent success and minimal complications.

Catheters, Indwelling↗
PubMed2000

Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program.

We examined oncologists' and nurses' ability to recognize depressive symptoms in two cancer patients who were interviewed on videotape. The study was conducted in a rural community, hospital-based outreach network. Staff were given a one-hour in-service on the use of the Mini International Neuropsychiatric Interview (MINI)-a brief diagnostic interview-to provide a differential diagnosis (no psychiatric diagnosis, major depressive disorder, or adjustment disorder with depressed mood). Next, the staff viewed a videotape of an investigator (S.P.) utilizing the MINI to interview two depressed breast cancer patients. Staff subsequently rated depressive symptoms on the MINI and made a diagnosis. Findings indicated a high concordance among staff regarding symptom ratings on a straightforward example of major depressive disorder. Concordance on diagnosis, severity level, and specific symptoms declined slightly on a more difficult case involving primarily cognitive symptoms and a diagnosis of adjustment disorder. Following brief didactic training on depressive disorders, oncologists and nurses were able to identify depressive symptoms in cancer patients on videotape. Learning to use a semistructured interview can increase oncologists' awareness of depressive symptoms and may be a good training model.

Adult↗
PubMedDate not supplied

An individual patient comparison of response to a memory training program--psychogenic V organic amnesia: brief report.

Psychogenic amnesia ("dissociative amnesia" in DSM-IV) has received relatively little attention in the literature. We compared neuropsychological and behavioral findings between a patient with psychogenic amnesia and one with organic amnesia from their early stages in a rehabilitation program. A 52-yr-old man developed anterograde and retrograde amnesia and short-term memory disturbance 1 mo after an operation for esophageal carcinoma, with no loss of personal identity and information. No apparent organic causes were identified, but because the patient and his wife rejected psychiatric treatment and memory deficit characteristics were compatible with that of an organic origin, the patient was referred to a physiatrist. A 46-yr-old man with anterograde amnesia was diagnosed with limbic encephalitis based on findings of magnetic resonance imaging and single-photon emission computed tomography, which showed lesions in both medial temporal lobes. Both patients underwent "memory book" training because they showed preserved performance in motor learning tasks. The first patient's responses to training contrasted with the other's and were indicative of psychogenic amnesia, with cancer representing a precipitating stress. Counseled by the physiatrist, the patient and his wife accepted suggestions to undergo psychiatric treatment. We propose that it is important to consider behavioral responses to memory rehabilitation as well as neuropsychological findings in differentiating psychogenic amnesia from an organic one and that physiatrists may be pivotal in diagnosing and initiating treatment in such psychiatric disorders.

Amnesia↗
PubMedDate not supplied

Outcomes of temporal clear cornea versus superior scleral tunnel phacoemulsification incisions in a university training program.

BACKGROUND AND OBJECTIVES: To evaluate the complication and visual outcomes of residents performing temporal clear cornea (TCC) compared to superior scleral tunnel (SST) phacoemulsification. PATIENTS AND METHODS: We conducted a retrospective analysis of complications and visual outcomes for 534 phacoemulsification procedures done by third-year residents over a five-year period (June 1992-July 1997) at the department of ophthalmology, University of Chicago. All cases were completed using a TCC or SST incision. RESULTS: There was vitreous loss in 6.0% of 348 eyes with TCC incisions and in 11.8% of 186 eyes with SST incisions (P < 0.02). Posterior capsule breaks occurred in 1 1.5% of the TCC group versus 17.7% in the SST group (P < 0.0453). Best corrected visual acuity of 20/40 or better was achieved in 82.5% of all eyes with TCC incisions and in 75.3% of all eyes with SST incisions (P < 0.05). When 151 patients with previous ophthalmic conditions were excluded, the difference in BCVA between the two groups was not statistically significant. CONCLUSIONS: Most institutions train residents with the SST technique prior to advancing to TCC. This study demonstrates that with proper teaching, residents can achieve excellent outcomes using TCC incisions, and can therefore be trained in this technique concurrently with SST incisions.

Chicago↗
PubMed1982

Physical training programs for mass scale use: effects on cardiovascular disease--facts and theories.

A significant increase in the numbers of Americans exercising during the 1970's has occurred, stimulated by an increased desire to improve the quality and, hopefully, the quantity of life. Fitness improvement is associated with an increase in HDL-cholesterol and a reduction in blood pressure, serum total cholesterol, LDL- and VLDL-cholesterol, triglycerides, glucose, uric acid and with weight loss and decrease in percent body fat. Correlations of risk factor changes with weight loss are greater than correlations with fitness improvement. After controlling for weight loss correlation of triglycerides and uric acid and percent body fat fitness improvement remains significant. Risk factor reduction has been shown to occur with fitness improvement without weight loss and with weight loss unaccompanied by fitness change, but the largest risk factor changes occur in the presence of both weight loss and fitness improvement. The aerobics exercise program concentrates on developing cardiorespiratory fitness first and musculoskeletal strength secondarily. Various physical activities can be quantified by means of a point system based on the intensity and duration of the activity. A fitness goal of 30 points per week for men and 24 points per week for women is reasonable and achievable by nearly all, regardless of age or sex. The most beneficial effect of exercise may be a biochemical mediated feeling of well-being.

Adult↗
PubMed2000

The educational value of autopsy in a residency training program.

BACKGROUND: Historically, the autopsy has been an indispensable educational tool. Over the past several decades, however, the national autopsy rate has declined and the educational role of autopsy in modern medicine is being questioned. OBJECTIVE: To assess the educational value of autopsy attendance in an internal medicine residency program. METHODS: We performed a retrospective review of all autopsies performed on the general internal medicine teaching service between October 1996 and September 1998. Premortem and postmortem diagnoses were determined and compared and attending physician surveys were reviewed. RESULTS: Eighty-eight deaths occurred during the study period. Twenty-nine (33%) patients underwent autopsy. All autopsies were observed by the primary team and the attending physician completed an autopsy survey on each patient. An unexpected pathological diagnosis directly contributing to death was detected in 10 (34%) patients at autopsy. Additional unexpected pathological diagnoses were discovered in 23 (79%) cases. Attending physician surveys revealed that all 10 unexpected diagnoses contributing to death were observed by the primary team at the time of autopsy. Autopsy attendance was rated as a valuable educational experience in 27 cases (93%). CONCLUSION: Autopsy is a valuable educational tool and autopsy attendance should remain an integral part of internal medicine residency training.

Autopsy↗
PubMedDate not supplied

[Age-related changes of PWC 170 (physical working capacity 170) in the course of a 4-week training program at a health resort].

The physical working capacity 170 (PWC 170) exhibits a characteristic age-dependent course: With advancing age the values increase, although the physical performance capacity decreases. This reaction points to a slow responding heart rate in elderly individuals. After a four weeks treatment in a rehabilitation center combined with a high level of physical activity there was a decline of the PWC 170 in middle-aged persons. These results show that regular exercise generates a pronounced acceleration of the heart rate; this adaptive functional situation leads to a fast adjustment of the heart rate to the actual level of the load. In untrained elderly individuals the PWC 170 is no reliable parameter to indicate the physical performance capacity and the cardiac adaptation.

Angina Pectoris↗
PubMed1986

Factors predisposing Army conscripts to knee exertion injuries incurred in a physical training program.

Factors causing predisposition to knee exertion injuries were sought by means of a questionnaire and detailed quantitative physical measurements in 62 healthy Finnish Army conscripts. The subjects consisted of two groups of 18- to 26-year-old conscripts; Group A comprised 34 subjects without knee exertion injuries and Group B, 28 subjects who experienced knee exertion injuries during the first eight weeks of military service. In Group B the extensor mechanism was the most common source of symptoms. The factors found in Group B that differed significantly from those in Group A included increased height (p less than 0.05), increased leg length inequality (LLI) (p less than 0.01), increased passive mediolateral patellar range of motion (PMLPM) (p less than 0.01), and increased knee laxity sum index (LSI) (p less than 0.05).

Adolescent↗
PubMed2006

[Unexplained physical symptoms: a widespread problem but still low-profile in training programs and guidelines].

Unexplained physical symptoms or functional somatic syndromes that cannot be explained in terms of a defined medical disease are common. If persistent, they can cause significant distress and disability, and lead to absenteeism and social isolation as well as major health-care costs. Unexplained physical symptoms form a spectrum from transient unexplained mild physical symptoms to chronic severe somatoform disorders. Various functional somatic syndromes overlap one another substantially in symptomatology and are often resistant to conventional medical therapy. The 'Vereniging Nederlands Tijdschrift voor Geneeskunde' (Dutch Journal of Medicine Association) recently held a special conference on unexplained physical symptoms. The conclusions were: (a) patients are reluctant to accept the diagnosis of unexplained physical symptoms, because physicians do not have sufficient knowledge, expertise, and skill to diagnose and treat them, (b) patients with unexplained physical symptoms do not necessarily need to be treated by a psychiatrist except in cases of chronic and serious somatoform disorder. Patients with unexplained physical symptoms, who often have multiple and complex problems, are best treated by a team of physicians and allied paramedical professionals; (c) patients with unexplained physical symptoms can be treated effectively by specialists using cognitive behaviour therapy. Different cognitive models are available; the 're-attribution model' focuses on the re-establishment of a liveable life, while 'the consequence model' is directed at reducing the consequences of the unexplained physical symptoms. Management using the attribution model may be followed up by the consequence model approach; (d) the development of a practice guideline for the diagnosis and treatment of patients with both acute and chronic unexplained physical symptoms would improve the quality of patient care, reduce disability, increase the possibility of reintegration, and stimulate scientific research; (e) both theoretical and practical training in the diagnosing and managing of unexplained physical symptoms is inadequate in both university curriculums and postgraduate training programmes for medical specialists. Scientific research for the development of an evidence-based practice guideline is urgently needed.

Cognitive Behavioral Therapy↗
PubMed1992

A faculty research and training program for undergraduates in the sciences.

Faculty enthusiasm, with actual hands-on involvement, is a critical factor in establishing student research interest and excitement in a university or college science environment. Such faculty involvement is infectious to students and therefore key to restoring United States leadership in science and technology in the next decades. Most scientists acknowledge that they were initially attracted into scientific careers through one or two notable teachers who served as role models. However, with the introduction of so-called "big science" and its distraction of university faculty away from meaningful, direct student contacts, and with associated withdrawal of funding from "little science" in the college teacher's laboratory, research languishes in nearly all undergraduate teaching institutions. The inspiring college science teacher seems essentially gone, tired or burnt out, unable to keep pace with the rigorous demands of an active research lab while simultaneously meeting the exhausting load of 15-18 (or more) contact teaching hours per week. With all of the associated lecture preparations, student counseling, and Dean's committee assignments, the teacher has little or no scholarly "think time" or opportunity to inspire even the bright students. Without the teacher's honest and evident involvement and deep commitment, the student fails to experience the essential impact of a convincing role model. It is therefore necessary to restore the college science teacher's opportunity and aspirations to be personally involved in research. This can only be accomplished by providing time, facilities, incentives, and encouragement to do what originally attracted the teacher into a career in science and teaching in the first place.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical, Undergraduate↗